It goes without saying, but the federal government is infamous for its bureaucracy. For example, several years ago, Department of Defense created centralized regional offices that managed multiple bases. Instead of each military facility standing on its own in regards to budget, structure, management, etc., multiple installations were regonalized and another inefficient layer of management added. Two years after the reorganization, fraud and inefficiency caused DoD to decentralize and return to each base managing itself.
Although the VA is divided into three groups (Veterans Health Administration (VHA), Veterans Benefits Administration (VBA) and Veterans Cemetery Administration (VCA)) for simplicity I will focus on VHA.
In similar fashion, and not to be out-bureaucratized by another agency, the Department of Veterans Affairs, Veterans Health Administration followed suit. About the time that DoD realized its mistake and began to restructure, the VA began to centralize into Veterans Integrated Service Networks (VISNs). Instead of each VA hospital having responsibility over its budget and services, the VISNs restructured into 23 regional offices. The VISNs have oversight and budgetary authority over all VA Hospitals within their respective geographical boundaries. To add to the doldrums, many VA hospitals were integrated into health care systems. For example, Tennessee Valley Health Care System (TVHS) is comprised of the Nashville, and Murfreesboro, TN VA hospitals and Eastern Kansas Health Care System (EKHCS) is comprised of both Leavenworth, and Topeka, KS VA hospitals. Further, plans exists to consolidate all VISN offices which oversee the hospitals and health care systems in their respective regions. Lets take a look at VISN 9, VA Mid South Healthcare and VISN 15, VA Heartland Networks and juxtapose.
VISN 9 consists of 9 VA hospitals in Kentucky, Tennessee and West Virginia; 8 Outpatient Clinics in Kentucky, Tennessee, and Virginia; and 37 Community Based Outpatient Clinics (CBOCs) in Arkansas, Indiana, Kentucky, Mississippi, Tennessee, and West Virginia. VISN 9 is not centralized, but funding is filtered through the VISN office (located in Nashville, TN) and divided up between the facilities. Each VA medical center is responsible for its own HR functions (Staffing, Position Classification, Retirement, Processing and Records (official records and files), and Employee and Labor Relations) and the CBOCs and clinics assigned to each hospital.
Filling a Vacant Position in a Non-Centralized VA Hospital:
When a position becomes available, the service line manager coordinates with HR for recruitment. HR reviews the paperwork and initiates the recruitment process through posting the position on USAJobs.gov. The HR office accepts all applications and reviews them to determine eligibility and qualification of applicants. The HR office creates a list of qualified and eligible applicants, then forwards the list to the service line manager to conduct interviews and make a selection. Once a selection is made, the paperwork is returned to the HR office and reviewed. If everything is on par, the applicant is offered the position and the HR office completes all the necessary paperwork.
VISN 15 consists of 8 VA hospitals in Missouri, Kansas and Illinois; and 41 CBOCs in Arkansas, Illinois, Indiana, Kansas, Kentucky, and Missouri. The centralized VISN office, Located in Leavenworth, KS handles all the HR functions for the 8 medical centers and 41 CBOCs with HR Liaisons located at each facility. The VISN office handles Staffing, Classification, and Processing and Records. The HR Specialists at the VISN office are GS-12 specialists and are divided into blocks. The HR Liaisons at the medical facilities are GS-11 specialist and coordinate with the VISN for staffing, classification and processing and records.
Filling a vacant position in a centralized VISN.
When a vacancy becomes available in the medical center, the HR liaisons initiate recruitment to fill the position. They receive information from the service line manager (i.e. nursing) requesting a position to be filled, complete the proper paperwork, then forward the paperwork to the VISN office for completion. The VISN office posts the job on USAJobs.gov, receives all applications, reviews applications to determine qualified applicants, creates lists of qualified applicants based on eligibility, Veterans' Preference and qualifications, then forwards the list to the HR Liaison in the facility. The HR Liaison will forward the lists of eligible and qualified applicants to the service line manager for interviews and selection. Upon selection being made by the service line, the paperwork is returned to the HR liaison for review. Once reviewed by the HR liaison, the paperwork is forwarded to the VISN for another review. After the second review, the paperwork is returned to the HR liaison. If no problems exist, the selected applicant is contact and offered a position by the HR liaison. If the applicant accepts, the paperwork is again returned to the VISN for completion. If problems exists, the process begins anew.
Unfortunately, VISN 9 is gearing up to centralize functions to mirror VISN 15, adding another needless level of bureaucracy to the stovepipe. VA Secretary Eric Shinseki is taking a close look at the centralized model and has concerns over the inefficiency in which it operates.
In October, Secretary Shinseki asked VA employees for their ideas on improving services and operations. I had written proposal to do away with the VISN offices and have have every VA hospital responsible only for itself and associated CBOCs. All VISN Directors are Senior Executive Service (SES) and not GS employees - translation: They make Big Bucks $150K +. If you assume a GS-15, step 1 salary for the 23 VISN directors, deleting the VISN offices (and directors) from the VA would generate an immediate cost savings of approximately $2.5 million. I never submitted my proposal. All ideas generated by VA employees were reviewed by the Network directors. My proposal would have been DOA.
Another problem is the inequity of salary between the VISN HR specialist and the HR Liaisons. VISN 15 purposely hoards information and work to justify their positions, yet they have no real knowledge of how the facilities operate, nor do they communicate with the hospital staff, with the exception of the HR Liaisons. Front line HR Specialist at the facilities are shafted by the needless organizational structure. Also, facility level staff rarely receive year-end bonuses. Amazingly, the money dries up before it leaves the VISN office. But you can rest assured that the VISN fat cats get their bonuses, some of which top out at about $20K!
All this to say, if you think health care is expensive now, wait until the government owns and runs it all. You will see VA Hospitals replaced with Federal Hospitals and lines of sick and dying patients across the U.S. Yet another example of bureaucratic red tape that hinders operations and creates inefficiency.
It's time to wake up America. This consolidation of power is getting worse under President Hussein. From czars to security lapses to indecisiveness, government is growing more powerful. Thomas Jefferson once said, "When people fear their government, there is tyranny; when government fears the people, there is liberty." I, for one, want more liberty!
