White House Review Calls for Restructuring of VHA

By Sandra Basu 

WASHINGTON – The VHA needs to be “restructured and reformed” according to a scathing White House review released late last month. “The VHA leadership structure is marked by a lack of responsiveness and an inability to effectively manage or communicate to employees or veterans,” noted the review, which focused on access to care at the VA. The review, which came several weeks after a VA inspector general’s report confirmed problems regarding access to care, was overseen by White House Deputy Chief of Staff Rob Nabors. The review, which was presented to President Barack Obama, noted that “a corrosive culture has led to personnel problems across the department that are seriously impacting morale and, by extension, the timeliness of healthcare.” Nabors further pointed out in the report that the VHA leadership team is “not prepared to deliver effective day-to-day management or crisis management,” and that the belief is widespread that “many issues raised by the public, the VA leadership, or oversight entities are exaggerated, unimportant, or ‘will pass.’” Furthermore, the report charged that “VHA field structure is not accountable or transparent to veterans, the secretary or the department as a whole.” “For example, performance data from the field is often slow to be reported and sometimes openly contested by VAMCs through the press in direct contravention of facts and established procedures,” a summary of the review pointed out. The report suggested that VHA “needs a better structure and more accountability in how to manage the field structure.” In addition, the report stated that VA central office “needs to be much more hands on with the VHA field structure.” The report also pointed to the need for more primary care physicians, specialty care physicians, administrators and support staff, and physical space. While the report acknowledged that many of the resource issues VA faces are “endemic to the healthcare field or to the federal government,” the report also stated that VA has “demonstrated an inability to clearly articulate budgetary needs and to tie budgetary needs to specific outcomes.” In response to the report House Committee on Veterans’ Affairs Chairman Rep. Jeff Miller (R-FL) said in a written statement that “it appears the White House has finally come to terms with the serious and systemic VA health care problems we’ve been investigating and documenting for years.”

Comments (2)

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  1. Michael Hutchison PharmD says:

    I’m very happy this is finally occuring.

  2. Rajeev Menon Sachdeva says:

    Speaking from the field – VA Field organizational structure is dominated by middle managers (not performing front line work) empowered as enslaving demigods who have typically transfered blame, have misrepresented “invisible” frontline employee effort, and taken credit/bonuses for fronliners’ “wins” (via biased contrived performance evaluations); where academic affiliations exist, it is automatically assumed that research focused university faculty are superior clinicians than fulltime VA docs who have refused university inducements (vis a vis faculty appointments) to uphold The VA’s conflict of interest stipulates – this organizational disease complex is what undelies poor frontline employee morale/lack of demonstrable initiative and decreased work efficiency. Frontline employees are responsible “adults” in their own right and comprise the core resource of any “production/service unit” and need to be treated with full work environment support, appreciation, fairness, empathy/respect, for them to “give back” i.e. (present a positive image of their employer to clients/customers. Also, the five tiered evaluation rating system needs to be simplified to two tiers (Satisfactory & Unsatisfactory).

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