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Making Improvements in the Management of IHS Programs and Responding to GAO's High Risk List

by Roselyn Tso, Indian Health Service Director

The Indian Health Service is continuously working to improve and sustain effective programs and services to meet our mission and provide quality health care services to American Indians and Alaska Natives. IHS leadership is committed to assessing and improving our programs and services to ensure that quality, safe patient care is provided with oversight. Improvements to strengthen oversight include establishing offices and committees to provide leadership and guidance across the agency, implementing policies that further set requirements and expectations for achieving high-quality standards, and ensuring communication and collaboration with stakeholders. Additionally, agency leadership is managing and overseeing resources to ensure the health care needs of American Indians and Alaska Natives are met.

Even though the IHS has implemented many actions related to management oversight, patient care, and access to services, in 2017, the IHS was included in the Government Accountability Office’s High Risk List for ineffectively administered Indian health care programs. The IHS has worked to demonstrate our commitment to ensuring that health care services provide safe, quality care and that our programs are effective. Since 2017, IHS has implemented 16 recommendations out of 20 cited in the GAO High Risk reports and is making progress on the implementation of the remaining four.

The IHS is committed to identifying solutions to ensure that health care programs are effective and efficient. In response to the GAO’s High Risk reports, the IHS developed an action plan to meet GAO’s criteria for removal from the High Risk List in 2021. This action plan builds internal capacity to design, implement, and evaluate actions and processes by applying principles of a learning organization, which includes utilizing the Model for Improvement and other strategies, that will lead to sustainable improvements in the management and oversight of our programs and services. The development of the action plan provides a foundation upon which the agency is implementing the 2023 Agency Work Plan.

The action plan includes 11 targeted and strategic action items that were developed to address findings from GAO, the Office of Inspector General, and other external reviewers, and to help improve internal communications within IHS, improve management oversight in the agency, and improve access to services. By completing these 11 action items, the IHS will be able to address the GAO high risk issue, improve the administration of our programs, monitor critical functions, and resolve the problems identified.

A table summarizing the work completed for the eleven action items to address the four remaining open GAO recommendations cited in the High Risk reports and other findings related to the management and oversight of our programs is available here.

Roselyn Tso, Indian Health Service Director

Roselyn Tso, an enrolled member of the Navajo Nation, is the director of the Indian Health Service. As director, Ms. Tso administers a nationwide health care delivery program that is responsible for providing preventive, curative, and community health care to approximately 2.7 million American Indians and Alaska Natives in hospitals, clinics, and other settings throughout the United States. She previously served as the director of the IHS Navajo Area, where she was responsible for providing leadership in the administration of a comprehensive federal, tribal, and urban Indian health care system for over 244,000 American Indians and Alaska Natives throughout Arizona, New Mexico, and Utah.