WHAT’S UP, DOC?
A short essay outlining how the Veterans Administration
might reorganize its Medical system
We have heard the problems. Now, let’s get a viable solution. The United States Congress seems unable to figure this out, perhaps because so few of them have served in the Armed Forces. Those few who have served are in positions where they will never have to personally encounter the Department of Veterans Affairs medical system.
It is certain nice to have Congress appropriate funds to run the system. The fix involves a restructuring of the medical system from the bottom to the top. If you change the basic structure, you will change the culture. It is the culture, which stems from the structure, which has pushed the VA Medical System over the cliff. Why must Veterans put up with a medical system that hasn’t evolved since its inception under Herbert Hoover: July 21, 1930
The second consolidation of federal Veterans programs took place July 21, 1930, when President Herbert Hoover signed Executive Order #5398 and elevated the Veterans Bureau to a federal administration—creating the Veterans Administration—to "consolidate and coordinate Government activities affecting war veterans”. At that time, the National Homes and Pension Bureau also joined the VA. 
Note Bene: Check out the number of “Executive Orders” enacted by President Hoover!
Surprisingly, the fix is relatively simple, as all the necessary parts already exist within. I understand that Congress loves to create new stuff and put their signatures on it. But, there is no reason to re-invent the wheel. The structure of a typical VA Medical Center looks like, if you will, a large farm field with a row of grain elevators: aka Silos. The field represents the whole Medical Center. Each Silo represents a specific department within that larger farm field. Call the farm field the “system”. Let’s take a look at the relationship between the Silos.
VA Medical Center’s Silo Structure
|Field of Dreams|
This may not look like it is relevant to this argument on the surface, but, remember, this a bottom up scenario.
This type of Personnel insulation/isolation is detrimental to anyone trying to run any VA Medical Center program effectively. The history of how this became the norm is not important, any more. What is important is that a solution be found before the entire Department of Veterans Affairs is purposely allowed to implode and become “privatized”.
One technique of solving industrial, commercial, or institutional problems that I am familiar with is the application of the “Six Sigma”/”Kaisen” theory of looking at one scenario. You draw on all your human resources to implement the most lean, streamlined, efficient way to deliver your product.
You the work out any bugs, and, when you are satisfied you have problem solved, you simply duplicate the new structure as many times as you need to. In this case, you take one VA Medical Center and work your magic on just that unit. Once you have it running correctly and efficiently, you simply go Medical Center by Medical Center and duplicate the first restructuring in each of the remaining Medical Centers.
I want to include one excerpt from:
Eric Whitney, Montana Public Radio and Michael Tomsic, WFAE
“Despite $10B 'Fix,' Veterans Are Waiting Even Longer To See Doctors” 
Congress and the VA came up with a fix: , a $10 billion program that was supposed to give veterans a card that would let them see a non-VA doctor if they were more than 40 miles away from a VA facility or they were going to have to wait longer than 30 days for a VA provider to see them.
This winter, when Montana sent his staff to meet with veterans across the state, Bobby Wilson showed up at a session in Superior. Wilson, a Navy vet who served in Vietnam, is trying to get his hearing aids fixed.
But he says he's mired in bureaucracy. "The VA can't do it in seven months, eight months? Something's wrong," he says. "Three hours on the phone," trying to make an appointment. "Not waiting," he says, "talking for three hours trying to get this thing set up for my new hearing aids”.
........Meanwhile, though, Veterans continue to wait. "If I knew half of what I knew now back then when I was just a kid, I would've never went in the military," says Bobby Wilson. "I see how they treat their veterans when they come home."
Many Veterans, me included, have friends and acquaintances who could sit down at a table for a week and hash out the details of a solution to this mess. Almost to a person, they have said, “All the Government has to do is ask.” Believe me! If I can identify the problem and start the ball rolling toward a solution, then far better minds than mine would have no problem, whatsoever, in completing the task of restructuring the Department of Veterans Affairs in very short order.
And, what will be the inevitable larger, big-picture problem? Young men and women will see how Veterans disrespected, mistreated, and lied to. The resultant plummeting of Armed Forces recruitment and enlistment will leave this Country without a means of defending itself, let alone others.
 http://www.npr.org/sections/health- shots/2016/05/16/477814218/attempted-fix-for-va-health-delays-creates-new-bureaucracy
further suggested reading: