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Maps and Much More Are Changing at VA

by U.S. Medicine

November 4, 2015

Five Regions with 18 VISNs by Late 2017

By Annette M. Boyle

WASHINGTON — For the VA, form affects function.

Bob Snyder, executive director of the MyVA Task Force

Bob Snyder, executive director of the MyVA Task Force

Secretary Robert McDonald recognized that as soon as he stepped into the agency’s top leadership role. He made it clear that multiple maps and reporting lines were crippling the ability of the organization to meet veterans’ needs.

“Bob saw the mess of different maps we had and directed us to get to one,” said Bob Snyder, executive director of the MyVA Task Force, the group in charge of the transformation of the VA’s structure and culture.

“We want every veteran to have a seamless, integrated and responsive VA customer service experience every time. This regional alignment is the first step in empowering Veterans to interact with one VA — MyVA,” McDonald said in announcing the changes. “Ultimately, this reform will improve the veteran experience by enabling veterans to more easily navigate VA and access their earned care and benefits.”

The new map divides the country into five regions for all of the VA’s service lines — Veterans’ Benefits Administration (VBA), National Cemetery Administration (NCA) and Veterans Health Administration (VHA). The VHA will have 18 VISNs within the five districts once the transition is complete, which is expected to be late in fiscal year 2017, although many of the other related initiatives are expected to go into effect much sooner.

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VISN Map - Click to enlarge

VISN Map – Click to enlarge

With just five divisions, “each VISN would have been expected to have a span of control that encompassed 30-40 hospitals,” Snyder told U.S. Medicine. That seemed unreasonable, so the team developed more-manageable groupings.

“The proper span of control is six to 11 medical centers, plus community-based outpatient clinics (CBOCs), which we’ve realigned to fit within the new districts and state boundaries,” he explained.

There are three exceptions to the state boundaries: California splits north and south into two

VISNs; the Upper Peninsula of Michigan and most of Illinois stay with Wisconsin in VISN 12; while Marion, IL, will remain with Missouri and Kansas in VISN 15.

The VA hopes the new, rationalized structure will ease internal coordination and veteran satisfaction with VA services. To assist in designing better customer interactions, the MyVA plan includes the creation of Veteran Experience offices that will deliver customer service curriculum, develop standard ways for measuring the veteran experience across services and help local facilities develop ways to help veterans navigate the entire system. Rather than “another layer of command and control,” Snyder characterized the Veterans Experience offices as locally based resource centers for the existing divisions.

Snyder noted that the MyVA program has some challenges ahead to deliver on its five themes: improving the veteran experience, improving the employee experience, improving support services, creating a culture of continuous performance improvement and building strategic partnerships.

McDonald has previously said that “no really good customer service organization is not also known for taking good care of its people,” commented Snyder, so the transformation plan includes programs that “build up employees, give them tools to improve their operations and impact veterans, and move from a rules-based culture to a principles-based one.” That includes training on the VA services beyond their own area and leadership programs at the front line and senior levels.

The veterans’ crisis line has already seen the benefit of the changes planned elsewhere. “We recognized that they didn’t have the resources needed to be a world-class operation, especially given the criticality of what they do, so we’ve added staff, provided more consistent resiliency training and support to enable these phenomenal people to deal with the high stress associated with their work,” Snyder pointed out.

Other areas still have considerable work before them, he said, noting, “Our human resources and IT support leave a lot to be desired and are not very supportive of internal customers,” while continuous improvement goals require changing the VA’s structure and culture to enable employees to “get past learned helplessness, and empower and engage them to improve their own and veteran’s experiences on the front line.”

Recognizing that the “VA does not — and cannot — do everything that veterans need or want, we will partner with communities and the private sector to extend the reach of services available to veterans and their families,” according to the MyVA Integrated Plan. Bureaucratic obstacles have hampered strategic partnerships in the past, but Snyder expressed optimism that the cultural changes and focus on involving communities in caring for veterans will make them easier to create and support.

“We have to get out of the mindset that we understand and know best,” he said. “Local communities have a good understanding of what their veterans want and need and partnering with them can bring our combined resources to help veterans and their families.”

Already, the VA has partnered with Walgreens for flu shots and established community liaisons in 28 locations, with a goal of 60 by the end of the fiscal year. In addition, 30 local partnerships with veterans’ service organizations that are run by individuals in the local community are now operational, and Snyder said he expects 100 to be in place by December 2016.

The December 2016 date isn’t random. Many of the initiatives will be completed or well underway by then. As Snyder explained, “We’re not naïve. There’s an election coming up, and there will be a change of administration. We want to have capability by next fall in all these areas and have progress that’s so significant that whoever comes into the White House and whoever leads the VA, whether that continues to be Bob McDonald or someone else, will want to see it through.”


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