Inspection of the Bureau of Medical Services

ISP-I-24-08
    Report Contents
    Unclassified
    Unclassified

    What OIG Inspected

    OIG inspected executive direction, operational effectiveness and program implementation, resource management, and information management operations of the Bureau of Medical Services.

    What OIG Recommends

    OIG made 16 recommendations: 15 to the Bureau of Medical Services and 1 to the Bureau of Administration. In its comments on the draft report, the Department concurred with 15 recommendations and neither agreed nor disagreed with 1 recommendation. OIG considers all 16 recommendations resolved. The Department’s response to each recommendation, and OIG’s reply, can be found in the Recommendations section of this report. The Department’s formal responses are reprinted in their entirety in Appendix B.

    What OIG Found

    • The Chief Medical Officer and Principal Deputy Chief Medical Officer set a positive tone for the Bureau of Medical Services and generally led the bureau in accordance with Department of State leadership and management principles.
    • The bureau demonstrated commitment to diversity, equity, inclusion, and accessibility principles, but staff believed the bureau should provide more career advancement and leadership opportunities to Civil Service personnel and Foreign Service medical specialists.
    • Duplicative and parallel functions throughout the bureau represented potentially inefficient use of resources and inconsistent practices, which the bureau was addressing through a planned reorganization.
    • Informal and ad-hoc decision-making processes resulted in a lack of clarity regarding policy and operational changes, inconsistent dissemination of decisions, and revisions of decisions after the fact.
    • Multiple factors contributed to the delay in deploying an electronic health record system, including inadequate project scope and cost management, and insufficient executive-level IT investment oversight.
    • The bureau’s quality management procedures did not comply with health care industry standards requiring regular clinical performance reviews of medical providers.
    • Staff vacancies, insufficient staffing, and increasing workloads affected some aspects of operations, particularly in the areas of medical clearances and mental health support services.
    • The bureau played an important and visible role in Department efforts to address COVID-19 and anomalous health incidents.
    • The bureau’s Executive Office lacked standards to measure its customer support services. The bureau also had shortcomings in its contract management, human resources, and facilities management operations.
    Recommendation Number
    1
    Open Resolved

    The Bureau of Medical Services should implement a system to identify and mitigate, on a continuous basis, the internal control risks to its programs and processes, in accordance with Department guidance.

    Recommendation Number
    2
    Open Resolved

    The Bureau of Medical Services should develop and submit a bureau evaluation plan and conduct annual evaluations of the bureau’s programs, projects, and processes in accordance with Department guidelines.

    Recommendation Number
    3
    Open Resolved

    The Bureau of Medical Services should establish and implement a bureau organizational structure that aligns with operational needs in accordance with Department guidelines.

    Recommendation Number
    4
    Open Resolved

    The Bureau of Medical Services should implement procedures that define and document its decision-making process for policy and operational changes.

    Recommendation Number
    5
    Open Resolved

    The Bureau of Medical Services should implement an information technology project management process for reviewing and prioritizing defined requirements for the electronic health record system.

    Recommendation Number
    6
    Open Resolved

    The Bureau of Medical Services should implement the earned value management methodology to track electronic health records system project costs, including communicating project status updates to bureau leadership, in accordance with Department standards.

    Recommendation Number
    7
    Open Resolved

    The Bureau of Medical Services should conduct annual reviews of medical provider clinical performance in accordance with health care industry standards.

    Recommendation Number
    8
    Open Resolved

    The Bureau of Medical Services should implement standard operating procedures and performance measures for the Directorate of Mental Health Services.

    Recommendation Number
    9
    Open Resolved

    The Bureau of Medical Services should implement written service standards for the services and support provided by the bureau’s Executive Office and hold the Executive Office accountable for meeting the service standards.

    Recommendation Number
    10
    Open Resolved

    The Bureau of Medical Services should bring the contracting officer’s representative program into compliance with Department standards.

    Recommendation Number
    11
    Open Resolved

    The Bureau of Medical Services, in coordination with the Bureau of Administration, should bring its contract and contracting officer’s representative files into compliance with Department and federal guidance.

    Recommendation Number
    12
    Open Resolved

    The Bureau of Medical Services, in coordination with the Bureau of Global Talent Management, should review the Directorate of Operational Medicine’s position descriptions and make any necessary updates or reclassifications so employee position descriptions accurately describe employees’ duties and responsibilities.

    Recommendation Number
    13
    Open Resolved

    The Bureau of Medical Services should align its payment of retention incentives with the retention incentive justification it provided to the Department.

    Recommendation Number
    14
    Open Resolved

    The Bureau of Medical Services should develop, disseminate, monitor, and enforce a single standard operating procedure detailing the bureau’s requirements for timekeeper training and documenting, tracking, and reporting employee time and attendance.

    Recommendation Number
    15
    Open Resolved

    The Bureau of Administration, in coordination with the Bureau of Medical Services, should bring its pest control program into compliance with federal and Department occupational safety and health standards.

    Recommendation Number
    16
    Open Resolved

    The Bureau of Medical Services should bring its records management program into compliance with Department standards.