VA leadership must step up and look at more meaningful reforms

The balance between adequately funding the VA and protecting taxpayer spending has always been a delicate balance.  Go too far in one direction and fiscal hawks will accuse you of wasteful spending, or rewarding poor performance with extra cash. Go too far in the other and pro-big government folks will accuse you of setting the agency up to fail, or worse, attempting to privatize it.

At the center of many of these spending struggles are conflicts over local versus centralized management of various VA-business lines. Although these struggles often occur over matters pertaining to direct healthcare services, one such struggle was recently on full display in an Office of Inspector General report issued last week, entitled Inadequate Governance of the VA Police Programs at Medical Facilities.

The report found that “VA did not have adequate and coordinated governance over its police program to ensure effective management and oversight for its approximately 4,000-strong police officer workforce at its 139 medical facilities.” The report went on to state that these governance problems stemmed from a lack of a centralized management plan or clearly designated staff at each local VHA facility to oversee the program.

The challenges highlighted in the OIG report about VA’s mismanagement of its police force are a symptom of a larger problem regarding VA and in particular VHA’s governance structure. To this end, in September 2016, the GAO criticized VHA at large for deficiencies in its organizational structure and not having any processes in place that allowed it to maneuver complex organizational structure changes.

In response to the GAO report, VA stated that it “is strongly committed to developing long-term solutions that mitigate risks to the timeliness, cost-effectiveness, quality and safety of VA’s healthcare system.”  

Similarly, in response to last week’s OIG report, VA responded that it “will continue to work with OIG and all relevant stakeholders to make improvements to security and law enforcement programs and maintain the public’s trust.”

The VA’s responses to both GAO and OIG in the above-referenced reports are not uncommon.  However, as stated by Julia BrownleyJulia Andrews BrownleyKatherine Clark quietly eyes leadership ascent California Democrats unveil redistricting reform bill after Supreme Court partisan gerrymandering ruling WHIP LIST: The 132 House Democrats backing an impeachment inquiry MORE (D-Calif.) at a House Veterans’ Affairs Committee hearing earlier this year, “we are tired of receiving reports . . . we are sick of inaction.”

Brownley is correct. VA leadership must step up and look at more meaningful reforms, particularly with regard to clarity around centralized leadership roles.  

Instead of simply concurring with the findings in each government watchdog report that comes out and then moving on to the next crisis du jour, VA should focus on abolishing the VISN (veterans integrated service network) structure altogether. By doing so, VA will eliminate what has become an unnecessary level of bureaucracy and allow VA to focus on centralized leadership where it is needed, such as for the Office of Security and Law Enforcement.

The VISN structure was implemented in the 1990s in response to changes in the needs and demographics of the veterans population. In theory, the VISNs allowed VA greater flexibility in regard to staffing and budgeting needs by decentralizing control of these functions and allowing VISN directors to focus solely on the needs of a specific geographic area. Instead, the VISN structure has swelled to a network of approximately 1,000 middle managers who often create more bureaucracy than efficiency.

Like many reforms, the VISN structure worked well at first, but due to the rapidly changing healthcare environment, no longer makes sense today. As was highlighted at a House Veterans Affairs Committee hearing earlier this year, both Republicans and Democrats agreed that it may be time to get rid of the outdated model.  

As summed up by Chairman Phil RoeDavid (Phil) Phillip RoeHouse panel delays vote on surprise medical bills legislation If Trump wants to stay popular among veterans he has to do more Want to solve surprise medical bills? Listen to patients MORE (R-Tenn.), VISNs “should be the fail-safe mechanism when a medical center goes off course.  Unfortunately, too many of them seem to be afflicted with a case of learned bureaucratic helplessness.”

Despite promises of reform and an additional report scheduled for July 1, 2018, VA’s promises of VISN reform have gone unfulfilled. Unfortunately, the agency’s efforts have been diverted by more pressing needs, such as how it spent money allocated for suicide prevention, implementing the Mission Act and working through high-level leadership challenges of its own.

On all levels, the VA would benefit from streamlined business practices and clearly defined roles for leadership and employees alike. By doing so, they will not only be allowed to address more nuanced issues such as those stemming from managing its police force, but broader issues such as accountability throughout the Department as well.

The last true overhaul of VHA’s management structure took place in 1995, through the implementation of then-Under Secretary for Health Kenneth Kizer’s Vision for Change. That document and the reforms implemented as a result, will be 25 years old in 2020.  Since that time, there have been many reports and many promises of change, but no substantive reform in terms of organizational structure.

As noted by Brownley, above, veterans, politicians and other stakeholders are tired of reports and inaction. Despite VA’s best efforts since that time to implement gradual reforms, a rare window of opportunity has emerged where both Democrats and Republicans are supportive of abolishing VISNs and replacing them with a more modern and efficient management structure. We should not allow that window to close.

Rory E. Riley-Topping served as a litigation staff attorney for the National Veterans Legal Services Program (NVLSP), where she represented veterans and their survivors before the U.S. Court of Appeals for Veterans Claims. She also served as the staff director and counsel for the House Committee on Veterans’ Affairs, Subcommittee on Disability Assistance and Memorial Affairs for former Chairman Jeff MillerJefferson (Jeff) Bingham MillerOhio school took hot lunch from 9-year-old on his birthday due to unpaid lunch debt Labor Day 2019: Provide VA whistleblowers with necessary legal tools If Trump wants to stay popular among veterans he has to do more MORE (R-Fla.). You can find her on Twitter: @RileyTopping.