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VA moving forward with Shulkin’s nationwide restructuring plan

The Department of Veterans Affairs (VA)

The Department of Veterans Affairs is moving forward with a restructuring of the agency started weeks before former VA Secretary David Shulkin was ousted from his job.

Shulkin on March 7 announced the first steps of an agency reorganization that he anticipated would improve widespread communication problems blamed for some of the VA’s biggest scandals.

Shulkin set a deadline of July 1 for finishing a proposal to present to Congress. But after he was fired March 28 by President Donald Trump, it was uncertain whether the VA would continue with the plan.

“July 1 is approaching fast, and we’ve heard very little about it,” Rep. Phil Roe, R-Tenn., chairman of the House Committee on Veterans’ Affairs, said Tuesday.

Carolyn Clancy, executive in charge of the VA health care system, assured the committee Tuesday that the VA was following through with the idea and would stick to the July 1 deadline.

“I have high expectations for these reorganization plans,” Roe told her. “This cannot merely be a public relations exercise to get through the crisis of the moment or more glossy reports that sit on shelves.”

Lawmakers have pointed to a communication breakdown between local, regional and national VA leaders as the reason for scandals during the past year, from unsanitary conditions in Washington, D.C., to misconduct in Roseburg, Ore., and poor patient care in Manchester, N.H. Problems at those facilities weren’t addressed until news reports or the VA inspector general brought attention to them.

Most of lawmakers’ concerns lie with the regional VA leadership, called Veteran Integrated Service Networks, or VISNs. Since 1995, the VA has been broken into 23 VISNs. Local hospitals and clinics report to VISNS, which are then supposed to relay information to the VA central office in Washington.

The system didn’t work in the case of the D.C. hospital. In early March, VA Inspector General Michael Missal released a report that detailed a “culture of complacency” at the Washington DC VA Medical Center that allowed problems to persist for years, putting veterans at risk and weakening core functions of the hospital.

Some VA leaders knew of the problems as far back as 2013, when the VA commissioned an analysis of the facility by the consulting firm Booz Allen Hamilton.

“The most worrying aspect for me is the fact the VISN and central office knew of the problems in D.C., in many cases for years, but were unable or unwilling to solve them,” Roe said. “I wholeheartedly agree the VISNS are due for an overhaul. They should be the fail-safe mechanism when a medical center goes off course. Unfortunately, too many of them seem to be affected with a case of learned bureaucratic helplessness.”

Sen. Jon Tester, D-Mont., the ranking Democrat on the Senate Veterans’ Affairs Committee, wrote a letter to Shulkin with concerns about VA communications. If the central office wasn’t aware of problems at the D.C. hospital, it’s likely oblivious to any problems in Montana or elsewhere, he wrote.

In response to the IG’s findings, Shulkin announced the beginnings of his restructuring effort. The D.C. medical center, as well as 22 other hospitals, now fall under direct oversight of VA headquarters under the Shulkin plan.

Before Shulkin was fired, he eliminated the top leadership positions at the New England Healthcare System, the Desert Pacific Healthcare Network and the VA Capitol Health Care Network, of which the Washington hospital is part. The people who held those leadership positions would retire, Shulkin said.

The action was intended to consolidate oversight of the three regions – the VA’s most troubled — under one person in Washington. Shulkin tapped Dr. Bryan Gamble, previously a VA executive in Orlando, to watch over them.

Gamble is now leading a team responsible for formulating a VISN redesign. He’s visited the three regional networks that he now oversees, as well as the VA’s most high-performing – the VA Midwest Health Care Network. That network includes parts of Nebraska, Iowa, North Dakota, South Dakota and Minnesota.

“It’s about leadership, boots on the ground. Walking the terrain, listening to the staff around you,” Gamble said Tuesday. “To really identify problems as they affect our veterans and deal with them in an expedient and timely manner.”

The VA is expected to brief lawmakers about their restructuring plan in July.


© 2018 the Stars and Stripes

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