October 2, 1995

Deputy Under Secretary for Health

Transition Work Group Reports - Catalog of Comments and Recommendations

All VA Staff

1\. In late July and early August, 1995, six work group reports which
set forth ideas and recommendations for implementing Dr. Kizer's
**Vision for** **Change** were made available for review by all
interested staff throughout the field and in headquarters. Numerous
comments to these reports were received and cataloged by recommendation
for each work group report. In some instances the comments received
precipitated revisions to the work group's original recommendations.

2\. The attached summary document is one of six catalogs of
recommendations. The recommendations were extracted from the work group
report. The catalog includes each original recommendation followed by a
summary of the comments received, the work group's reaction to the
comments, the rationale for that reaction, and any resulting change to
the recommendation. In some cases, the "comments" section is followed by
"approve" or "disapprove." This is an indication of the work group's
reaction to the comments. It does [not]{.underline} indicate a final
decision by the Under Secretary.

3\. Please keep in mind as you review these documents that they catalog
recommendations of the work groups to Dr. Kizer. Dr. Kizer is in the
process of reviewing the recommendations for final decision and
implementation.

4\. It is also important to remember that the restructuring of VHA will
evolve over time. While some changes began on October 1st, many things
that need to happen are sequenced in time beyond that date. This is the
reason the July reports did not describe the complete closure on many
issues that some reviewers may have expected. The six work group reports
are being summarized and edited to create a new document, **Vision for**
**Change - Implementation**, which should be distributed in November
1995. This will be a companion report to the original **Vision for**
**Change** that was published in March 1995.

5\. Please direct any questions about these documents to Greg Neuner in
Headquarters at 202-273-5823.

Thomas L. Garthwaite, M.D.

Attachments

VISN ACTIVATION WORK GROUP

EXECUTIVE SUMMARY OF COMMENTS RECEIVED

IN RESPONSE TO DRAFT REPORT

Over 140 individuals responded to the report of the VISN Activation Work
Group. In general, comments were highly positive with many specific
references to the qualify and comprehensives of work and the strength of
the approaches suggested. All comments were carefully reviewed and were
captured in one of two ways. Those referring to specific recommendations
were matched with the recommendation and are included in this document.
Those of a general nature were categorized in terms of key thoughts
expressed and attached in another document (e\\visn\\nonrec.doc). Each
comment was reviewed and rationale for agreement or disagreement with
the comment was developed. This Executive Summary will highlight the
tone and general themes of the responses.

A number of respondents felt the level of detail in some sections of the
document was too great, inhibiting flexibility in the new organizational
structure. The need for flexibility and autonomy at the VISN level in
order to achieve the mission intended was stressed. Others believed that
there was not enough detail to fully communicate where certain existing
functions would be placed. Skepticism was expressed regarding the level
of autonomy which would actually be delegated and several comments that
the report appeared inconsistent in this regard (e.g., VISN Directors
have delegated authority for operations yet the size of their staff was
limited to 7-10 persons, the staffing plan would need to be submitted
for approval, etc.).

One area which obviously needs more elaboration in the reports of both
the VISN Activation Work Group and the Headquarters Restructuring Group
is that of the role of "special programs" in the proposed
reorganization. It certainly has always been the intent that special
programs would be maintained and even strengthened under the new
structure. Several comments from service organizations indicate that
this intent may not be as clear as it should be.

Many comments were received relating to the role and composition of the
VISN Executive Leadership and Management Assistance Councils. The manner
in which the two groups would function appeared to be unclear in terms
of their advisory vs. "operational" relationship. Specific
recommendations were made as to the inclusion of certain individuals
and/or groups on the councils.

Proposed staffing within the VISN office generated a number of
responses. The limitation of 7-10 staff for the VISN Office was seen as
unnecessarily restrictive and perhaps inadequate. A number of comments
specifically recommended the addition of certain types of staff (i.e.,
clerical, nursing, social work, etc.) In particular there were many
comments regarding the need to have a strong nursing presence within the
VISN. The recruitment of Clinical Services and Financial Managers before
it was known where the VISN Office would be located and who the VISN
Director would be was not perceived positively. There was general
concern that in the attempt to expedite VISN start-up through early
recruitment, the applicant pool, quality of applicants and achievement
of well functioning "teams" would be sacrificed.

The overall pace of the VISN transition, dissolution of regions and
restructuring of Headquarters was viewed by many as exceedingly rapid.
Concern was specifically expressed relating to the fact that so much
change would be occurring simultaneously without time to deal with the
"people" issues required to create such massive cultural reorientation.

The differences in approach between the recommendation of the VISN
Activation Work Group and the Headquarters Restructuring Work Group
relating to VISN Support Teams was noted by many. The contrast between
the 11 member team recommended by VISN Activation and the 42+ members of
the teams proposed by the Headquarters Restructuring Work Group is
significant. Comments ranged from the belief that the support team
proposed by the VISN Activation Work Group was "vital to the success of
the implementation" to the team would provide yet another level of
bureaucracy. There was also concern that current functions perceived to
be redundant and unnecessary would be perpetuated in the VSSCs and
Operations. One comment was that the talents and skills of clinicians on
the team would be underutilized in what was perceived as an
"administrative" role. Also the issue of salary inequity for individuals
working on the support team was acknowledged.

The VSSC has been one of the most heavily debated issues in this
process. Originally, the SSC emerged as a concept to deal with issues
outside of Headquarters, but in a forum larger than the VISN. At that
time, the VSSC seemed a reasonable piece of the organization to deal
with roll-up functions for finance and construction, larger planning
issues and perhaps as a "home" for any region functions which did not
neatly fit into other parts of the organization. As the planning process
began and the debate ensued, the need for this function, in view of
current computer capabilities, the organization and structure analysis
that occurred during the planning process, etc., became less clear and
it appeared there might be a time-limited need for the VSSC\--to absorb
region functions that would gradually be transitioned to VISNs and
Headquarters during initial implementation. Current thinking of the Work
Group is that establishment of the VSSC would be redundant, that we
should not establish something which we would then phase out in the next
six to twelve months. Hence the recommendation that VSSCs should be
established [only if a value-added need is determined]{.underline}
through analysis of Region functions which the VISNs and CNO office will
now be conducting. This analysis is an important task and must be
accomplished without bias. Many comments support the Work Group's
conclusion that the VSSC is redundant. This proposed change to the role
of VSSCs outlined in the *Vision for Change* should be carefully
considered, and probably adopted, but no final decision should be made
until the analysis occurs.

Several comments were received from the General Counsel relating to some
of the procedural matters which should be considered in various parts of
the implementation (i.e., leasing, legislative changes, etc.). These
comments will be useful as implementation planning proceeds.

Suggestions were made relating to the proposed outplacement program and
difficulty which may be encountered in outplacing region staff. The plan
for reassigning remaining region staff to the office of the CNO on
October 1 and conducting a thorough review of current region functions
drew many comments relating to the need to be "people- sensitive" during
the transition. Also many of the respondents wanted more detail
regarding exactly where current region functions would be placed and who
would hold responsibility for them. There were specific recommendations
regarding which functions were no longer needed, which programs should
remain and where they should be placed.

Comments related to affiliations were diverse, ranging from recommending
immediate decentralization of education funding and house staff
positions to advising that they remain centralized. The one theme which
came through in the comments was agreement that further study would be
required and that there should not be a rush to implement change in this
area in light of the many other structural and cultural changes which
would be undertaken simultaneously.

In summary, while there were not major issues addressed which had not
been contemplated and discussed by the Work Group in its deliberations,
the comments were quite helpful. They will be useful as further
implementation strategies are developed and recommendations are refined.
The level and thoughtfulness of many responses was indicative that the
"field" is indeed engaged in the process.

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | VISN Directors with       |   |   |    |    | A |               |
| e | concurrence of the CNO    |   |   |    |    | / |               |
| f | will determine the        |   |   |    |    | D |               |
| N | organizational structure  |   |   |    |    | / |               |
| o | that best meet the needs  |   |   |    |    | O |               |
| ] | of their respective VISN; |   |   |    |    | ] |               |
| { | will support the          |   |   |    |    | { |               |
| . | operation of a fully      |   |   |    |    | . |               |
| u | integrated managed care   |   |   |    |    | u |               |
| n | organization and support  |   |   |    |    | n |               |
| d | the following major       |   |   |    |    | d |               |
| e | functions: leadership,    |   |   |    |    | e |               |
| r | planning, resource        |   |   |    |    | r |               |
| l | management, clinical      |   |   |    |    | l |               |
| i | services management,      |   |   |    |    | i |               |
| n | human resources           |   |   |    |    | n |               |
| e | management, performance   |   |   |    |    | e |               |
| } | measurement, management   |   |   |    |    | } |               |
| * | of affiliations and       |   |   |    |    | * |               |
| * | internal and external     |   |   |    |    | * |               |
|   | stakeholders relations.   |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | determine organizational  | V |   | 11 |    |   |               |
| . | structure                 | I |   | /1 |    |   |               |
| 1 |                           | S |   | 5/ |    |   |               |
| . |                           | N |   | 95 |    |   |               |
| 1 |                           | D |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
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|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | s |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | We received four comments | A | W |    |    |   |               |
| . | on the flexibility of     |   | e |    |    |   |               |
| 1 | VISN Directors to develop | D | a |    |    |   |               |
|   | the VISNs. Most were      |   | r |    |    |   |               |
|   | supportive of the idea    | D | e |    |    |   |               |
|   | \-- "We believe that      |   | a |    |    |   |               |
|   | flexibility is the key to |   | t |    |    |   |               |
|   | success. It is hoped that |   | t |    |    |   |               |
|   | unneeded services and     |   | e |    |    |   |               |
|   | functions will be         |   | m |    |    |   |               |
|   | eliminated."              |   | p |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   | However, one comment      |   | i |    |    |   |               |
|   | disagreed \-- "This is    |   | n |    |    |   |               |
|   | the same as 'no           |   | g |    |    |   |               |
|   | recommendation.' Specific |   | t |    |    |   |               |
|   | programmatic requirements |   | o |    |    |   |               |
|   | can be identified, they   |   | m |    |    |   |               |
|   | are currently being       |   | a |    |    |   |               |
|   | performed by Regional     |   | i |    |    |   |               |
|   | Offices. They should be   |   | n |    |    |   |               |
|   | stated in the Report and  |   | t |    |    |   |               |
|   | specific plans for their  |   | a |    |    |   |               |
|   | continuation or           |   | i |    |    |   |               |
|   | elimination proposed."    |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   | One other comment was     |   | s |    |    |   |               |
|   | concerned with the        |   | m |    |    |   |               |
|   | concurrence of the CNO    |   | a |    |    |   |               |
|   | for VISN organizational   |   | n |    |    |   |               |
|   | structure \-- "This       |   | y |    |    |   |               |
|   | appears to be contrary to |   | d |    |    |   |               |
|   | the concept of            |   | e |    |    |   |               |
|   | decentralization of       |   | g |    |    |   |               |
|   | responsibility and        |   | r |    |    |   |               |
|   | accountability."          |   | e |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | o |    |    |   |               |
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|   |                           |   | . |    |    |   |               |
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|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | Three comments were       | A | T |    |    |   |               |
| . | concerned with the staff  |   | h |    |    |   |               |
| 1 | levels within the VISN    | A | e |    |    |   |               |
|   | office. "Given the        |   | r |    |    |   |               |
|   | initial functions         |   | e |    |    |   |               |
|   | assigned to the VISNs and |   | c |    |    |   |               |
|   | the likelihood of         |   | o |    |    |   |               |
|   | assuming other functions, |   | m |    |    |   |               |
|   | a major concerns whether  |   | m |    |    |   |               |
|   | or not there will be      |   | e |    |    |   |               |
|   | sufficient staffing to    |   | n |    |    |   |               |
|   | accomplish the tasks      |   | d |    |    |   |               |
|   | assigned."                |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   | "Some analytical          |   | 7 |    |    |   |               |
|   | resources currently at    |   | - |    |    |   |               |
|   | individual facilities may |   | 1 |    |    |   |               |
|   | have to be pooled at the  |   | 0 |    |    |   |               |
|   | VISN level while          |   | F |    |    |   |               |
|   | maintaining adequate      |   | T |    |    |   |               |
|   | resources at the local    |   | E |    |    |   |               |
|   | facility. The use of task |   | i |    |    |   |               |
|   | forces and councils is    |   | s |    |    |   |               |
|   | essential in streamlining |   | f |    |    |   |               |
|   | the VISN and VSSC."       |   | o |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | t |    |    |   |               |
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|   |                           |   | V |    |    |   |               |
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|   |                           |   | . |    |    |   |               |
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|   |                           |   | I |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | N |    |    |   |               |
|   |                           |   | . |    |    |   |               |
|   |                           |   |   |    |    |   |               |
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|   |                           |   | V |    |    |   |               |
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|   |                           |   | S |    |    |   |               |
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|   |                           |   | t |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | w |    |    |   |               |
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|   |                           |   | r |    |    |   |               |
|   |                           |   | g |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | z |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "Although the report      | \ | T |    |    |   |               |
| . | offers a great deal of    | - | h |    |    |   |               |
| 1 | detail regarding certain  | - | e |    |    |   |               |
|   | aspects of the transition |   | n |    |    |   |               |
|   | from the Region structure |   | e |    |    |   |               |
|   | to the VISN organization, |   | e |    |    |   |               |
|   | adequate information is   |   | d |    |    |   |               |
|   | not available regarding   |   | t |    |    |   |               |
|   | the means by which the    |   | o |    |    |   |               |
|   | VISN Directors will       |   | e |    |    |   |               |
|   | implement the changes     |   | l |    |    |   |               |
|   | necessary to bring the VA |   | i |    |    |   |               |
|   | into the realm of         |   | m |    |    |   |               |
|   | competition with the      |   | i |    |    |   |               |
|   | private sector.           |   | n |    |    |   |               |
|   | Historically, the VA has  |   | a |    |    |   |               |
|   | been restricted by many   |   | t |    |    |   |               |
|   | issues which impact its   |   | e |    |    |   |               |
|   | operations; without       |   | u |    |    |   |               |
|   | elimination of these      |   | n |    |    |   |               |
|   | restrictions it is        |   | n |    |    |   |               |
|   | uncertain whether the     |   | e |    |    |   |               |
|   | VISN organization can     |   | c |    |    |   |               |
|   | effect necessary          |   | e |    |    |   |               |
|   | changes."                 |   | s |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | y |    |    |   |               |
|   |                           |   | r |    |    |   |               |
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|   |                           |   | s |    |    |   |               |
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|   |                           |   | . |    |    |   |               |
|   |                           |   | A |    |    |   |               |
|   |                           |   | t |    |    |   |               |
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|   |                           |   | d |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | x |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | x |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | b |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | y |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | Another comment stated,   | A |   |    |    |   |               |
| . | "..that while the VISN    |   |   |    |    |   |               |
| 1 | Director appears to have  |   |   |    |    |   |               |
|   | authority to change       |   |   |    |    |   |               |
|   | modify or delete          |   |   |    |    |   |               |
|   | functions at facilities   |   |   |    |    |   |               |
|   | in his/her area, it's not |   |   |    |    |   |               |
|   | clear what authority      |   |   |    |    |   |               |
|   | he/she has in reassigning |   |   |    |    |   |               |
|   | personnel. Specifically   |   |   |    |    |   |               |
|   | he/she appear to be       |   |   |    |    |   |               |
|   | prohibited from assigning |   |   |    |    |   |               |
|   | employees, surplused by   |   |   |    |    |   |               |
|   | increased efficiency to   |   |   |    |    |   |               |
|   | the VISN office if the    |   |   |    |    |   |               |
|   | FTE of 10 - 12 is         |   |   |    |    |   |               |
|   | exceeded. For example,    |   |   |    |    |   |               |
|   | with the resource         |   |   |    |    |   |               |
|   | allocation for the entire |   |   |    |    |   |               |
|   | VISN resting with the CFO |   |   |    |    |   |               |
|   | (and CEO) he/she cannot   |   |   |    |    |   |               |
|   | accomplish this alone;    |   |   |    |    |   |               |
|   | nor can it be done        |   |   |    |    |   |               |
|   | efficiently and           |   |   |    |    |   |               |
|   | effectively by a          |   |   |    |    |   |               |
|   | "committee or advisory    |   |   |    |    |   |               |
|   | group" (the members of    |   |   |    |    |   |               |
|   | which are certain to have |   |   |    |    |   |               |
|   | parochial interests).     |   |   |    |    |   |               |
|   | He/She will need a staff  |   |   |    |    |   |               |
|   | working for and with him. |   |   |    |    |   |               |
|   | That is not to suggest    |   |   |    |    |   |               |
|   | that the fiscal operation |   |   |    |    |   |               |
|   | at any facility should be |   |   |    |    |   |               |
|   | abolished but rather to   |   |   |    |    |   |               |
|   | recommend that fiscal     |   |   |    |    |   |               |
|   | staff working on VISN     |   |   |    |    |   |               |
|   | fiscal responsibilities   |   |   |    |    |   |               |
|   | be assigned to the VISN.  |   |   |    |    |   |               |
|   | This is but one example   |   |   |    |    |   |               |
|   | of the probable need for  |   |   |    |    |   |               |
|   | personnel realignment     |   |   |    |    |   |               |
|   | within the VISN."         |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "One of the stated goals  | A | T |    |    |   |               |
| . | of the VISN structure is  |   | h |    |    |   |               |
| 1 | the inclusion of external |   | e |    |    |   |               |
|   | health care providers as  |   | i |    |    |   |               |
|   | part of the network.      |   | n |    |    |   |               |
|   | However, the VISN reports |   | t |    |    |   |               |
|   | do not address the        |   | e |    |    |   |               |
|   | process for developing,   |   | n |    |    |   |               |
|   | writing, negotiating, and |   | t |    |    |   |               |
|   | signing these contracts   |   | i |    |    |   |               |
|   | or who within the VISN    |   | s |    |    |   |               |
|   | has the expertise and     |   | t |    |    |   |               |
|   | authority to complete     |   | o |    |    |   |               |
|   | contracts with external   |   | g |    |    |   |               |
|   | providers."               |   | i |    |    |   |               |
|   |                           |   | v |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | V |    |    |   |               |
|   |                           |   | I |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | N |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | y |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | v |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | One comment agreed that   | A | \ |    |    |   |               |
| . | VISN management will need |   | - |    |    |   |               |
| 1 | to take advantage of      |   | - |    |    |   |               |
|   | research (HSR&D,          |   |   |    |    |   |               |
|   | Affiliates, VHA Research  |   |   |    |    |   |               |
|   | Service).                 |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | One comment suggested     | A | T |    |    |   |               |
| . | that we add research as a |   | h |    |    |   |               |
| 1 | VISN Director             |   | e |    |    |   |               |
|   | responsibility that       |   | r |    |    |   |               |
|   | states, "VISN Directors   |   | e |    |    |   |               |
|   | should encourage          |   | i |    |    |   |               |
|   | research, promote its     |   | s |    |    |   |               |
|   | application to ensure     |   | p |    |    |   |               |
|   | best practices, and       |   | r |    |    |   |               |
|   | publicize its benefits to |   | e |    |    |   |               |
|   | veteran patients."        |   | s |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
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|   |                           |   | n |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "VISN clinical advisory   | A | T |    |    |   |               |
| . | councils such as Mental   |   | h |    |    |   |               |
| 1 | Health and Long Term Care |   | e |    |    |   |               |
|   | could strengthen and      |   | s |    |    |   |               |
|   | support efforts,          |   | e |    |    |   |               |
|   | especially if an          |   | w |    |    |   |               |
|   | interdisciplinary         |   | i |    |    |   |               |
|   | membership model is used  |   | l |    |    |   |               |
|   | to share the broadest     |   | l |    |    |   |               |
|   | appropriate knowledge     |   | b |    |    |   |               |
|   | base to address issues    |   | e |    |    |   |               |
|   | and problems facing       |   | d |    |    |   |               |
|   | clinical programs in the  |   | e |    |    |   |               |
|   | VISN."                    |   | v |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | V |    |    |   |               |
|   |                           |   | I |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | N |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | . |    |    |   |               |
|   |                           |   | V |    |    |   |               |
|   |                           |   | I |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | N |    |    |   |               |
|   |                           |   | D |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | c |    |    |   |               |
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|   |                           |   | l |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | w |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | v |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | v |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | y |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | y |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | V |    |    |   |               |
|   |                           |   | I |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | N |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | g |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | No change recommended at  |   |   |    |    |   |               |
|   | this time to the          |   |   |    |    |   |               |
|   | recommendation.           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

<table style="width:100%;">
<colgroup>
<col style="width: 5%" />
<col style="width: 39%" />
<col style="width: 4%" />
<col style="width: 6%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 0%" />
<col style="width: 5%" />
<col style="width: 0%" />
<col style="width: 22%" />
</colgroup>
<tbody>
<tr class="odd">
<td><p><strong><u>RefNo</u></strong></p>
<p>2.2</p></td>
<td colspan="6"><p><strong><u>Recommendation:</u></strong></p>
<p>Each VISN Director will establish an Executive Leadership Council
consisting primarily of internal stakeholders and a Management
Assistance Council consisting primarily of external stakeholders. These
councils will represent diverse viewpoints and serve to advise the VISN
Director regarding key aspects of VISN operations.</p></td>
<td colspan="2"><strong><u>A/D/O</u></strong></td>
<td><strong><u>Remarks</u>-K<sup>2</sup></strong></td>
</tr>
<tr class="even">
<td></td>
<td><strong>Action Required</strong></td>
<td colspan="2"><strong>Action Office</strong></td>
<td><strong>Target Date</strong></td>
<td><strong>Actual Date</strong></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td>2.2.1</td>
<td>establish Executive Leadership Council</td>
<td colspan="2">VISN Directors</td>
<td>10/15/95</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td>2.2.2</td>
<td>establish Management Assistance Council</td>
<td colspan="2">VISN Directors</td>
<td>10/15/95</td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td></td>
<td><strong>Comments</strong></td>
<td><strong>A/D</strong></td>
<td colspan="4"><strong>Rationale</strong></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td>2.2</td>
<td><p>There were seventeen (17) comments related to the ELC and the
MAC. Most comments support both councils. The following comments and
questions relate to establishment of these councils--</p>
<p>“How will the members of the councils be selected? What will be taken
into consideration? Can advisory councils, as outlined, function
efficiently in a decremental budgeting environment?”</p>
<p>“VISN use of advisory/management councils to resolve local issues -­-
How would these groups relate to national policy and national advisory
groups? (What are the limits of ‘local’ issues and ‘loca’
authority?)”</p></td>
<td>--</td>
<td colspan="4"><p>The details of Council membership and organization
will be determined as the organization develops based upon individual
VISN needs. Advisory councils can be very helpful and supportive even in
a “decremental budgeting” environment.</p>
<p>Linkage is through VISN Directors and CNO. Limits of authority
determined by USH and CNO.</p></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td>2.2</td>
<td>We received several suggestions for membership to the Executive
Leadership Council (ELC). This included such professions as nurses (“The
nurse’s broad perspective of the continuum of patient care and support
of seamless delivery of systems makes him/her an ideal candidate for
inclusion.”) and mental health representatives (“...to reflect the
importance of mental health in the composition of VHA health
services.”). Other council suggestions included: “Membership should
include all the Directors within each VISN initially to assume full
representation of all VISN internal stakeholders.”; “The ELC should have
external stockholder presence to provide input on special programs for
identification and organization of major process and procedure lines at
the network level.”; and “Membership in the ELC should include a very
broad representation of clinical management expertise to promote service
integration and resource development.”</td>
<td>D</td>
<td colspan="4">Composition of the ELC should not be mandated but
determined by VISN needs. The intent of the ELC is to have a wide range
of members representing the key internal stakeholders. VISN Directors
will be charged with determining membership, however the suggestion will
be passed on to those developing VISN Director orientation.</td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td>2.2</td>
<td><p>We also received numerous suggestions for the membership of the
Management Assistance Council (MAC). They included such groups as -- “a
broad representation of the community health and social services
network”; “For those members of the Puerto Rican community, will
distance be taken into consideration? We feel that it is important to
have members of the Puerto Rican community included in the MAC since our
health care program is quite different from that in Florida.”; “Include
mental health reps at this level. Add Social Work representatives to
insure community liaison and care to long-term patients.”; “The MAC
should include consumer groups beyond the VSO’s such as the National
Alliance for the Mentally Ill.”; “Consideration should be given to
relying of the State Veterans Service Commission staff instead of the
VSO officers for meaningful input.”</p>
<p>“What is the Management Assistance Council’s (MAC) authority and
responsibility in addition to information collection?”</p></td>
<td><p>D</p>
<p>--</p></td>
<td colspan="4"><p>A variety of advisory groups will be important to
VISN management. Actual membership to be determined as VISNs mature.
VSO’s are vital to the success of VHA and will be actively involved.</p>
<p>The capacity of the MAC is advisory. It will deal with wide range of
issues from that advisory standpoint.</p></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td>2.2</td>
<td><p>Other advisory councils were suggested. These include the
following --</p>
<p>“...Research Council to ensure that VISN management (a) is informed
of all research activities, (b) is aware of the contributions of the
research program to the VISN mission, and (c) receives advice regarding
needed organizational changes as experience grows with the VISN
structure. This council should be chaired by an ACOS/R&amp;D or
equivalent and members should include representatives from affected
universities, Veterans Service Organizations, Offices of Public Affairs,
and others as appropriate, e.g., representatives from research regional
office, field programs, and R&amp;D centers.”</p>
<p>“Establish a Mental Health Advisory Council for each VISN to insure
coordination of services and eliminate duplication of programs. Include
Social Work representatives to insure coordination with community.”</p>
<p>“The Emergency Medical Preparedness Office has proposed the
establishment of an Emergency Medical Preparedness Assistance Council,
headed by an experienced EMPO Area Emergency Manager from a network
facility within the VISN and assisted by other VAMC AEMs and/or
Emergency Preparedness Coordinators, to advise and assist the VISN
Director and staff in developing and conducting emergency management
activities within the VISN. Close coordination will be maintained with
EMPO headquarters to coordinate approvals and integration of emergency
preparedness activities that cross VISN boundaries.”</p></td>
<td><p>D</p>
<p>D</p>
<p>D</p></td>
<td colspan="4"><p>Research input can be garnered in a variety of ways.
Need for councils should be evaluated as VISNs mature. In order to offer
flexibility, no specific councils are mandated.</p>
<p>(see above comment)</p>
<p>Need for Advisory Councils should be evaluated as the VISN matures.
It is, however, important that EMPO be an activity receiving high
priority.</p></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td>2.2</td>
<td>“Labor organizations are included as an external stakeholder in the
MAC. Labor organizations must be involved as an internal stakeholder in
these re-organizations.”</td>
<td>--</td>
<td colspan="4">While union members are indeed internal stakeholders,
unions themselves are external. It is vital that strong partnerships be
developed and highly positive working relationships be maintained with
labor partners.</td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td><strong>Proposed Revision</strong></td>
<td colspan="2"><strong>Action Office</strong></td>
<td><strong>Target Date</strong></td>
<td><strong>Actual Date</strong></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td>No change is recommended at this time. Labor partnership issue may
need to be discussed by Headquarters for a policy or philosophy
direction.</td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
</tbody>
</table>

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | VISN Directors will be    |   |   |    |    | A |               |
| e | accountable for meeting   |   |   |    |    | / |               |
| f | performance goals         |   |   |    |    | D |               |
| N | established in their      |   |   |    |    | / |               |
| o | performance contracts.    |   |   |    |    | O |               |
| ] |                           |   |   |    |    | ] |               |
| { |                           |   |   |    |    | { |               |
| . |                           |   |   |    |    | . |               |
| u |                           |   |   |    |    | u |               |
| n |                           |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 3 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| * | ***establish and          | * |   | ** |    |   |               |
| * | communicate VISN Director | * |   | *1 |    |   |               |
| * | performance contracts     | * |   | 0/ |    |   |               |
| 2 | (new action item)***      | C |   | 15 |    |   |               |
| . |                           | h |   | /9 |    |   |               |
| 3 |                           | i |   | 5* |    |   |               |
| . |                           | e |   | ** |    |   |               |
| 1 |                           | f |   |    |    |   |               |
| * |                           | N |   |    |    |   |               |
| * |                           | e |   |    |    |   |               |
| * |                           | t |   |    |    |   |               |
|   |                           | w |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | k |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 3 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | We received four comments | A | R |    |    |   |               |
| . | regarding this            |   | e |    |    |   |               |
| 3 | recommendation. One       | \ | f |    |    |   |               |
|   | comments supported making | - | e |    |    |   |               |
|   | VISN Directors            | - | r |    |    |   |               |
|   | accountable for the       |   | t |    |    |   |               |
|   | success of the VISN while | \ | o |    |    |   |               |
|   | another requested clarity | - | P |    |    |   |               |
|   | in Headquarters and VISN  | - | e |    |    |   |               |
|   | roles in establishing     |   | r |    |    |   |               |
|   | performance criteria and  |   | f |    |    |   |               |
|   | standards.                |   | o |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   | One comment related to    |   | m |    |    |   |               |
|   | the VISN Directors        |   | a |    |    |   |               |
|   | Performance Contract      |   | n |    |    |   |               |
|   | period (Jan 1, 1996-Sept. |   | c |    |    |   |               |
|   | 30, 1996) and questioned  |   | e |    |    |   |               |
|   | whether this was          |   | M |    |    |   |               |
|   | sufficient time for VISN  |   | e |    |    |   |               |
|   | Directors to put their    |   | a |    |    |   |               |
|   | organizations in place.   |   | s |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   | The last comment was a    |   | r |    |    |   |               |
|   | lengthy set of questions  |   | e |    |    |   |               |
|   | related to employee       |   | m |    |    |   |               |
|   | education \-- "How will   |   | e |    |    |   |               |
|   | or should the VISNs       |   | n |    |    |   |               |
|   | interact with the Office  |   | t |    |    |   |               |
|   | of Employee Education?    |   | W |    |    |   |               |
|   | What access will or       |   | o |    |    |   |               |
|   | should the VISNs have to  |   | r |    |    |   |               |
|   | the 10 Regional Medical   |   | k |    |    |   |               |
|   | Development Centers and 3 |   | G |    |    |   |               |
|   | National Media            |   | r |    |    |   |               |
|   | Development Centers? What |   | o |    |    |   |               |
|   | level of funding and/or   |   | u |    |    |   |               |
|   | other support (NRM,       |   | p |    |    |   |               |
|   | equipment, FTE, etc.)     |   | . |    |    |   |               |
|   | should be allocated for   |   | P |    |    |   |               |
|   | employee education? None  |   | e |    |    |   |               |
|   | of the reports include    |   | r |    |    |   |               |
|   | any reference to the VISN |   | f |    |    |   |               |
|   | Director's responsibility |   | o |    |    |   |               |
|   | toward employee           |   | r |    |    |   |               |
|   | education. No performance |   | m |    |    |   |               |
|   | measures are identified   |   | a |    |    |   |               |
|   | in regard to employee     |   | n |    |    |   |               |
|   | education. Yet, the       |   | c |    |    |   |               |
|   | Education and Training    |   | e |    |    |   |               |
|   | Work Group Report         |   | c |    |    |   |               |
|   | recommends that each VISN |   | o |    |    |   |               |
|   | Director develop an       |   | n |    |    |   |               |
|   | educational plan, conduct |   | t |    |    |   |               |
|   | a base line assessment at |   | r |    |    |   |               |
|   | each network facility,    |   | a |    |    |   |               |
|   | develop measurement tools |   | c |    |    |   |               |
|   | to assess organizational  |   | t |    |    |   |               |
|   | progress, and measure     |   | s |    |    |   |               |
|   | organizational progress   |   | w |    |    |   |               |
|   | toward culture change."   |   | i |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | b |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | j |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | y |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | v |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | b |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | w |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | b |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | . |    |    |   |               |
|   |                           |   |   |    |    |   |               |
|   |                           |   | D |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | C |    |    |   |               |
|   |                           |   | N |    |    |   |               |
|   |                           |   | O |    |    |   |               |
|   |                           |   | . |    |    |   |               |
|   |                           |   |   |    |    |   |               |
|   |                           |   | R |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | E |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | T |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | g |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | P |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | M |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | W |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | k |    |    |   |               |
|   |                           |   | G |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "It is stated that        | A | A |    |    |   |               |
| . | contracting for services  |   | g |    |    |   |               |
| 3 | will require significant  |   | r |    |    |   |               |
|   | involvement as it becomes |   | e |    |    |   |               |
|   | common practice           |   | e |    |    |   |               |
|   | experience has shown, in  |   | i |    |    |   |               |
|   | many cases, that          |   | n |    |    |   |               |
|   | contracting various       |   | p |    |    |   |               |
|   | services outside the      |   | r |    |    |   |               |
|   | facility has resulted in  |   | i |    |    |   |               |
|   | higher costs over time.   |   | n |    |    |   |               |
|   | Cost effectiveness of     |   | c |    |    |   |               |
|   | contracting any service   |   | i |    |    |   |               |
|   | must continually be       |   | p |    |    |   |               |
|   | assessed."                |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | No change recommended at  |   |   |    |    |   |               |
|   | this time.                |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Each VISN will be         |   |   |    |    | A |               |
| e | assigned three FTE as of  |   |   |    |    | / |               |
| f | October 1, 1995 (VISN     |   |   |    |    | D |               |
| N | Director, Clinical        |   |   |    |    | / |               |
| o | Services Manager). Needs  |   |   |    |    | O |               |
| ] | for other FTE will be     |   |   |    |    | ] |               |
| { | developed and presented   |   |   |    |    | { |               |
| . | to the CNO for            |   |   |    |    | . |               |
| u | concurrence and will be   |   |   |    |    | u |               |
| n | made available from the   |   |   |    |    | n |               |
| d | FTE resource pool held by |   |   |    |    | d |               |
| e | the CNO.                  |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 4 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | finalize position         | V |   | 7  | 8/ |   |               |
| * | descriptions and          | I |   | /1 | 3/ |   |               |
| 2 | functional statements     | S |   | 7/ | 95 |   |               |
| . |                           | N |   | 95 |    |   |               |
| 4 |                           | A |   |    |    |   |               |
| . |                           | c |   |    |    |   |               |
| 1 |                           | t |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | v |   |    |    |   |               |
|   |                           | a |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | W |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | k |   |    |    |   |               |
|   |                           | G |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | u |   |    |    |   |               |
|   |                           | p |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | classify positions and    | H |   | 7  | 8/ |   |               |
| * | develop qualification     | u |   | /2 | 3/ |   |               |
| 2 | statements                | m |   | 0/ | 95 |   |               |
| . |                           | a |   | 95 |    |   |               |
| 4 |                           | n |   |    |    |   |               |
| . |                           | R |   |    |    |   |               |
| 2 |                           | e |   |    |    |   |               |
|   |                           | s |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | u |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | s |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 0 |   |    |    |   |               |
|   |                           | 5 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | identify strategies for   | V |   | 7  | 7  |   |               |
| * | recruitment process       | I |   | /2 | /2 |   |               |
| 2 |                           | S |   | 0/ | 8/ |   |               |
| . |                           | N |   | 95 | 95 |   |               |
| 4 |                           | A |   |    |    |   |               |
| . |                           | c |   |    |    |   |               |
| 3 |                           | t |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | v |   |    |    |   |               |
|   |                           | a |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | W |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | k |   |    |    |   |               |
|   |                           | G |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | u |   |    |    |   |               |
|   |                           | p |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | select preferred          | U |   | 7  | 7  |   |               |
| * | recruitment plan          | n |   | /2 | /2 |   |               |
| 2 |                           | d |   | 0/ | 8/ |   |               |
| . |                           | e |   | 95 | 95 |   |               |
| 4 |                           | r |   |    |    |   |               |
| . |                           | S |   |    |    |   |               |
| 4 |                           | e |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | a |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | y |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | H |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | a |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | h |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 0 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | advertise through         | H |   | 7  |    |   |               |
| * | Centralize Staffing       | u |   | /2 |    |   |               |
| 2 | System and pertinent      | m |   | 4/ |    |   |               |
| . | journals and publications | a |   | 95 |    |   |               |
| 4 |                           | n |   |    |    |   |               |
| . |                           | R |   |    |    |   |               |
| 5 |                           | e |   |    |    |   |               |
|   |                           | s |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | u |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | s |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 0 |   |    |    |   |               |
|   |                           | 5 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| * | ***"request local         | * |   | ** |    |   |               |
| * | examining authority from  | * |   | *8 |    |   |               |
| * | OPM" changed to "perform  | * |   | /8 |    |   |               |
| \ | job analysis panel by     | H |   | /9 |    |   |               |
| * | OPM" (revised action      | u |   | 5* |    |   |               |
| 2 | item)***                  | m |   | ** |    |   |               |
| . |                           | a |   |    |    |   |               |
| 4 |                           | n |   |    |    |   |               |
| . |                           | R |   |    |    |   |               |
| 6 |                           | e |   |    |    |   |               |
| * |                           | s |   |    |    |   |               |
| * |                           | o |   |    |    |   |               |
| * |                           | u |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | s |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 0 |   |    |    |   |               |
|   |                           | 5 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | establish voice mail      | M |   | 8/ |    |   |               |
| * | system to receive         | a |   | 4/ |    |   |               |
| 2 | inquiries about the       | n |   | 95 |    |   |               |
| . | vacancy announcement and  | a |   |    |    |   |               |
| 4 | application procedures    | g |   |    |    |   |               |
| . |                           | e |   |    |    |   |               |
| 7 |                           | m |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | S |   |    |    |   |               |
|   |                           | u |   |    |    |   |               |
|   |                           | p |   |    |    |   |               |
|   |                           | p |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 6 |   |    |    |   |               |
|   |                           | 3 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | rank and rate applicants  | M |   | 9/ |    |   |               |
| . | and develop best          | a |   | 8/ |    |   |               |
| 4 | qualified (BQ) list       | n |   | 95 |    |   |               |
| . |                           | a |   |    |    |   |               |
| 8 |                           | g |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | m |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | S |   |    |    |   |               |
|   |                           | u |   |    |    |   |               |
|   |                           | p |   |    |    |   |               |
|   |                           | p |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 6 |   |    |    |   |               |
|   |                           | 3 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | provide BQ list to VISN   | 1 |   |    |    |   |               |
| . | Directors                 | 0 |   |    |    |   |               |
| 4 |                           | / |   |    |    |   |               |
| . |                           | 1 |   |    |    |   |               |
| 9 |                           | / |   |    |    |   |               |
|   |                           | 9 |   |    |    |   |               |
|   |                           | 5 |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | make selections           | V |   | 10 |    |   |               |
| . |                           | I |   | /1 |    |   |               |
| 4 |                           | S |   | 5/ |    |   |               |
| . |                           | N |   | 95 |    |   |               |
| 1 |                           | D |   |    |    |   |               |
| 0 |                           | i |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | s |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| * | ***review and approve     | * |   |    |    |   |               |
| * | requests for additional   | * |   |    |    |   |               |
| * | FTE (beyond 3) for full   | * |   |    |    |   |               |
| 2 | VISN activation. (new     | C |   |    |    |   |               |
| . | action item)***           | h |   |    |    |   |               |
| 4 |                           | i |   |    |    |   |               |
| . |                           | e |   |    |    |   |               |
| 1 |                           | f |   |    |    |   |               |
| 1 |                           | N |   |    |    |   |               |
| * |                           | e |   |    |    |   |               |
| * |                           | t |   |    |    |   |               |
| * |                           | w |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | k |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 3 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | We received 26 comments   | A | C |    |    |   |               |
| . | regarding the VISN office |   | l |    |    |   |               |
| 4 | staffing. Three comments  | A | e |    |    |   |               |
|   | recommended a fourth      |   | r |    |    |   |               |
|   | position provide clerical |   | i |    |    |   |               |
|   | support (a secretary or   |   | c |    |    |   |               |
|   | office manager position)  |   | a |    |    |   |               |
|   | to the VISN office.       |   | l |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   | One comment recognized    |   | u |    |    |   |               |
|   | that the VISN Directors   |   | p |    |    |   |               |
|   | will have access to staff |   | p |    |    |   |               |
|   | within their entire VISN, |   | o |    |    |   |               |
|   | extracting staff from     |   | r |    |    |   |               |
|   | facilities within their   |   | t |    |    |   |               |
|   | VISN to perform needed    |   | w |    |    |   |               |
|   | functions. They           |   | i |    |    |   |               |
|   | recommended " (1) FTE for |   | l |    |    |   |               |
|   | only the VISN Director    |   | l |    |    |   |               |
|   | and allow this person to  |   | i |    |    |   |               |
|   | utilize facility staff at |   | n |    |    |   |               |
|   | his/her discretion? This  |   | d |    |    |   |               |
|   | would eliminate the need  |   | e |    |    |   |               |
|   | for the CNO to be         |   | e |    |    |   |               |
|   | involved with approving   |   | d |    |    |   |               |
|   | the hiring of the         |   | b |    |    |   |               |
|   | remaining (6 - 9) VISN    |   | e |    |    |   |               |
|   | positions."               |   | n |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | y |    |    |   |               |
|   |                           |   | , |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | w |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | v |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | , |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | V |    |    |   |               |
|   |                           |   | I |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | N |    |    |   |               |
|   |                           |   | D |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | t |    |    |   |               |
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|   |                           |   | u |    |    |   |               |
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|   |                           |   | d |    |    |   |               |
|   |                           |   | h |    |    |   |               |
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|   |                           |   | i |    |    |   |               |
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|   |                           |   | y |    |    |   |               |
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|   |                           |   | v |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | a |    |    |   |               |
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|   |                           |   | V |    |    |   |               |
|   |                           |   | I |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | N |    |    |   |               |
|   |                           |   | o |    |    |   |               |
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|   |                           |   | g |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | z |    |    |   |               |
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|   |                           |   | d |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | . |    |    |   |               |
|   |                           |   |   |    |    |   |               |
|   |                           |   | C |    |    |   |               |
|   |                           |   | N |    |    |   |               |
|   |                           |   | O |    |    |   |               |
|   |                           |   | w |    |    |   |               |
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|   |                           |   | n |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | t |    |    |   |               |
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|   |                           |   | z |    |    |   |               |
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|   |                           |   | o |    |    |   |               |
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|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | V |    |    |   |               |
|   |                           |   | I |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | N |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | Two comments disagreed    | D | A |    |    |   |               |
| . | that remaining VISN staff |   | s |    |    |   |               |
| 4 | requires the concurrence  |   | s |    |    |   |               |
|   | of the CNO.               |   | u |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | v |    |    |   |               |
|   |                           |   | i |    |    |   |               |
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|   |                           |   | I |    |    |   |               |
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|   |                           |   | D |    |    |   |               |
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|   |                           |   | a |    |    |   |               |
|   |                           |   | s |    |    |   |               |
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|   |                           |   | n |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | k |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | w |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | w |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | V |    |    |   |               |
|   |                           |   | I |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | N |    |    |   |               |
|   |                           |   | w |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | b |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "VISN staff will have     | A | \ |    |    |   |               |
| . | dual responsibility for   |   | ( |    |    |   |               |
| 4 | operations (day-to-day    |   | 1 |    |    |   |               |
|   | issues) and implementing  |   | \ |    |    |   |               |
|   | change. Operational       |   | ) |    |    |   |               |
|   | issues may burden the     |   | O |    |    |   |               |
|   | staff to such an extent   |   | r |    |    |   |               |
|   | that implementing change  |   | g |    |    |   |               |
|   | may become a secondary    |   | a |    |    |   |               |
|   | task. The change that is  |   | n |    |    |   |               |
|   | proposed is a major one.  |   | i |    |    |   |               |
|   | How are the staff of the  |   | z |    |    |   |               |
|   | VISN and the facilities   |   | a |    |    |   |               |
|   | to be educated and        |   | t |    |    |   |               |
|   | trained to make this      |   | i |    |    |   |               |
|   | transition? The tasks     |   | o |    |    |   |               |
|   | currently performed by    |   | n |    |    |   |               |
|   | the Regions are           |   | a |    |    |   |               |
|   | formidable. It would be   |   | l |    |    |   |               |
|   | advisable to              |   | n |    |    |   |               |
|   | recommend/suggest those   |   | e |    |    |   |               |
|   | tasks that could be       |   | e |    |    |   |               |
|   | performed by the          |   | d |    |    |   |               |
|   | facilities and those task |   | s |    |    |   |               |
|   | to be performed by the    |   | t |    |    |   |               |
|   | VISNs. The tasks to be    |   | o |    |    |   |               |
|   | performed by the VISNs    |   | b |    |    |   |               |
|   | could be grouped into     |   | e |    |    |   |               |
|   | organizational areas that |   | e |    |    |   |               |
|   | would logically lead to   |   | v |    |    |   |               |
|   | positions of              |   | a |    |    |   |               |
|   | responsibility, i.e.,     |   | l |    |    |   |               |
|   | staff."                   |   | u |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | b |    |    |   |               |
|   |                           |   | y |    |    |   |               |
|   |                           |   | V |    |    |   |               |
|   |                           |   | I |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | N |    |    |   |               |
|   |                           |   | D |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | . |    |    |   |               |
|   |                           |   |   |    |    |   |               |
|   |                           |   | \ |    |    |   |               |
|   |                           |   | ( |    |    |   |               |
|   |                           |   | 2 |    |    |   |               |
|   |                           |   | \ |    |    |   |               |
|   |                           |   | ) |    |    |   |               |
|   |                           |   | T |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
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|   |                           |   | u |    |    |   |               |
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|   |                           |   | l |    |    |   |               |
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|   |                           |   | m |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | j |    |    |   |               |
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|   |                           |   | r |    |    |   |               |
|   |                           |   | c |    |    |   |               |
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|   |                           |   | n |    |    |   |               |
|   |                           |   | c |    |    |   |               |
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|   |                           |   | n |    |    |   |               |
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|   |                           |   | f |    |    |   |               |
|   |                           |   | C |    |    |   |               |
|   |                           |   | N |    |    |   |               |
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|   |                           |   | D |    |    |   |               |
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|   |                           |   | r |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | . |    |    |   |               |
|   |                           |   |   |    |    |   |               |
|   |                           |   | \ |    |    |   |               |
|   |                           |   | ( |    |    |   |               |
|   |                           |   | 3 |    |    |   |               |
|   |                           |   | \ |    |    |   |               |
|   |                           |   | ) |    |    |   |               |
|   |                           |   | E |    |    |   |               |
|   |                           |   | x |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | t |    |    |   |               |
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|   |                           |   | s |    |    |   |               |
|   |                           |   | e |    |    |   |               |
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|   |                           |   | r |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | g |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | V |    |    |   |               |
|   |                           |   | I |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | N |    |    |   |               |
|   |                           |   | w |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | b |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | Six comments recommended  | \ | O |    |    |   |               |
| . | that there be a           | - | p |    |    |   |               |
| 4 | designated nursing        | - | p |    |    |   |               |
|   | presence at the VISN      |   | o |    |    |   |               |
|   | level or that we mandate  |   | r |    |    |   |               |
|   | that the Clinical         |   | t |    |    |   |               |
|   | Services Manager is a     |   | u |    |    |   |               |
|   | nurse.                    |   | n |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | y |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | x |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | g |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | y |    |    |   |               |
|   |                           |   | f |    |    |   |               |
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+---+---------------------------+---+---+----+----+---+---------------+
| 2 | One comment suggested     | \ | P |    |    |   |               |
| . | that the Clinical         | - | h |    |    |   |               |
| 4 | Services Manager should   | - | y |    |    |   |               |
|   | go to a physician "since  |   | s |    |    |   |               |
|   | the appointee should      |   | i |    |    |   |               |
|   | serve as advisor for all  |   | c |    |    |   |               |
|   | clinical programs and     |   | i |    |    |   |               |
|   | have oversight            |   | a |    |    |   |               |
|   | responsibility for        |   | n |    |    |   |               |
|   | contracted service        |   | s |    |    |   |               |
|   | providers (e.g.,          |   | h |    |    |   |               |
|   | University physicians     |   | a |    |    |   |               |
|   | contracted services)."    |   | v |    |    |   |               |
|   |                           |   | e |    |    |   |               |
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|   |                           |   | n |    |    |   |               |
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|   |                           |   | d |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | v |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | x |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
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|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | One comment recommended   | A | O |    |    |   |               |
| . | that the VISN include     |   | p |    |    |   |               |
| 4 | representation by a       |   | p |    |    |   |               |
|   | Physician, Nursing,       |   | o |    |    |   |               |
|   | Pharmacy and Social Work. |   | r |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | i |    |    |   |               |
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|   |                           |   | r |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | r |    |    |   |               |
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|   |                           |   | t |    |    |   |               |
|   |                           |   | . |    |    |   |               |
|   |                           |   | I |    |    |   |               |
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|   |                           |   | m |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | g |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | v |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | v |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | g |    |    |   |               |
|   |                           |   | k |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | y |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | k |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | One comment was concerned | A | V |    |    |   |               |
| . | with the crucial balance  |   | I |    |    |   |               |
| 4 | to outplace Region and    |   | S |    |    |   |               |
|   | Headquarters staff with   |   | N |    |    |   |               |
|   | the need to allow the     |   | D |    |    |   |               |
|   | VISN Directors the        |   | i |    |    |   |               |
|   | ability to select a few   |   | r |    |    |   |               |
|   | key staff who will work   |   | e |    |    |   |               |
|   | as a cohesive unit.       |   | c |    |    |   |               |
|   | "Employees without the    |   | t |    |    |   |               |
|   | appropriate knowledge and |   | o |    |    |   |               |
|   | skills will be            |   | r |    |    |   |               |
|   | detrimental to the VISNs  |   | s |    |    |   |               |
|   | mission."                 |   | w |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | V |    |    |   |               |
|   |                           |   | I |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | N |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | One comment questioned,   | A | N |    |    |   |               |
| . | "What impact does the     |   | u |    |    |   |               |
| 4 | restructuring have on     |   | r |    |    |   |               |
|   | Regional Nurse            |   | s |    |    |   |               |
|   | Professional Standards    |   | e |    |    |   |               |
|   | Board, i.e., areas of     |   | P |    |    |   |               |
|   | responsibility,           |   | r |    |    |   |               |
|   | mechanisms to process;    |   | o |    |    |   |               |
|   | who is accountable at the |   | f |    |    |   |               |
|   | VISN level, etc.? Please  |   | e |    |    |   |               |
|   | clarify. Product lines    |   | s |    |    |   |               |
|   | include various specific  |   | s |    |    |   |               |
|   | patient care programs.    |   | i |    |    |   |               |
|   | How will other patient    |   | o |    |    |   |               |
|   | care programs be affected |   | n |    |    |   |               |
|   | by the restructuring?     |   | a |    |    |   |               |
|   | Patient care is the focus |   | l |    |    |   |               |
|   | of restructuring and will |   | S |    |    |   |               |
|   | be affected either        |   | t |    |    |   |               |
|   | directly or indirectly by |   | a |    |    |   |               |
|   | each restructuring        |   | n |    |    |   |               |
|   | component and each        |   | d |    |    |   |               |
|   | decision made. Therefore, |   | a |    |    |   |               |
|   | a representative of       |   | r |    |    |   |               |
|   | nursing should be at the  |   | d |    |    |   |               |
|   | table; part of the group  |   | s |    |    |   |               |
|   | in the new structure."    |   | B |    |    |   |               |
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|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | One comment recommended   | A | V |    |    |   |               |
| . | that the CFO participate  |   | I |    |    |   |               |
| 4 | in selection of and       |   | S |    |    |   |               |
|   | concur with appointment   |   | N |    |    |   |               |
|   | of VISN Financial         |   | D |    |    |   |               |
|   | Managers to strengthen    |   | i |    |    |   |               |
|   | the relationships between |   | r |    |    |   |               |
|   | the CFO and VISNs. ("What |   | e |    |    |   |               |
|   | is the intended           |   | c |    |    |   |               |
|   | relationship between CFO  |   | t |    |    |   |               |
|   | and VISN CFOs?")          |   | o |    |    |   |               |
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+---+---------------------------+---+---+----+----+---+---------------+
| 2 | Two other specific        | A | \ |    |    |   |               |
| . | functions in the VISN     |   | ( |    |    |   |               |
| 4 | were recommended: (1)     |   | 1 |    |    |   |               |
|   | "Although strategic       |   | \ |    |    |   |               |
|   | planning is listed as a   |   | ) |    |    |   |               |
|   | core responsibility of    |   | T |    |    |   |               |
|   | VISNs, planning staff is  |   | h |    |    |   |               |
|   | not included as part of   |   | e |    |    |   |               |
|   | the core VISN staff." (2) |   | p |    |    |   |               |
|   | "Recommend a CIO function |   | l |    |    |   |               |
|   | at each VISN, either as a |   | a |    |    |   |               |
|   | full-time position or     |   | n |    |    |   |               |
|   | collateral duty of VAMC   |   | n |    |    |   |               |
|   | or VSSC employee.         |   | i |    |    |   |               |
|   | Responsibilities would    |   | n |    |    |   |               |
|   | include coordination of   |   | g |    |    |   |               |
|   | IRM activities at field   |   | f |    |    |   |               |
|   | facilities and            |   | u |    |    |   |               |
|   | informatics/database      |   | n |    |    |   |               |
|   | activities at VSSCs."     |   | c |    |    |   |               |
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+---+---------------------------+---+---+----+----+---+---------------+
| 2 | One comment questioned    | A | T |    |    |   |               |
| . | the announcement of the   |   | h |    |    |   |               |
| 4 | Clinical Services Manager | D | e |    |    |   |               |
|   | and Financial Manager     |   | b |    |    |   |               |
|   | positions prior to        |   | e |    |    |   |               |
|   | selection of the VISN     |   | n |    |    |   |               |
|   | Directors. "This will     |   | e |    |    |   |               |
|   | provide a pool of         |   | f |    |    |   |               |
|   | applicants for VISN       |   | i |    |    |   |               |
|   | Directors to selection    |   | t |    |    |   |               |
|   | from and expedite the     |   | o |    |    |   |               |
|   | process. While this       |   | f |    |    |   |               |
|   | approach will minimize    |   | h |    |    |   |               |
|   | delay in establishing key |   | a |    |    |   |               |
|   | positions in each VISN,   |   | v |    |    |   |               |
|   | it may also preclude some |   | i |    |    |   |               |
|   | people from applying for  |   | n |    |    |   |               |
|   | these positions since     |   | g |    |    |   |               |
|   | they will not know for    |   | t |    |    |   |               |
|   | whom they will be         |   | h |    |    |   |               |
|   | working."                 |   | e |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   | One comment questioned    |   | e |    |    |   |               |
|   | why the VISN Directors    |   | k |    |    |   |               |
|   | were not involved in the  |   | e |    |    |   |               |
|   | process of selecting      |   | y |    |    |   |               |
|   | Clinical Services and     |   | p |    |    |   |               |
|   | Financial Managers?       |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   | One comment suggested     |   | s |    |    |   |               |
|   | that expediting the       |   | o |    |    |   |               |
|   | recruitment and selection |   | n |    |    |   |               |
|   | processes for VISN        |   | s |    |    |   |               |
|   | Clinical Services and     |   | a |    |    |   |               |
|   | Financial Managers        |   | v |    |    |   |               |
|   | contradicts allowing VISN |   | a |    |    |   |               |
|   | Directors maximum         |   | i |    |    |   |               |
|   | flexibility in            |   | l |    |    |   |               |
|   | determining their         |   | a |    |    |   |               |
|   | specific organizational   |   | b |    |    |   |               |
|   | structures and staffing   |   | l |    |    |   |               |
|   | requirements.             |   | e |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | b |    |    |   |               |
|   |                           |   | l |    |    |   |               |
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|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | Three comments related to | \ | M |    |    |   |               |
| . | the requirements for the  | ( | a |    |    |   |               |
| 4 | Clinical Services         | 1 | y |    |    |   |               |
|   | Manager. (1) "Recommend   | \ | b |    |    |   |               |
|   | that education            | ) | e |    |    |   |               |
|   | requirements be more      | D | d |    |    |   |               |
|   | specific for VISN         |   | e |    |    |   |               |
|   | positions. Generally, a   | \ | s |    |    |   |               |
|   | Master's Degree would be  | ( | i |    |    |   |               |
|   | the minimum." (2) "It is  | 2 | r |    |    |   |               |
|   | very important that the   | \ | a |    |    |   |               |
|   | incumbent have knowledge  | ) | b |    |    |   |               |
|   | and skills that will      | A | l |    |    |   |               |
|   | promote the development   |   | e |    |    |   |               |
|   | and expansion of          | \ | b |    |    |   |               |
|   | community services and    | ( | u |    |    |   |               |
|   | resources needed to       | 3 | t |    |    |   |               |
|   | support VHA health care   | \ | c |    |    |   |               |
|   | objectives." (3) " The    | ) | a |    |    |   |               |
|   | position description      | A | n |    |    |   |               |
|   | limits this position to   |   | n |    |    |   |               |
|   | physicians or nurses.     |   | o |    |    |   |               |
|   | Given the responsibility  |   | t |    |    |   |               |
|   | of this position other    |   | b |    |    |   |               |
|   | clinical staff with the   |   | e |    |    |   |               |
|   | requisite experience and  |   | r |    |    |   |               |
|   | expertise should be       |   | e |    |    |   |               |
|   | afforded consideration    |   | q |    |    |   |               |
|   | for this critical         |   | u |    |    |   |               |
|   | community-interactive     |   | i |    |    |   |               |
|   | role."                    |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | . |    |    |   |               |
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|   |                           |   | n |    |    |   |               |
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|   |                           |   | a |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | k |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | q |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | Add additional action     |   |   |    |    |   |               |
|   | items as suggested above. |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | VISN Directors will       |   |   |    |    | A |               |
| e | select, once the          |   |   |    |    | / |               |
| f | organizational plan is    |   |   |    |    | D |               |
| N | approved by the CNO, all  |   |   |    |    | / |               |
| o | their staff.              |   |   |    |    | O |               |
| ] |                           |   |   |    |    | ] |               |
| { |                           |   |   |    |    | { |               |
| . |                           |   |   |    |    | . |               |
| u |                           |   |   |    |    | u |               |
| n |                           |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 5 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | recruit and select VISN   | V |   | 1/ |    |   |               |
| . | staff                     | I |   | 1/ |    |   |               |
| 5 |                           | S |   | 96 |    |   |               |
| . |                           | N |   |    |    |   |               |
| 1 |                           | D |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | s |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | No change recommended.    |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Utilize those individuals |   |   |    |    | A |               |
| e | currently in "Operations" |   |   |    |    | / |               |
| f | to provide primary        |   |   |    |    | D |               |
| N | assistance on a           |   |   |    |    | / |               |
| o | time-limited basis to     |   |   |    |    | O |               |
| ] | achieve deactivation of   |   |   |    |    | ] |               |
| { | regional offices, conduct |   |   |    |    | { |               |
| . | analyses relating to the  |   |   |    |    | . |               |
| u | elimination or            |   |   |    |    | u |               |
| n | reassignment of current   |   |   |    |    | n |               |
| d | regional activities and   |   |   |    |    | d |               |
| e | provide support for       |   |   |    |    | e |               |
| r | outplacement of staff.    |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 6 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | assign Region staff to    | C |   | 1  |    |   |               |
| * | Chief Network Officer     | h |   | 0/ |    |   |               |
| 2 |                           | i |   | 1/ |    |   |               |
| . |                           | e |   | 95 |    |   |               |
| 6 |                           | f |   |    |    |   |               |
| . |                           | N |   |    |    |   |               |
| 1 |                           | e |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | w |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | k |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 3 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "The VISN Activation Plan | D | T |    |    |   |               |
| . | contains detailed         |   | h |    |    |   |               |
| 6 | recommendations for       |   | e |    |    |   |               |
|   | issuing press releases,   |   | p |    |    |   |               |
|   | resolving property        |   | l |    |    |   |               |
|   | management questions,     |   | a |    |    |   |               |
|   | renovating offices, and   |   | n |    |    |   |               |
|   | hiring senior staff.      |   | s |    |    |   |               |
|   | However, an orderly       |   | p |    |    |   |               |
|   | process for managing      |   | e |    |    |   |               |
|   | program duties during the |   | c |    |    |   |               |
|   | transition, and providing |   | i |    |    |   |               |
|   | administrative and        |   | f |    |    |   |               |
|   | financial support for     |   | i |    |    |   |               |
|   | those activities, is      |   | c |    |    |   |               |
|   | missing."                 |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | l |    |    |   |               |
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|   |                           |   | r |    |    |   |               |
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|   |                           |   | i |    |    |   |               |
|   |                           |   | t |    |    |   |               |
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|   |                           |   | n |    |    |   |               |
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|   |                           |   | a |    |    |   |               |
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|   |                           |   | e |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "Recommendation to        | \ | \ |    |    |   |               |
| . | utilize existing staff in | - | ( |    |    |   |               |
| 6 | 'Operations' \-- Existing | - | 1 |    |    |   |               |
|   | staff and their           |   | \ |    |    |   |               |
|   | corresponding functions   |   | ) |    |    |   |               |
|   | within the current        |   | T |    |    |   |               |
|   | 'Operations' structure    |   | h |    |    |   |               |
|   | include individuals       |   | e |    |    |   |               |
|   | assigned primary duties   |   | n |    |    |   |               |
|   | as the operations         |   | e |    |    |   |               |
|   | 'budget' person and       |   | e |    |    |   |               |
|   | operations 'planning'     |   | d |    |    |   |               |
|   | person. Under the new     |   | f |    |    |   |               |
|   | paradigm being introduced |   | o |    |    |   |               |
|   | by the *Vision for        |   | r |    |    |   |               |
|   | Change*, Headquarters     |   | c |    |    |   |               |
|   | program offices are being |   | o |    |    |   |               |
|   | challenged to redirect    |   | o |    |    |   |               |
|   | their thinking and        |   | p |    |    |   |               |
|   | actions toward a field    |   | e |    |    |   |               |
|   | customer orientation. The |   | r |    |    |   |               |
|   | new CNO organization      |   | a |    |    |   |               |
|   | should support this new   |   | t |    |    |   |               |
|   | orientation and rely      |   | i |    |    |   |               |
|   | directly upon the CFO for |   | o |    |    |   |               |
|   | budget support. This will |   | n |    |    |   |               |
|   | foster Headquarters team  |   | b |    |    |   |               |
|   | building and eliminate    |   | e |    |    |   |               |
|   | duplication of functions  |   | t |    |    |   |               |
|   | within Headquarters.      |   | w |    |    |   |               |
|   | Positions such as planner |   | e |    |    |   |               |
|   | and budget/resource       |   | e |    |    |   |               |
|   | manager are inappropriate |   | n |    |    |   |               |
|   | and duplicative within    |   | t |    |    |   |               |
|   | the new CNO               |   | h |    |    |   |               |
|   | organization."            |   | e |    |    |   |               |
|   |                           |   | V |    |    |   |               |
|   |                           |   | I |    |    |   |               |
|   |                           |   | S |    |    |   |               |
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|   |                           |   | d |    |    |   |               |
|   |                           |   | H |    |    |   |               |
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|   |                           |   | a |    |    |   |               |
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|   |                           |   | p |    |    |   |               |
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|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
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|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
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|   |                           |   | u |    |    |   |               |
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|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | No change recommended.    |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | As soon as deemed         |   |   |    |    | A |               |
| e | possible, appoint members |   |   |    |    | / |               |
| f | of the VISN Support Team  |   |   |    |    | D |               |
| N | in order to have them     |   |   |    |    | / |               |
| o | on-board to assist with   |   |   |    |    | O |               |
| ] | VISN activation and       |   |   |    |    | ] |               |
| { | provide immediate         |   |   |    |    | { |               |
| . | interface with the Office |   |   |    |    | . |               |
| u | of the Chief Network      |   |   |    |    | u |               |
| n | Officer. Team members     |   |   |    |    | n |               |
| d | will also be available to |   |   |    |    | d |               |
| e | assist newly appointed    |   |   |    |    | e |               |
| r | VISN Directors in their   |   |   |    |    | r |               |
| l | orientation, establishing |   |   |    |    | l |               |
| i | VISN offices and          |   |   |    |    | i |               |
| n | providing immediate       |   |   |    |    | n |               |
| e | support with other        |   |   |    |    | e |               |
| } | transition activities.    |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 7 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | designate routing         | P |   | 1  |    |   |               |
| * | symbols, T&L numbers,     | o |   | 0/ |    |   |               |
| 2 | etc.                      | l |   | 1/ |    |   |               |
| . |                           | i |   | 95 |    |   |               |
| 7 |                           | c |   |    |    |   |               |
| . |                           | y |   |    |    |   |               |
| 1 |                           | & |   |    |    |   |               |
|   |                           | P |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | a |   |    |    |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | n |   |    |    |   |               |
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|   |                           | g |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 0 |   |    |    |   |               |
|   |                           | 0 |   |    |    |   |               |
|   |                           | 5 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
|   |                           | a |   |    |    |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | d |   |    |    |   |               |
|   |                           | M |   |    |    |   |               |
|   |                           | g |   |    |    |   |               |
|   |                           | m |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | . |   |    |    |   |               |
|   |                           | S |   |    |    |   |               |
|   |                           | u |   |    |    |   |               |
|   |                           | p |   |    |    |   |               |
|   |                           | p |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 6 |   |    |    |   |               |
|   |                           | 3 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | orient VA facilities to   | C |   | 9/ |    |   |               |
| * | transition plan           | h |   | 8/ |    |   |               |
| 2 |                           | i |   | 95 |    |   |               |
| . |                           | e |   |    |    |   |               |
| 7 |                           | f |   |    |    |   |               |
| . |                           | N |   |    |    |   |               |
| 2 |                           | e |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | w |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | k |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 3 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | orientation with VISN     | C |   | 9/ |    |   |               |
| * | Directors and key staff   | h |   | 7/ |    |   |               |
| 2 |                           | i |   | 95 |    |   |               |
| . |                           | e |   |    |    |   |               |
| 7 |                           | f |   |    |    |   |               |
| . |                           | N |   |    |    |   |               |
| 3 |                           | e |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | w |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | k |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 3 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | establish regular         | C |   | 1  |    |   |               |
| * | conference calls between  | h |   | 0/ |    |   |               |
| 2 | Chief Network Officer     | i |   | 2/ |    |   |               |
| . |                           | e |   | 95 |    |   |               |
| 7 |                           | f |   |    |    |   |               |
| . |                           | N |   |    |    |   |               |
| 4 |                           | e |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | w |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | k |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 3 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | evaluate Region and       | C |   | 3  |    |   |               |
| . | decentralized             | h |   | /3 |    |   |               |
| 7 | Headquarters functions    | i |   | 1/ |    |   |               |
| . | and determine disposition | e |   | 95 |    |   |               |
| 5 |                           | f |   |    |    |   |               |
|   |                           | N |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | w |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | k |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 3 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | We received 30 comments   | A | A |    |    |   |               |
| . | regarding this            |   | f |    |    |   |               |
| 7 | recommendation. Most of   |   | t |    |    |   |               |
|   | the comments addressed    |   | e |    |    |   |               |
|   | how our VISN Support      |   | r |    |    |   |               |
|   | Staff model conflicted    |   | m |    |    |   |               |
|   | with that model suggested |   | e |    |    |   |               |
|   | by the Headquarters       |   | e |    |    |   |               |
|   | Restructuring Work Group. |   | t |    |    |   |               |
|   | Additional comments       |   | i |    |    |   |               |
|   | include: "Both appear to  |   | n |    |    |   |               |
|   | want to address the       |   | g |    |    |   |               |
|   | operations/ clinical      |   | w |    |    |   |               |
|   | schism which proved to be |   | i |    |    |   |               |
|   | enervating, at least to   |   | t |    |    |   |               |
|   | many clinical staff,      |   | h |    |    |   |               |
|   | following the last        |   | t |    |    |   |               |
|   | reorganization."; "The    |   | h |    |    |   |               |
|   | VISN support team concept |   | e |    |    |   |               |
|   | is sound but will only    |   | C |    |    |   |               |
|   | function well if the      |   | o |    |    |   |               |
|   | people are capable and    |   | o |    |    |   |               |
|   | understand that their     |   | r |    |    |   |               |
|   | mission is to support the |   | d |    |    |   |               |
|   | VISN offices."; "The      |   | i |    |    |   |               |
|   | success of this is        |   | n |    |    |   |               |
|   | dependent on the success  |   | a |    |    |   |               |
|   | of the implementation of  |   | t |    |    |   |               |
|   | a 'flat' rather than a    |   | i |    |    |   |               |
|   | hierarchical              |   | n |    |    |   |               |
|   | organization.";           |   | g |    |    |   |               |
|   | "Relationship between     |   | C |    |    |   |               |
|   | VISN and SHG offices, in  |   | o |    |    |   |               |
|   | terms of their            |   | m |    |    |   |               |
|   | roles/responsibilities    |   | m |    |    |   |               |
|   | with clinical programs,   |   | i |    |    |   |               |
|   | needs to be fully         |   | t |    |    |   |               |
|   | described."; "We have     |   | t |    |    |   |               |
|   | concern that this support |   | e |    |    |   |               |
|   | would not be responsive   |   | e |    |    |   |               |
|   | to the needs of the VISN  |   | , |    |    |   |               |
|   | but would continue the    |   | t |    |    |   |               |
|   | current hierarchy. This   |   | h |    |    |   |               |
|   | could easily lead the     |   | e |    |    |   |               |
|   | 'support' services to     |   | H |    |    |   |               |
|   | drive the efforts of the  |   | e |    |    |   |               |
|   | VISN rather than provide  |   | a |    |    |   |               |
|   | consultation and          |   | d |    |    |   |               |
|   | resource."; "If           |   | q |    |    |   |               |
|   | decisio                   |   | u |    |    |   |               |
|   | ns/responsibility/actions |   | a |    |    |   |               |
|   | are decentralized, VISNs  |   | r |    |    |   |               |
|   | would not need technical  |   | t |    |    |   |               |
|   | experts for advocacy in   |   | e |    |    |   |               |
|   | Headquarters, unless      |   | r |    |    |   |               |
|   | Headquarters plans to     |   | s |    |    |   |               |
|   | dictate to VISN           |   | R |    |    |   |               |
|   | directors."; "Expertise   |   | e |    |    |   |               |
|   | should be provided in as  |   | s |    |    |   |               |
|   | many diverse (and         |   | t |    |    |   |               |
|   | critically important)     |   | r |    |    |   |               |
|   | areas as possible (i.e.,  |   | u |    |    |   |               |
|   | have 11 distinct subject  |   | c |    |    |   |               |
|   | areas). Consider          |   | t |    |    |   |               |
|   | replacing redundant       |   | u |    |    |   |               |
|   | subject areas such as     |   | r |    |    |   |               |
|   | admin. and clinician with |   | i |    |    |   |               |
|   | Quality Assurance,        |   | n |    |    |   |               |
|   | 'Safety' and the          |   | g |    |    |   |               |
|   | Information Management    |   | W |    |    |   |               |
|   | since questions in these  |   | o |    |    |   |               |
|   | areas arise from time to  |   | r |    |    |   |               |
|   | time and this type of     |   | k |    |    |   |               |
|   | in-house expertise within |   | G |    |    |   |               |
|   | the Office of the CNO     |   | r |    |    |   |               |
|   | could be beneficial.";    |   | o |    |    |   |               |
|   | "Some reference to the    |   | u |    |    |   |               |
|   | desirability of research  |   | p |    |    |   |               |
|   | expertise on the VISN     |   | " |    |    |   |               |
|   | support team would be     |   | V |    |    |   |               |
|   | helpful."; "The VISN      |   | I |    |    |   |               |
|   | support team as described |   | S |    |    |   |               |
|   | here is a useful          |   | N |    |    |   |               |
|   | mechanism to advise the   |   | S |    |    |   |               |
|   | CNO and provide a primary |   | u |    |    |   |               |
|   | contact point for each    |   | p |    |    |   |               |
|   | VISN. The HQ group        |   | p |    |    |   |               |
|   | recommendation is a       |   | o |    |    |   |               |
|   | stronger mechanism for    |   | r |    |    |   |               |
|   | integrating across HQ     |   | t |    |    |   |               |
|   | product lines and         |   | T |    |    |   |               |
|   | disciplines and provides  |   | e |    |    |   |               |
|   | stronger contact in HQ    |   | a |    |    |   |               |
|   | for VISNs. The two ideas  |   | m |    |    |   |               |
|   | can he combined.";        |   | " |    |    |   |               |
|   | "Eliminate VISN Support   |   | m |    |    |   |               |
|   | Team. This is a valueless |   | o |    |    |   |               |
|   | layering and perpetuation |   | d |    |    |   |               |
|   | of present operation      |   | e |    |    |   |               |
|   | model. Adds to            |   | l |    |    |   |               |
|   | bureaucracy."; "The idea  |   | w |    |    |   |               |
|   | must be conveyed that the |   | a |    |    |   |               |
|   | VISNs, Headquarters and   |   | s |    |    |   |               |
|   | the individual facilities |   | a |    |    |   |               |
|   | are a team, each with     |   | c |    |    |   |               |
|   | responsibility and        |   | c |    |    |   |               |
|   | authority even if         |   | e |    |    |   |               |
|   | performing staff          |   | p |    |    |   |               |
|   | functions."; "One lesson  |   | t |    |    |   |               |
|   | learned from VA's         |   | e |    |    |   |               |
|   | involvement with National |   | d |    |    |   |               |
|   | Health Care Reform and    |   | . |    |    |   |               |
|   | VA's implementation of    |   |   |    |    |   |               |
|   | the proposed reform was   |   |   |    |    |   |               |
|   | that the intermeshing of  |   |   |    |    |   |               |
|   | the clinical manager's    |   |   |    |    |   |               |
|   | perspective resulted in   |   |   |    |    |   |               |
|   | recommendations that were |   |   |    |    |   |               |
|   | both patient-centered and |   |   |    |    |   |               |
|   | cost effective."; "I      |   |   |    |    |   |               |
|   | agree with the team       |   |   |    |    |   |               |
|   | approach concept,         |   |   |    |    |   |               |
|   | however, I support        |   |   |    |    |   |               |
|   | advertising the positions |   |   |    |    |   |               |
|   | together with competition |   |   |    |    |   |               |
|   | for membership on the     |   |   |    |    |   |               |
|   | teams (not reassignment   |   |   |    |    |   |               |
|   | of current Operations HSS |   |   |    |    |   |               |
|   | staff)."; and "Since EMPO |   |   |    |    |   |               |
|   | develops policy,          |   |   |    |    |   |               |
|   | implements programs,      |   |   |    |    |   |               |
|   | maintains and coordinates |   |   |    |    |   |               |
|   | strategic and operational |   |   |    |    |   |               |
|   | emergency (or             |   |   |    |    |   |               |
|   | contingency) planning at  |   |   |    |    |   |               |
|   | national, network, and    |   |   |    |    |   |               |
|   | local levels for VHA and  |   |   |    |    |   |               |
|   | VA, a close working and   |   |   |    |    |   |               |
|   | coordinating mechanism    |   |   |    |    |   |               |
|   | between designated EMPO   |   |   |    |    |   |               |
|   | Headquarters staff and    |   |   |    |    |   |               |
|   | VISN Support Team must    |   |   |    |    |   |               |
|   | exist."                   |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | edit the document to      | H |   | 8  |    |   |               |
|   | reflect the VISN Support  | Q |   | /2 |    |   |               |
|   | team as recommended in    | R |   | 9/ |    |   |               |
|   | the Headquarters          | e |   | 95 |    |   |               |
|   | Restructuring Work Group  | s |   |    |    |   |               |
|   | Report (Five teams, each  | t |   |    |    |   |               |
|   | composed of 12-14         | r |   |    |    |   |               |
|   | members; each team will   | u |   |    |    |   |               |
|   | support one or more       | c |   |    |    |   |               |
|   | VISNs).                   | t |   |    |    |   |               |
|   |                           | u |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | g |   |    |    |   |               |
|   |                           | G |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | u |   |    |    |   |               |
|   |                           | p |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Since the primary purpose |   |   |    |    | A |               |
| e | of service centers is to  |   |   |    |    | / |               |
| f | support VISNs, they       |   |   |    |    | D |               |
| N | should be formally titled |   |   |    |    | / |               |
| o | "VISN Support Service     |   |   |    |    | O |               |
| ] | Centers (VSSC)".          |   |   |    |    | ] |               |
| { |                           |   |   |    |    | { |               |
| . |                           |   |   |    |    | . |               |
| u |                           |   |   |    |    | u |               |
| n |                           |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 8 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | No change needed.         |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Establish four VSSCs at   |   |   |    |    | A |               |
| e | existing region           |   |   |    |    | / |               |
| f | locations.                |   |   |    |    | D |               |
| N |                           |   |   |    |    | / |               |
| o |                           |   |   |    |    | O |               |
| ] |                           |   |   |    |    | ] |               |
| { |                           |   |   |    |    | { |               |
| . |                           |   |   |    |    | . |               |
| u |                           |   |   |    |    | u |               |
| n |                           |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 9 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | Of the seven comments     | \ | T |    |    |   |               |
| . | received on the VSSCs,    | - | h |    |    |   |               |
| 7 | all supported the         | - | e |    |    |   |               |
|   | elimination or reduction  |   | i |    |    |   |               |
|   | of the VSSCs. Specific    |   | s |    |    |   |               |
|   | concerns include the      |   | s |    |    |   |               |
|   | following: "While the     |   | u |    |    |   |               |
|   | report initially argues   |   | e |    |    |   |               |
|   | for not replicating the   |   | s |    |    |   |               |
|   | services now provided by  |   | o |    |    |   |               |
|   | the Regional offices, the |   | f |    |    |   |               |
|   | regionally located        |   | S |    |    |   |               |
|   | support centers will      |   | S |    |    |   |               |
|   | result in this undesired  |   | C |    |    |   |               |
|   | outcome. I predict that   |   | s |    |    |   |               |
|   | Quality, Safety,          |   | c |    |    |   |               |
|   | Construction, Risk        |   | o |    |    |   |               |
|   | Management and other      |   | n |    |    |   |               |
|   | staff who currently       |   | t |    |    |   |               |
|   | provide oversight than    |   | i |    |    |   |               |
|   | service will continue     |   | n |    |    |   |               |
|   | doing the same jobs under |   | u |    |    |   |               |
|   | new titles."; "Eliminate  |   | e |    |    |   |               |
|   | VISN support centers.     |   | s |    |    |   |               |
|   | This is a valueless       |   | t |    |    |   |               |
|   | layering and perpetuation |   | o |    |    |   |               |
|   | of present operation      |   | n |    |    |   |               |
|   | model. Adds to            |   | e |    |    |   |               |
|   | bureaucracy."; "Although  |   | e |    |    |   |               |
|   | for a few months VSSCs    |   | d |    |    |   |               |
|   | could be supportive of    |   | d |    |    |   |               |
|   | routine business during   |   | i |    |    |   |               |
|   | transition, many          |   | s |    |    |   |               |
|   | functions should be       |   | c |    |    |   |               |
|   | transferred to the VISN   |   | u |    |    |   |               |
|   | or be field based."; "The |   | s |    |    |   |               |
|   | proposed Board of         |   | s |    |    |   |               |
|   | Directors for the various |   | i |    |    |   |               |
|   | VISN Support Service      |   | o |    |    |   |               |
|   | Centers (VSSCs) seem to   |   | n |    |    |   |               |
|   | mirror the existing       |   | a |    |    |   |               |
|   | Regions."; "I am also     |   | n |    |    |   |               |
|   | concerned that the VISN   |   | d |    |    |   |               |
|   | offices housing these     |   | r |    |    |   |               |
|   | VSSCs will somehow take   |   | e |    |    |   |               |
|   | on a greater aura of      |   | f |    |    |   |               |
|   | importance that VISN      |   | i |    |    |   |               |
|   | offices with no special   |   | n |    |    |   |               |
|   | emphasis programs. I      |   | e |    |    |   |               |
|   | recommend that all VSSC   |   | m |    |    |   |               |
|   | activities be             |   | e |    |    |   |               |
|   | consolidated in a central |   | n |    |    |   |               |
|   | location in the country,  |   | t |    |    |   |               |
|   | geographically separate   |   | . |    |    |   |               |
|   | from any VISN office.";   |   | T |    |    |   |               |
|   | "With a limited staff, it |   | h |    |    |   |               |
|   | will be very difficult    |   | e |    |    |   |               |
|   | for a VSSC to adequately  |   | V |    |    |   |               |
|   | provide the highly        |   | i |    |    |   |               |
|   | specialized expert        |   | s |    |    |   |               |
|   | technical and             |   | i |    |    |   |               |
|   | consultative services in  |   | o |    |    |   |               |
|   | addition to the required  |   | n |    |    |   |               |
|   | data development,         |   | F |    |    |   |               |
|   | analysis and              |   | o |    |    |   |               |
|   | consolidation             |   | r |    |    |   |               |
|   | functions."; "I see the   |   | C |    |    |   |               |
|   | need for at least 2       |   | h |    |    |   |               |
|   | VSSCs: financial and      |   | a |    |    |   |               |
|   | education. All the rest   |   | n |    |    |   |               |
|   | can be done at the VISN   |   | g |    |    |   |               |
|   | level."                   |   | e |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | a |    |    |   |               |
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|   |                           |   | C |    |    |   |               |
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|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "Under paragraph titled   | A | R |    |    |   |               |
| . | [C                        |   | o |    |    |   |               |
| 9 | onsultation]{.underline}, |   | l |    |    |   |               |
|   | examples of services that |   | e |    |    |   |               |
|   | might be included as VSSC |   | s |    |    |   |               |
|   | functions include risk    |   | w |    |    |   |               |
|   | management and quality    |   | i |    |    |   |               |
|   | assurance. Many of the    |   | l |    |    |   |               |
|   | traditional quality       |   | l |    |    |   |               |
|   | assurance functions are   |   | b |    |    |   |               |
|   | already transitioning     |   | e |    |    |   |               |
|   | towards organization      |   | d |    |    |   |               |
|   | performance and it might  |   | e |    |    |   |               |
|   | be worth while            |   | t |    |    |   |               |
|   | incorporating many of the |   | e |    |    |   |               |
|   | current functions into    |   | r |    |    |   |               |
|   | planning and performance. |   | m |    |    |   |               |
|   | This is true for risk     |   | i |    |    |   |               |
|   | management as well        |   | n |    |    |   |               |
|   | although to a lesser      |   | e |    |    |   |               |
|   | extent. However, there is |   | d |    |    |   |               |
|   | probably a continued need |   | d |    |    |   |               |
|   | for some kind of JCAHO    |   | u |    |    |   |               |
|   | accreditation consultants |   | r |    |    |   |               |
|   | and these roles might     |   | i |    |    |   |               |
|   | well be suited to VSSCs.  |   | n |    |    |   |               |
|   | I think it fairly         |   | g |    |    |   |               |
|   | important to not separate |   | t |    |    |   |               |
|   | quality assurance         |   | h |    |    |   |               |
|   | functions from planning   |   | e |    |    |   |               |
|   | and performance. That     |   | t |    |    |   |               |
|   | almost invites            |   | r |    |    |   |               |
|   | duplication of efforts."  |   | a |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "I question the need for  | \ | ( |    |    |   |               |
| . | 4 VSSCs. I support the    | - | s |    |    |   |               |
| 9 | VISN directors with small | - | e |    |    |   |               |
|   | staffs, and cross         |   | e |    |    |   |               |
|   | functional work groups    |   | a |    |    |   |               |
|   | providing information,    |   | b |    |    |   |               |
|   | roll-ups and so on. I am  |   | o |    |    |   |               |
|   | making the assertion that |   | v |    |    |   |               |
|   | we attain a high level of |   | e |    |    |   |               |
|   | data base integration,    |   | c |    |    |   |               |
|   | and advance computer      |   | o |    |    |   |               |
|   | programming and platforms |   | m |    |    |   |               |
|   | in order to perform these |   | m |    |    |   |               |
|   | functions."               |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | ) |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | No change is recommended  |   |   |    |    |   |               |
|   | at this time.             |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Adopt VSSC core functions |   |   |    |    | A |               |
| e | as consultation and data  |   |   |    |    | / |               |
| f | development/analysis.     |   |   |    |    | D |               |
| N |                           |   |   |    |    | / |               |
| o |                           |   |   |    |    | O |               |
| ] |                           |   |   |    |    | ] |               |
| { |                           |   |   |    |    | { |               |
| . |                           |   |   |    |    | . |               |
| u |                           |   |   |    |    | u |               |
| n |                           |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
| 0 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | Of the five comments we   | D | R |    |    |   |               |
| . | received, two comments    |   | o |    |    |   |               |
| 1 | disagreed to maintain     |   | l |    |    |   |               |
| 0 | staff in the VSSC to      |   | e |    |    |   |               |
|   | provide high quality      |   | s |    |    |   |               |
|   | technical and             |   | a |    |    |   |               |
|   | consultative support      |   | n |    |    |   |               |
|   | functions. "We have that  |   | d |    |    |   |               |
|   | expertise within each     |   | s |    |    |   |               |
|   | facility." One comment    |   | t |    |    |   |               |
|   | questioned the need for   |   | a |    |    |   |               |
|   | VSSCs and the final       |   | f |    |    |   |               |
|   | comment recommended that  |   | f |    |    |   |               |
|   | the VSSCs "should prepare |   | i |    |    |   |               |
|   | reports, manage           |   | n |    |    |   |               |
|   | databases, and provide    |   | g |    |    |   |               |
|   | technical expertise in    |   | o |    |    |   |               |
|   | accessing VHA databases.  |   | f |    |    |   |               |
|   | Recommend that region     |   | t |    |    |   |               |
|   | staff who currently       |   | h |    |    |   |               |
|   | perform these functions   |   | e |    |    |   |               |
|   | be carried to the VSSCs." |   | V |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | C |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | w |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | b |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | g |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | It is suggested that all  |   |   |    |    |   |               |
|   | VSSC recommendations be   |   |   |    |    |   |               |
|   | combined.                 |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Align VSSCs               |   |   |    |    | A |               |
| e | organizationally under    |   |   |    |    | / |               |
| f | VSSC Board of Directors.  |   |   |    |    | D |               |
| N |                           |   |   |    |    | / |               |
| o |                           |   |   |    |    | O |               |
| ] |                           |   |   |    |    | ] |               |
| { |                           |   |   |    |    | { |               |
| . |                           |   |   |    |    | . |               |
| u |                           |   |   |    |    | u |               |
| n |                           |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | establish four (4) VSSC   | C |   | 10 |    |   |               |
| . | Board of Directors.       | h |   | /1 |    |   |               |
| 1 |                           | i |   | 5/ |    |   |               |
| 1 |                           | e |   | 95 |    |   |               |
| . |                           | f |   |    |    |   |               |
| 1 |                           | N |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | w |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | k |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 3 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "The report indicates     | D | T |    |    |   |               |
| . | VISNs and VSSCs are to be |   | h |    |    |   |               |
| 1 | configured to draw upon   |   | e |    |    |   |               |
| 1 | the expertise within a    |   | e |    |    |   |               |
|   | give geographic area to   |   | x |    |    |   |               |
|   | perform necessary tasks.  |   | a |    |    |   |               |
|   | No where is it implied or |   | c |    |    |   |               |
|   | stated that VISNs will    |   | t |    |    |   |               |
|   | draw upon staff in VSSCs  |   | c |    |    |   |               |
|   | outside their geographic  |   | o |    |    |   |               |
|   | area (i.e., VISN 22 will  |   | n |    |    |   |               |
|   | rely on service within    |   | f |    |    |   |               |
|   | VISN 22 and/or the VSSC   |   | i |    |    |   |               |
|   | in San Francisco; VISN 22 |   | g |    |    |   |               |
|   | should not have to call   |   | u |    |    |   |               |
|   | on staff in any other     |   | r |    |    |   |               |
|   | VISN or VSSC for          |   | a |    |    |   |               |
|   | assistance. Therefore, it |   | t |    |    |   |               |
|   | is critical that key      |   | i |    |    |   |               |
|   | functions area available  |   | o |    |    |   |               |
|   | throughout the country    |   | n |    |    |   |               |
|   | and located such that     |   | o |    |    |   |               |
|   | each geographic area has  |   | f |    |    |   |               |
|   | access to those critical  |   | t |    |    |   |               |
|   | functions (either via     |   | h |    |    |   |               |
|   | their local VSSC or       |   | e |    |    |   |               |
|   | within their respective   |   | V |    |    |   |               |
|   | VISN)."                   |   | S |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | C |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | b |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | . |    |    |   |               |
|   |                           |   | D |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | g |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | w |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | b |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | w |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | b |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | g |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | V |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | C |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | . |    |    |   |               |
|   |                           |   | T |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | w |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | b |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | y |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | v |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | d |    |    |   |               |
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|   |                           |   | a |    |    |   |               |
|   |                           |   | v |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | - |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | v |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | V |    |    |   |               |
|   |                           |   | I |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | N |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | Suggest combining all     |   |   |    |    |   |               |
|   | VSSC recommendations.     |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Determine exact staffing  |   |   |    |    | A |               |
| e | mix for the VSSCs after   |   |   |    |    | / |               |
| f | VSSC Boards of Directors  |   |   |    |    | D |               |
| N | are established, local    |   |   |    |    | / |               |
| o | needs are determined and  |   |   |    |    | O |               |
| ] | region functions are      |   |   |    |    | ] |               |
| { | assessed/revised.         |   |   |    |    | { |               |
| . |                           |   |   |    |    | . |               |
| u |                           |   |   |    |    | u |               |
| n |                           |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | begin recruitment of VSSC |   |   |    |    |   |               |
| . | staff                     |   |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "What is the intent that  | \ | L |    |    |   |               |
| . | the host VISN will        | - | o |    |    |   |               |
| 1 | provide administrative    | - | g |    |    |   |               |
| 2 | support to the VSSC?"     |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | y |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | Of the 10 comments        | \ | C |    |    |   |               |
| . | submitted, most were      | - | l |    |    |   |               |
| 1 | concerned with the        | - | e |    |    |   |               |
| 2 | limitation of staff at    |   | r |    |    |   |               |
|   | the VISN and VSSCs and    |   | i |    |    |   |               |
|   | the functions these       |   | c |    |    |   |               |
|   | offices will perform.     |   | a |    |    |   |               |
|   | "VISNs should have        |   | l |    |    |   |               |
|   | sufficient resources      |   | s |    |    |   |               |
|   | within their respective   |   | t |    |    |   |               |
|   | network and/or within     |   | a |    |    |   |               |
|   | their supporting VSSC to  |   | f |    |    |   |               |
|   | achieve VHA's goals."     |   | f |    |    |   |               |
|   | "Increasing staff within  |   | a |    |    |   |               |
|   | a VSSC must be a viable   |   | r |    |    |   |               |
|   | option. But rather than   |   | e |    |    |   |               |
|   | choosing an arbitrary     |   | i |    |    |   |               |
|   | figure of 7 to 10 staff   |   | n |    |    |   |               |
|   | at the VISN and 13 staff  |   | c |    |    |   |               |
|   | at each VSSC, place no    |   | l |    |    |   |               |
|   | restrictions on FTE. If   |   | u |    |    |   |               |
|   | FTE restrictions are      |   | d |    |    |   |               |
|   | necessary, place them on  |   | e |    |    |   |               |
|   | the networks (collection  |   | d |    |    |   |               |
|   | of facilities, VISN and   |   | i |    |    |   |               |
|   | pro-rated portion of the  |   | n |    |    |   |               |
|   | VSSC). Mandating FTE      |   | t |    |    |   |               |
|   | encumbers the VISN        |   | h |    |    |   |               |
|   | Directors." "A maximum    |   | e |    |    |   |               |
|   | number of FTE (52) should |   | 1 |    |    |   |               |
|   | not be prescribed as      |   | 3 |    |    |   |               |
|   | needs should dictate      |   | . |    |    |   |               |
|   | staffing." "The VISN      |   | T |    |    |   |               |
|   | Board of Directors should |   | h |    |    |   |               |
|   | have the flexibility to   |   | e |    |    |   |               |
|   | establish the numbers of  |   | n |    |    |   |               |
|   | FTEE per VSSC including   |   | a |    |    |   |               |
|   | the type positions and    |   | t |    |    |   |               |
|   | their selections." "I     |   | u |    |    |   |               |
|   | agree that VISN directors |   | r |    |    |   |               |
|   | should take part in the   |   | e |    |    |   |               |
|   | review and recommendation |   | o |    |    |   |               |
|   | of VSSCs." "Given the     |   | f |    |    |   |               |
|   | nature of tasks           |   | t |    |    |   |               |
|   | anticipated for the       |   | h |    |    |   |               |
|   | VSSCs, I think it         |   | e |    |    |   |               |
|   | unlikely all can perform  |   | t |    |    |   |               |
|   | the same function with    |   | a |    |    |   |               |
|   | only 13 staff." "Will     |   | s |    |    |   |               |
|   | VISN Directors be willing |   | k |    |    |   |               |
|   | to delegate the authority |   | s |    |    |   |               |
|   | to provide specific       |   | f |    |    |   |               |
|   | guidance to those at the  |   | o |    |    |   |               |
|   | VSSCs, or will we often   |   | r |    |    |   |               |
|   | grind to a halt while our |   | V |    |    |   |               |
|   | technical advisors 'check |   | S |    |    |   |               |
|   | with the VISN,' or will   |   | S |    |    |   |               |
|   | the opposite happen and   |   | C |    |    |   |               |
|   | we wait while the VISN    |   | s |    |    |   |               |
|   | Director's staff seeks    |   | h |    |    |   |               |
|   | technical guidance? I see |   | a |    |    |   |               |
|   | this slowdown as          |   | s |    |    |   |               |
|   | extremely likely in the   |   | y |    |    |   |               |
|   | construction area,        |   | e |    |    |   |               |
|   | especially if the VISN    |   | t |    |    |   |               |
|   | Director does not employ  |   | t |    |    |   |               |
|   | a construction manager."  |   | o |    |    |   |               |
|   | "I agree they should not  |   | b |    |    |   |               |
|   | be the 'ghost of region's |   | e |    |    |   |               |
|   | past.' Fire/Safety, IH,   |   | d |    |    |   |               |
|   | CM may be appropriate     |   | e |    |    |   |               |
|   | roles."                   |   | t |    |    |   |               |
|   |                           |   | e |    |    |   |               |
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|   |                           |   | r |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | y |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | Recommend combining all   |   |   |    |    |   |               |
|   | VSSC recommendations.     |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Create a structure for    |   |   |    |    | A |               |
| e | VSSCs that is flexible    |   |   |    |    | / |               |
| f | and enables the           |   |   |    |    | D |               |
| N | organization to evolve as |   |   |    |    | / |               |
| o | needs and requirements    |   |   |    |    | O |               |
| ] | change.                   |   |   |    |    | ] |               |
| { |                           |   |   |    |    | { |               |
| . |                           |   |   |    |    | . |               |
| u |                           |   |   |    |    | u |               |
| n |                           |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
| 3 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | Recommend combining all   |   |   |    |    |   |               |
|   | VSSC recommendations.     |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

<table style="width:100%;">
<colgroup>
<col style="width: 5%" />
<col style="width: 39%" />
<col style="width: 4%" />
<col style="width: 6%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 0%" />
<col style="width: 5%" />
<col style="width: 0%" />
<col style="width: 22%" />
</colgroup>
<tbody>
<tr class="odd">
<td><p><strong><u>RefNo</u></strong></p>
<p>2.14</p></td>
<td colspan="5"><p><strong><u>Recommendation:</u></strong></p>
<p>Do not include in VSSCs those functions/services that are primarily
designed to support VHA Headquarters (e.g. Boston Development Center,
Decision Support System).</p></td>
<td colspan="2"><strong><u>A/D/O</u></strong></td>
<td colspan="2"><strong><u>Remarks</u>-K<sup>2</sup></strong></td>
</tr>
<tr class="even">
<td></td>
<td><strong>Action Required</strong></td>
<td colspan="2"><strong>Action Office</strong></td>
<td><strong>Target Date</strong></td>
<td colspan="2"><strong>Actual Date</strong></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td>2.14.1</td>
<td>determine functions to be assigned to VSSCs</td>
<td colspan="2">VSSC Board of Directors</td>
<td>3/31/96</td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td><strong>Comments</strong></td>
<td><strong>A/D</strong></td>
<td colspan="3"><strong>Rationale</strong></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td><strong>Proposed Revision</strong></td>
<td colspan="2"><strong>Action Office</strong></td>
<td><strong>Target Date</strong></td>
<td colspan="2"><strong>Actual Date</strong></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td>Recommend combining all VSSC recommendations.</td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
</tr>
</tbody>
</table>

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Allow VISNs and           |   |   |    |    | A |               |
| e | facilities to shape the   |   |   |    |    | / |               |
| f | future of other           |   |   |    |    | D |               |
| N | consolidated programs     |   |   |    |    | / |               |
| o | (such as Consolidated     |   |   |    |    | O |               |
| ] | Mail Outpatient           |   |   |    |    | ] |               |
| { | Pharmacies, Central       |   |   |    |    | { |               |
| . | Dental Labs) based on     |   |   |    |    | . |               |
| u | their willingness to      |   |   |    |    | u |               |
| n | purchase services that    |   |   |    |    | n |               |
| d | are high quality and cost |   |   |    |    | d |               |
| e | efficient.                |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
| 5 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "It would be noted that   | A | \ |    |    |   |               |
| . | it requires significant   |   | - |    |    |   |               |
| 1 | resources, time, effort   |   | - |    |    |   |               |
| 5 | and dedication to         |   |   |    |    |   |               |
|   | establish an efficient    |   |   |    |    |   |               |
|   | and cost effective        |   |   |    |    |   |               |
|   | consolidated program. The |   |   |    |    |   |               |
|   | savings and cost          |   |   |    |    |   |               |
|   | efficiencies achieved by  |   |   |    |    |   |               |
|   | these programs should     |   |   |    |    |   |               |
|   | provide benefits on a     |   |   |    |    |   |               |
|   | long-term basis and in    |   |   |    |    |   |               |
|   | many cases, our system    |   |   |    |    |   |               |
|   | planning is completed on  |   |   |    |    |   |               |
|   | more of a short-term      |   |   |    |    |   |               |
|   | basis with the focus on   |   |   |    |    |   |               |
|   | immediate returns."       |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "In the establishment of  | A | T |    |    |   |               |
| . | VISN support services     | / | h |    |    |   |               |
| 1 | centers as a centralized  | D | e |    |    |   |               |
| 5 | group or as transitional  |   | d |    |    |   |               |
|   | offices, some service     |   | i |    |    |   |               |
|   | centers should be         |   | f |    |    |   |               |
|   | considered unique to      |   | f |    |    |   |               |
|   | clinical specialties. The |   | e |    |    |   |               |
|   | out-placed National VA    |   | r |    |    |   |               |
|   | Chaplain Center with its  |   | e |    |    |   |               |
|   | Chaplain School component |   | n |    |    |   |               |
|   | should be considered such |   | c |    |    |   |               |
|   | a resource."              |   | e |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | b |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | w |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | z |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | V |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | C |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | . |    |    |   |               |
|   |                           |   | T |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | y |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | w |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | b |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | v |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | No change recommended.    |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Colocate VISNs with VA    |   |   |    |    | A |               |
| e | Medical Centers in        |   |   |    |    | / |               |
| f | Boston, MA; Albany, NY;   |   |   |    |    | D |               |
| N | Bronx, NY; Pittsburgh     |   |   |    |    | / |               |
| o | (HD), PA; Bay Pines, FL;  |   |   |    |    | O |               |
| ] | Cleveland, OH; Chicago    |   |   |    |    | ] |               |
| { | (Hines), IL; Minneapolis, |   |   |    |    | { |               |
| . | MN; Portland, OR; and     |   |   |    |    | . |               |
| u | Long Beach, CA VISN       |   |   |    |    | u |               |
| n | sites.                    |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
| 6 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | prepare press releases to | P |   | 8/ |    |   |               |
| * | announce VISN sites       | u |   | 7/ |    |   |               |
| 2 |                           | b |   | 95 |    |   |               |
| . |                           | l |   |    |    |   |               |
| 1 |                           | i |   |    |    |   |               |
| 6 |                           | c |   |    |    |   |               |
| . |                           | A |   |    |    |   |               |
| 1 |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | a |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | s |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 8 |   |    |    |   |               |
|   |                           | 0 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | forward letter to host    | C |   | 8/ |    |   |               |
| * | facilities regarding      | h |   | 7/ |    |   |               |
| 2 | support for VISN          | i |   | 95 |    |   |               |
| . | activation activities     | e |   |    |    |   |               |
| 1 |                           | f |   |    |    |   |               |
| 6 |                           | N |   |    |    |   |               |
| . |                           | e |   |    |    |   |               |
| 2 |                           | t |   |    |    |   |               |
|   |                           | w |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | k |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 3 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | issue authorization       | C |   | 8/ |    |   |               |
| * | letter and TDA            | h |   | 7/ |    |   |               |
| 2 |                           | i |   | 95 |    |   |               |
| . |                           | e |   |    |    |   |               |
| 1 |                           | f |   |    |    |   |               |
| 6 |                           | N |   |    |    |   |               |
| . |                           | e |   |    |    |   |               |
| 3 |                           | t |   |    |    |   |               |
|   |                           | w |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | k |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 3 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | start A/E procurement;    | h |   | 8  |    |   |               |
| . | advertise for A/E; select | o |   | /3 |    |   |               |
| 1 | A/E; negotiate A/E cost;  | s |   | 1/ |    |   |               |
| 6 | award A/E design contract | t |   | 95 |    |   |               |
| . |                           | f |   |    |    |   |               |
| 4 |                           | a |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | y |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | complete design and       | h |   | 10 |    |   |               |
| . | contract documents        | o |   | /1 |    |   |               |
| 1 |                           | s |   | 5/ |    |   |               |
| 6 |                           | t |   | 95 |    |   |               |
| . |                           | f |   |    |    |   |               |
| 5 |                           | a |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | y |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | advertise for             | h |   | 10 |    |   |               |
| . | construction bids         | o |   | /2 |    |   |               |
| 1 |                           | s |   | 2/ |    |   |               |
| 6 |                           | t |   | 95 |    |   |               |
| . |                           | f |   |    |    |   |               |
| 6 |                           | a |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | y |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | open construction bids    | h |   | 1  |    |   |               |
| . |                           | o |   | 2/ |    |   |               |
| 1 |                           | s |   | 8/ |    |   |               |
| 6 |                           | t |   | 95 |    |   |               |
| . |                           | f |   |    |    |   |               |
| 7 |                           | a |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | y |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | award construction        | h |   | 12 |    |   |               |
| . | contract                  | o |   | /1 |    |   |               |
| 1 |                           | s |   | 5/ |    |   |               |
| 6 |                           | t |   | 95 |    |   |               |
| . |                           | f |   |    |    |   |               |
| 8 |                           | a |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | y |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | start construction        | V |   | 12 |    |   |               |
| . |                           | I |   | /3 |    |   |               |
| 1 |                           | S |   | 1/ |    |   |               |
| 6 |                           | N |   | 95 |    |   |               |
| . |                           | O |   |    |    |   |               |
| 9 |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | A |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | - |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | v |   |    |    |   |               |
|   |                           | a |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | T |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | a |   |    |    |   |               |
|   |                           | m |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | complete construction;    | h |   | 3/ |    |   |               |
| . | occupy VISN office        | o |   | 3/ |    |   |               |
| 1 |                           | s |   | 96 |    |   |               |
| 6 |                           | t |   |    |    |   |               |
| . |                           | f |   |    |    |   |               |
| 1 |                           | a |   |    |    |   |               |
| 0 |                           | c |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | y |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "The plans to establish   | D | T |    |    |   |               |
| . | office space prior to     |   | h |    |    |   |               |
| 1 | selection of VISN         |   | e |    |    |   |               |
| 6 | Directors is              |   | l |    |    |   |               |
|   | understandable due to the |   | o |    |    |   |               |
|   | lead time necessary to    |   | g |    |    |   |               |
|   | obtain such space.        |   | i |    |    |   |               |
|   | However, in some          |   | s |    |    |   |               |
|   | instances new leased      |   | t |    |    |   |               |
|   | space will be identified  |   | i |    |    |   |               |
|   | in a community before the |   | c |    |    |   |               |
|   | VISN Director is able to  |   | a |    |    |   |               |
|   | have any input into the   |   | l |    |    |   |               |
|   | process. While the VISN   |   | r |    |    |   |               |
|   | Directors will not have   |   | e |    |    |   |               |
|   | any choice regarding the  |   | q |    |    |   |               |
|   | city in which the VISN    |   | u |    |    |   |               |
|   | office is to be located,  |   | i |    |    |   |               |
|   | it would be nice if the   |   | r |    |    |   |               |
|   | VISN Director could have  |   | e |    |    |   |               |
|   | some control over the     |   | m |    |    |   |               |
|   | exact location of the     |   | e |    |    |   |               |
|   | office within the         |   | n |    |    |   |               |
|   | selected community. If    |   | t |    |    |   |               |
|   | this cannot be done, then |   | s |    |    |   |               |
|   | factors such as proximity |   | f |    |    |   |               |
|   | to the airport, community |   | o |    |    |   |               |
|   | distances, and proximity  |   | r |    |    |   |               |
|   | to those with whom the    |   | e |    |    |   |               |
|   | VISN staff will be doing  |   | s |    |    |   |               |
|   | business should be        |   | t |    |    |   |               |
|   | carefully considered when |   | a |    |    |   |               |
|   | selecting the site."      |   | b |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | g |    |    |   |               |
|   |                           |   | V |    |    |   |               |
|   |                           |   | I |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | N |    |    |   |               |
|   |                           |   | O |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | q |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | b |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | t |    |    |   |               |
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|   |                           |   | e |    |    |   |               |
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|   |                           |   | r |    |    |   |               |
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|   |                           |   | n |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | s |    |    |   |               |
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|   |                           |   | o |    |    |   |               |
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|   |                           |   | e |    |    |   |               |
|   |                           |   | . |    |    |   |               |
|   |                           |   | T |    |    |   |               |
|   |                           |   | h |    |    |   |               |
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|   |                           |   | r |    |    |   |               |
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|   |                           |   | e |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | b |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "The reason site          | A | T |    |    |   |               |
| . | selection information is  |   | h |    |    |   |               |
| 1 | not included in this      |   | e |    |    |   |               |
| 6 | report is unclear, as the |   | s |    |    |   |               |
|   | report itself is only a   |   | i |    |    |   |               |
|   | draft report. Comments on |   | t |    |    |   |               |
|   | recommended sites may be  |   | e |    |    |   |               |
|   | useful during the         |   | s |    |    |   |               |
|   | approval process."        |   | e |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | w |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | R |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | q |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | g |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | v |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "VISN offices need to be  | A | T |    |    |   |               |
| . | located centrally for     |   | h |    |    |   |               |
| 1 | easy access."             |   | i |    |    |   |               |
| 6 |                           |   | s |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | b |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Colocate VISNs with other |   |   |    |    | A |               |
| e | existing VA functions in  |   |   |    |    | / |               |
| f | Durham, NC; Nashville,    |   |   |    |    | D |               |
| N | TN; Kansas City, OH; and  |   |   |    |    | / |               |
| o | Phoenix, AZ VISN sites    |   |   |    |    | O |               |
| ] | utilizing the amended     |   |   |    |    | ] |               |
| { | lease process.            |   |   |    |    | { |               |
| . |                           |   |   |    |    | . |               |
| u |                           |   |   |    |    | u |               |
| n |                           |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
| 7 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| * | ***prepare reimbursable   |   |   |    |    |   |               |
| * | work authorization to GSA |   |   |    |    |   |               |
| * | for renovating space, if  |   |   |    |    |   |               |
| 2 | necessary (new action     |   |   |    |    |   |               |
| . | item)***                  |   |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
| 7 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
| * |                           |   |   |    |    |   |               |
| * |                           |   |   |    |    |   |               |
| * |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| * | ***notify GSA regarding   |   |   |    |    |   |               |
| * | leasing action and agree  |   |   |    |    |   |               |
| * | to additional renovation  |   |   |    |    |   |               |
| 2 | costs, if necessary (new  |   |   |    |    |   |               |
| . | action item***            |   |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
| 7 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| * |                           |   |   |    |    |   |               |
| * |                           |   |   |    |    |   |               |
| * |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Establish new leases for  |   |   |    |    | A |               |
| e | VISNs in Atlanta, GA;     |   |   |    |    | / |               |
| f | Omaha, NE; and Denver     |   |   |    |    | D |               |
| N | (Fitzsimons), CO          |   |   |    |    | / |               |
| o | utilizing expedited lease |   |   |    |    | O |               |
| ] | authority.                |   |   |    |    | ] |               |
| { |                           |   |   |    |    | { |               |
| . |                           |   |   |    |    | . |               |
| u |                           |   |   |    |    | u |               |
| n |                           |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| \ |                           |   |   |    |    |   |               |
| * |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
| 8 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | review bid proposal(s)    | h |   | 9/ |    |   |               |
| * | and determine most        | o |   | 8/ |    |   |               |
| 2 | advantageous to VA        | s |   | 95 |    |   |               |
| . |                           | t |   |    |    |   |               |
| 1 |                           | f |   |    |    |   |               |
| 8 |                           | a |   |    |    |   |               |
| . |                           | c |   |    |    |   |               |
| 1 |                           | i |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | y |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | submit best bid to        | h |   | 9/ |    |   |               |
| * | professional appraiser;   | o |   | 8/ |    |   |               |
| 2 | complete GSA form 1241E   | s |   | 95 |    |   |               |
| . |                           | t |   |    |    |   |               |
| 1 |                           | f |   |    |    |   |               |
| 8 |                           | a |   |    |    |   |               |
| . |                           | c |   |    |    |   |               |
| 2 |                           | i |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | y |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | submit bid for legal      | h |   | 9/ |    |   |               |
| * | review to District        | o |   | 8/ |    |   |               |
| 2 | Counsel                   | s |   | 95 |    |   |               |
| . |                           | t |   |    |    |   |               |
| 1 |                           | f |   |    |    |   |               |
| 8 |                           | a |   |    |    |   |               |
| . |                           | c |   |    |    |   |               |
| 3 |                           | i |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | y |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | receive professional      | h |   | 9  |    |   |               |
| * | appraisal and legal       | o |   | /1 |    |   |               |
| 2 | review; execute lease     | s |   | 4/ |    |   |               |
| . |                           | t |   | 95 |    |   |               |
| 1 |                           | f |   |    |    |   |               |
| 8 |                           | a |   |    |    |   |               |
| . |                           | c |   |    |    |   |               |
| 4 |                           | i |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | y |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | lessor work with VA to    | h |   | 10 |    |   |               |
| . | prepare build-out space   | o |   | /1 |    |   |               |
| 1 |                           | s |   | 6/ |    |   |               |
| 8 |                           | t |   | 95 |    |   |               |
| . |                           | f |   |    |    |   |               |
| 5 |                           | a |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | y |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | inspect space for         | h |   | 10 |    |   |               |
| . | suitability               | o |   | /1 |    |   |               |
| 1 |                           | s |   | 7/ |    |   |               |
| 8 |                           | t |   | 95 |    |   |               |
| . |                           | f |   |    |    |   |               |
| 6 |                           | a |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | y |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | occupy space              | h |   | 10 |    |   |               |
| . |                           | o |   | /2 |    |   |               |
| 1 |                           | s |   | 4/ |    |   |               |
| 8 |                           | t |   | 95 |    |   |               |
| . |                           | f |   |    |    |   |               |
| 7 |                           | a |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | y |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | Three comments were       | A | E |    |    |   |               |
| . | concerned that the new    |   | x |    |    |   |               |
| 1 | leases will require       | A | p |    |    |   |               |
| 8 | expedited lease           |   | e |    |    |   |               |
|   | authority. "The Action    | A | d |    |    |   |               |
|   | Plan should make it clear |   | i |    |    |   |               |
|   | that local funding for    |   | t |    |    |   |               |
|   | all lease costs must be   |   | e |    |    |   |               |
|   | available at the host     |   | d |    |    |   |               |
|   | facility, or the leased   |   | l |    |    |   |               |
|   | space cannot be procured  |   | e |    |    |   |               |
|   | locally. In addition, the |   | a |    |    |   |               |
|   | space must be under       |   | s |    |    |   |               |
|   | 10,000 net usable (now    |   | e |    |    |   |               |
|   | 'occupiable') square      |   | w |    |    |   |               |
|   | feet, and cost no more    |   | i |    |    |   |               |
|   | than \$300,000 annually,  |   | l |    |    |   |               |
|   | or VA Central Office must |   | l |    |    |   |               |
|   | procure the space, unless |   | b |    |    |   |               |
|   | VACO specifically         |   | e |    |    |   |               |
|   | delegates authority for   |   | u |    |    |   |               |
|   | that lease to the host    |   | s |    |    |   |               |
|   | facility."                |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   | "With respect to leasing  |   | w |    |    |   |               |
|   | VISN property, the use of |   | i |    |    |   |               |
|   | expedited leasing         |   | t |    |    |   |               |
|   | procedures may not be     |   | h |    |    |   |               |
|   | appropriate for some of   |   | i |    |    |   |               |
|   | the VISN leases because   |   | n |    |    |   |               |
|   | the build-out required    |   | t |    |    |   |               |
|   | may be too extensive.     |   | h |    |    |   |               |
|   | Therefore, reference to   |   | e |    |    |   |               |
|   | standard negotiations     |   | l |    |    |   |               |
|   | procedures should be made |   | i |    |    |   |               |
|   | in the Action Plan."      |   | m |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   | "The Action Plan for      |   | t |    |    |   |               |
|   | leasing should be         |   | s |    |    |   |               |
|   | consistent with Directive |   | o |    |    |   |               |
|   | 10-94-057. Therefore,     |   | f |    |    |   |               |
|   | insert the statement that |   | t |    |    |   |               |
|   | a copy of the executed    |   | h |    |    |   |               |
|   | lease and supporting      |   | e |    |    |   |               |
|   | documentation will be     |   | e |    |    |   |               |
|   | forwarded to the          |   | x |    |    |   |               |
|   | Director, Real Property   |   | p |    |    |   |               |
|   | Management Service (084)  |   | e |    |    |   |               |
|   | for inventory control     |   | d |    |    |   |               |
|   | purposes."                |   | i |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
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|   |                           |   | t |    |    |   |               |
|   |                           |   | y |    |    |   |               |
|   |                           |   | . |    |    |   |               |
|   |                           |   |   |    |    |   |               |
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|   |                           |   | t |    |    |   |               |
|   |                           |   | b |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | b |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "Add a new box for the    | A |   |    |    |   |               |
| . | following action:         |   |   |    |    |   |               |
| 1 | 'conduct a site visit and |   |   |    |    |   |               |
| 8 | negotiate unique          |   |   |    |    |   |               |
|   | requirements.' The box    |   |   |    |    |   |               |
|   | should be inserted        |   |   |    |    |   |               |
|   | between 'conduct market   |   |   |    |    |   |               |
|   | survey of the proposed    |   |   |    |    |   |               |
|   | site,' and 'distribute    |   |   |    |    |   |               |
|   | short form \... bid       |   |   |    |    |   |               |
|   | proposals.' "             |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "The Action Plan should   | A |   |    |    |   |               |
| . | make clear that the       |   |   |    |    |   |               |
| 1 | Offices of the General    |   |   |    |    |   |               |
| 8 | Counsel and Acquisition   |   |   |    |    |   |               |
|   | and Materiel Management   |   |   |    |    |   |               |
|   | should be consulted and   |   |   |    |    |   |               |
|   | participate in any        |   |   |    |    |   |               |
|   | reviews and approvals     |   |   |    |    |   |               |
|   | routinely necessary. This |   |   |    |    |   |               |
|   | is of particular          |   |   |    |    |   |               |
|   | importance because of the |   |   |    |    |   |               |
|   | possible need for certain |   |   |    |    |   |               |
|   | waivers for the expedited |   |   |    |    |   |               |
|   | procedure envisioned."    |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "Contracting issues       | A | T |    |    |   |               |
| . | (including leasing) must  |   | h |    |    |   |               |
| 1 | be dealt with as soon as  |   | e |    |    |   |               |
| 8 | possible in order to make |   | V |    |    |   |               |
|   | the stated transitions in |   | I |    |    |   |               |
|   | a timely fashion. The     |   | S |    |    |   |               |
|   | Office of General Counsel |   | N |    |    |   |               |
|   | and appropriate           |   | A |    |    |   |               |
|   | contracting officials     |   | c |    |    |   |               |
|   | should be included in any |   | t |    |    |   |               |
|   | future working groups to  |   | i |    |    |   |               |
|   | help identify and address |   | v |    |    |   |               |
|   | contracting issues at the |   | a |    |    |   |               |
|   | earliest possible time."  |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | T |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | , |    |    |   |               |
|   |                           |   | w |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | s |    |    |   |               |
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|   |                           |   | r |    |    |   |               |
|   |                           |   | d |    |    |   |               |
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|   |                           |   | r |    |    |   |               |
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|   |                           |   | d |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
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|   |                           |   | s |    |    |   |               |
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|   |                           |   | o |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | c |    |    |   |               |
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|   |                           |   | s |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Establish VISNs in        |   |   |    |    | A |               |
| e | Baltimore, MD; Ann Arbor, |   |   |    |    | / |               |
| f | MI; Jackson, MS; San      |   |   |    |    | D |               |
| N | Francisco, CA; and        |   |   |    |    | / |               |
| o | Dallas, TX utilizing      |   |   |    |    | O |               |
| ] | existing Region leases    |   |   |    |    | ] |               |
| { |                           |   |   |    |    | { |               |
| . |                           |   |   |    |    | . |               |
| u |                           |   |   |    |    | u |               |
| n |                           |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
| 9 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| * | ***modify lease for new   |   |   |    |    |   |               |
| * | space configuration, if   |   |   |    |    |   |               |
| * | necessary (new action     |   |   |    |    |   |               |
| 2 | item)***                  |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
| 9 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
| * |                           |   |   |    |    |   |               |
| * |                           |   |   |    |    |   |               |
| * |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| * | ***prepare supplemental   |   |   |    |    |   |               |
| * | lease agreement for       |   |   |    |    |   |               |
| * | renovation, if necessary  |   |   |    |    |   |               |
| 2 | (new action item)***      |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
| 9 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| * |                           |   |   |    |    |   |               |
| * |                           |   |   |    |    |   |               |
| * |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Establish a VISN Office   |   |   |    |    | A |               |
| e | Activation Team in        |   |   |    |    | / |               |
| f | Headquarters to           |   |   |    |    | D |               |
| N | coordinate renovation and |   |   |    |    | / |               |
| o | delegated leasing         |   |   |    |    | O |               |
| ] | activities for the        |   |   |    |    | ] |               |
| { | preparation of VISN       |   |   |    |    | { |               |
| . | office space. This team   |   |   |    |    | . |               |
| u | should include            |   |   |    |    | u |               |
| n | representatives from the  |   |   |    |    | n |               |
| d | Engineering Management    |   |   |    |    | d |               |
| e | and Field Support Office  |   |   |    |    | e |               |
| r | (138) and Real Property   |   |   |    |    | r |               |
| l | Management Office (084)   |   |   |    |    | l |               |
| i | and be coordinated by the |   |   |    |    | i |               |
| n | CNO office.               |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| \ |                           |   |   |    |    |   |               |
| * |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| 0 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Set aside funds in        |   |   |    |    | A |               |
| e | Headquarters to cover     |   |   |    |    | / |               |
| f | renovation and lease      |   |   |    |    | D |               |
| N | costs (FY95/96 NRM funds  |   |   |    |    | / |               |
| o | and All Other,            |   |   |    |    | O |               |
| ] | respectively). Once VISN  |   |   |    |    | ] |               |
| { | office locations have     |   |   |    |    | { |               |
| . | been approved, TDAs       |   |   |    |    | . |               |
| u | should be sent directly   |   |   |    |    | u |               |
| n | from Headquarters to host |   |   |    |    | n |               |
| d | (or other designated)     |   |   |    |    | d |               |
| e | facilities to begin       |   |   |    |    | e |               |
| r | planning and design for   |   |   |    |    | r |               |
| l | projects and negotiations |   |   |    |    | l |               |
| i | for leases.               |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| \ |                           |   |   |    |    |   |               |
| * |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Reassign certain Region   |   |   |    |    | A |               |
| e | furniture and office      |   |   |    |    | / |               |
| f | equipment to VISNs and    |   |   |    |    | D |               |
| N | VSSCs in Baltimore, MD;   |   |   |    |    | / |               |
| o | Ann Arbor, MI; Jackson,   |   |   |    |    | O |               |
| ] | MS; and San Francisco,    |   |   |    |    | ] |               |
| { | CA. Maintain an inventory |   |   |    |    | { |               |
| . | of remaining Region       |   |   |    |    | . |               |
| u | furniture and equipment   |   |   |    |    | u |               |
| n | as it becomes available   |   |   |    |    | n |               |
| d | for excess and give       |   |   |    |    | d |               |
| e | priority consideration to |   |   |    |    | e |               |
| r | redistributing it to new  |   |   |    |    | r |               |
| l | VISNs. Allow new VISNs to |   |   |    |    | l |               |
| i | purchase furniture and    |   |   |    |    | i |               |
| n | equipment if excessed     |   |   |    |    | n |               |
| e | Region items are not      |   |   |    |    | e |               |
| } | suitable or available in  |   |   |    |    | } |               |
| * | a timely manner. Set      |   |   |    |    | * |               |
| * | aside funds in            |   |   |    |    | * |               |
|   | Headquarters to support   |   |   |    |    |   |               |
| 2 | furniture and equipment   |   |   |    |    |   |               |
| . | purchases. Redistribute   |   |   |    |    |   |               |
| 2 | unassigned Region         |   |   |    |    |   |               |
| 2 | furniture to other        |   |   |    |    |   |               |
|   | facilities within the     |   |   |    |    |   |               |
|   | system utilizing existing |   |   |    |    |   |               |
|   | excess property programs. |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | distribute funds for      | C |   | 8/ |    |   |               |
| * | procurement of            | h |   | 7/ |    |   |               |
| 2 | furnishings and equipment | i |   | 95 |    |   |               |
| . | to Regions                | e |   |    |    |   |               |
| 2 |                           | f |   |    |    |   |               |
| 2 |                           | N |   |    |    |   |               |
| . |                           | e |   |    |    |   |               |
| 1 |                           | t |   |    |    |   |               |
|   |                           | w |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | k |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 3 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | determine specific        | h |   | 8/ |    |   |               |
| * | requirements and identify | o |   | 7/ |    |   |               |
| 2 | sources for procurement;  | s |   | 95 |    |   |               |
| . | draft orders (2237)       | t |   |    |    |   |               |
| 2 |                           | f |   |    |    |   |               |
| 2 |                           | a |   |    |    |   |               |
| . |                           | c |   |    |    |   |               |
| 2 |                           | i |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | y |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | develop plan showing      | h |   | 8  |    |   |               |
| . | location of furnishings   | o |   | /1 |    |   |               |
| 2 | and equipment; determine  | s |   | 4/ |    |   |               |
| 2 | resource requirement      | t |   | 95 |    |   |               |
| . |                           | f |   |    |    |   |               |
| 3 |                           | a |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | y |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | submit orders (2237) to   | h |   | 8  |    |   |               |
| . | host facility A&MM (90)   | o |   | /2 |    |   |               |
| 2 | for processing            | s |   | 1/ |    |   |               |
| 2 |                           | t |   | 95 |    |   |               |
| . |                           | f |   |    |    |   |               |
| 4 |                           | a |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | y |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | install furnishings and   | h |   | 1/ |    |   |               |
| . | office equipment to       | o |   | 5/ |    |   |               |
| 2 | occupy space              | s |   | 96 |    |   |               |
| 2 |                           | t |   |    |    |   |               |
| . |                           | f |   |    |    |   |               |
| 5 |                           | a |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | y |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "The VISN Activation Work | \ | W |    |    |   |               |
| . | Group provided a schedule | - | e |    |    |   |               |
| 2 | for VISN office site      | - | r |    |    |   |               |
| 2 | selection, design,        |   | e |    |    |   |               |
|   | remodel of offices,       |   | c |    |    |   |               |
|   | procurement of office     |   | o |    |    |   |               |
|   | furniture, etc. That      |   | g |    |    |   |               |
|   | schedule will not provide |   | n |    |    |   |               |
|   | adequate facilities fast  |   | i |    |    |   |               |
|   | enough for VISN directors |   | z |    |    |   |               |
|   | to set-up their offices   |   | e |    |    |   |               |
|   | and begin functioning."   |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | v |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | g |    |    |   |               |
|   |                           |   | V |    |    |   |               |
|   |                           |   | I |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | N |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | y |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | ; |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | v |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | y |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | w |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | b |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | k |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Pursue video conference   |   |   |    |    | A |               |
| e | equipment capability for  |   |   |    |    | / |               |
| f | 22 VISNs and the Office   |   |   |    |    | D |               |
| N | of the CNO. Charge MIRMO  |   |   |    |    | / |               |
| o | with coordinating the     |   |   |    |    | O |               |
| ] | specifications for video  |   |   |    |    | ] |               |
| { | conference equipment and  |   |   |    |    | { |               |
| . | coordinating equipment    |   |   |    |    | . |               |
| u | purchase, installation,   |   |   |    |    | u |               |
| n | and training.             |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| 3 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | No change recommended at  |   |   |    |    |   |               |
|   | this time.                |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Develop and submit a      |   |   |    |    | A |               |
| e | legislative initiative to |   |   |    |    | / |               |
| f | deal with salary          |   |   |    |    | D |               |
| N | discrepancies for senior  |   |   |    |    | / |               |
| o | management staff          |   |   |    |    | O |               |
| ] | including VISN Directors  |   |   |    |    | ] |               |
| { | and others between Title  |   |   |    |    | { |               |
| . | 38 and SES and within     |   |   |    |    | . |               |
| u | Title 38.                 |   |   |    |    | u |               |
| n |                           |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| 4 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | Several comments were     | A | T |    |    |   |               |
| . | received, all supporting  |   | h |    |    |   |               |
| 2 | this legislation.         |   | e |    |    |   |               |
| 4 | Additional comments       |   | r |    |    |   |               |
|   | include: "The most        |   | e |    |    |   |               |
|   | significant of these      |   | c |    |    |   |               |
|   | would be the salary       |   | o |    |    |   |               |
|   | differential that would   |   | m |    |    |   |               |
|   | exist between physicians  |   | m |    |    |   |               |
|   | and others who would all  |   | e |    |    |   |               |
|   | be doing essentially the  |   | n |    |    |   |               |
|   | same jobs."; "If          |   | d |    |    |   |               |
|   | legislative initiative is |   | a |    |    |   |               |
|   | introduced to correct the |   | t |    |    |   |               |
|   | discrepancy between Title |   | i |    |    |   |               |
|   | 5 and Title 38 for VISN   |   | o |    |    |   |               |
|   | Directors, it should also |   | n |    |    |   |               |
|   | include the discrepancy   |   | w |    |    |   |               |
|   | presently existing for    |   | a |    |    |   |               |
|   | Medical Center            |   | s |    |    |   |               |
|   | Directors."; "OMB         |   | s |    |    |   |               |
|   | Circular A-19 requires    |   | p |    |    |   |               |
|   | that before VA makes      |   | e |    |    |   |               |
|   | available to Congress or  |   | c |    |    |   |               |
|   | the public any proposal   |   | i |    |    |   |               |
|   | for or endorsement of     |   | f |    |    |   |               |
|   | Federal legislation, the  |   | i |    |    |   |               |
|   | proposal or endorsement   |   | c |    |    |   |               |
|   | must be submitted to the  |   | a |    |    |   |               |
|   | Office of Management and  |   | l |    |    |   |               |
|   | Budget for coordination   |   | l |    |    |   |               |
|   | and clearance. This       |   | y |    |    |   |               |
|   | report would thus need to |   | d |    |    |   |               |
|   | be cleared by OMB before  |   | e |    |    |   |               |
|   | it is released to         |   | v |    |    |   |               |
|   | Congress or the public."  |   | e |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | p |    |    |   |               |
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|   |                           |   | d |    |    |   |               |
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|   |                           |   | n |    |    |   |               |
|   |                           |   | . |    |    |   |               |
|   |                           |   | T |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
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|   |                           |   | . |    |    |   |               |
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|   |                           |   | f |    |    |   |               |
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|   |                           |   | v |    |    |   |               |
|   |                           |   | i |    |    |   |               |
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|   |                           |   | d |    |    |   |               |
|   |                           |   | w |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | Change recommendation as  |   |   |    |    |   |               |
|   | above and add actions     |   |   |    |    |   |               |
|   | items indicated.          |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Region offices will be    |   |   |    |    | A |               |
| e | immediately charged with  |   |   |    |    | / |               |
| f | developing VISN specific  |   |   |    |    | D |               |
| N | "Transition Resource      |   |   |    |    | / |               |
| o | Guides". These guides     |   |   |    |    | O |               |
| ] | will be assigned to the   |   |   |    |    | ] |               |
| { | Regional Directors by the |   |   |    |    | { |               |
| . | AsCMD for Operations to   |   |   |    |    | . |               |
| u | be completed by September |   |   |    |    | u |               |
| n | 30, 1995 or sooner.       |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| 5 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | develop "Transition       | R |   | 9  |    |   |               |
| * | Resource Guides"          | e |   | /3 |    |   |               |
| 2 |                           | g |   | 0/ |    |   |               |
| . |                           | i |   | 95 |    |   |               |
| 2 |                           | o |   |    |    |   |               |
| 5 |                           | n |   |    |    |   |               |
| . |                           | s |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "Copies of Transition     | A | A |    |    |   |               |
| . | Resource Guides with      |   | g |    |    |   |               |
| 2 | VISN-specific data should |   | r |    |    |   |               |
| 5 | also go to HQ offices,    |   | e |    |    |   |               |
|   | including SHG offices."   |   | e |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | No change recommended at  |   |   |    |    |   |               |
|   | this time.                |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Effective October 1,      |   |   |    |    | A |               |
| e | 1995, Region employees    |   |   |    |    | / |               |
| f | will be operationally     |   |   |    |    | D |               |
| N | realigned to the CNO, but |   |   |    |    | / |               |
| o | will remain on the        |   |   |    |    | O |               |
| ] | Medical Care              |   |   |    |    | ] |               |
| { | Appropriation account;    |   |   |    |    | { |               |
| . | Region functions will be  |   |   |    |    | . |               |
| u | transitionally realigned  |   |   |    |    | u |               |
| n | to the Office of the CNO. |   |   |    |    | n |               |
| d | A process of critically   |   |   |    |    | d |               |
| e | evaluating Region         |   |   |    |    | e |               |
| r | functions will begin      |   |   |    |    | r |               |
| l | immediately. (Disposition |   |   |    |    | l |               |
| i | recommendations for all   |   |   |    |    | i |               |
| n | functions will occur no   |   |   |    |    | n |               |
| e | later than March 31,      |   |   |    |    | e |               |
| } | 1996).                    |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| 6 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | We had 19 comments on     | A | E |    |    |   |               |
| . | this subject. Some of the |   | v |    |    |   |               |
| 2 | comments included:        | A | e |    |    |   |               |
| 6 |                           |   | r |    |    |   |               |
|   | "Careful consideration    | A | y |    |    |   |               |
|   | must be given to Region   |   | a |    |    |   |               |
|   | staff during the          | D | t |    |    |   |               |
|   | transition process to     |   | t |    |    |   |               |
|   | demonstrate the assertion | A | e |    |    |   |               |
|   | that 'VHA's employees are |   | m |    |    |   |               |
|   | perhaps the greatest      |   | p |    |    |   |               |
|   | strength of the           |   | t |    |    |   |               |
|   | organization.' To more    |   | w |    |    |   |               |
|   | effectively utilize       |   | i |    |    |   |               |
|   | staff, productively       |   | l |    |    |   |               |
|   | standards should be       |   | l |    |    |   |               |
|   | implemented and cross     |   | b |    |    |   |               |
|   | training should be        |   | e |    |    |   |               |
|   | explored where            |   | m |    |    |   |               |
|   | appropriate.              |   | a |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   | "During transition the    |   | e |    |    |   |               |
|   | CNO supervisory span of   |   | t |    |    |   |               |
|   | control (Region staff,    |   | o |    |    |   |               |
|   | SSC staff, etc.) may      |   | b |    |    |   |               |
|   | become unwieldy,          |   | e |    |    |   |               |
|   | alternatives may need to  |   | a |    |    |   |               |
|   | be considered."           |   | s |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   | "How realistic is it to   |   | m |    |    |   |               |
|   | retain regional offices   |   | p |    |    |   |               |
|   | for 6 months as functions |   | l |    |    |   |               |
|   | are being reviewed? Won't |   | o |    |    |   |               |
|   | most good staff leave for |   | y |    |    |   |               |
|   | other positions?"         |   | e |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   | "The transition process   |   | - |    |    |   |               |
|   | appears too hurried."     |   | s |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   | "I am troubled that the   |   | n |    |    |   |               |
|   | 'plan' fails to identify  |   | s |    |    |   |               |
|   | what office(s) within the |   | i |    |    |   |               |
|   | new organization will be  |   | t |    |    |   |               |
|   | responsible for carrying  |   | i |    |    |   |               |
|   | out the [440]{.underline} |   | v |    |    |   |               |
|   | tasks currently performed |   | e |    |    |   |               |
|   | by regional offices. I    |   | a |    |    |   |               |
|   | agree that it makes sense |   | s |    |    |   |               |
|   | that VISN support centers |   | p |    |    |   |               |
|   | be established at         |   | o |    |    |   |               |
|   | existing region           |   | s |    |    |   |               |
|   | locations. But it makes   |   | s |    |    |   |               |
|   | no sense to leave         |   | i |    |    |   |               |
|   | unresolved the assignment |   | b |    |    |   |               |
|   | of responsibility for     |   | l |    |    |   |               |
|   | current region            |   | e |    |    |   |               |
|   | responsibilities and      |   | a |    |    |   |               |
|   | allow for additional      |   | s |    |    |   |               |
|   | functions to evolve at    |   | e |    |    |   |               |
|   | the new centers, while    |   | v |    |    |   |               |
|   | planning for only a       |   | i |    |    |   |               |
|   | marginal number of        |   | d |    |    |   |               |
|   | support center staff."    |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   | "The region construction  |   | c |    |    |   |               |
|   | attorneys have served as  |   | e |    |    |   |               |
|   | effective in-house        |   | d |    |    |   |               |
|   | counsel. We believe that  |   | b |    |    |   |               |
|   | service should continue   |   | y |    |    |   |               |
|   | at that level."           |   | t |    |    |   |               |
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|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
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|   |                           |   | l |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | Some comments provided    | D | S |    |    |   |               |
| . | suggestions and other     |   | t |    |    |   |               |
| 2 | recommendations such as   | A | a |    |    |   |               |
| 6 | the following:            |   | f |    |    |   |               |
|   |                           | A | f |    |    |   |               |
|   | "One option available is  |   | w |    |    |   |               |
|   | to use these staff for a  | A | i |    |    |   |               |
|   | specific period of time   |   | l |    |    |   |               |
|   | to perform their current  | A | l |    |    |   |               |
|   | duties, then ask them to  |   | b |    |    |   |               |
|   | train (or become) VISN or |   | e |    |    |   |               |
|   | facility staff performing |   | r |    |    |   |               |
|   | these functions."         |   | e |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   | "I am concerned that all  |   | s |    |    |   |               |
|   | the requirements of the   |   | s |    |    |   |               |
|   | various work groups may   |   | i |    |    |   |               |
|   | not be doable. I would    |   | g |    |    |   |               |
|   | suggest that a special    |   | n |    |    |   |               |
|   | work group examine the    |   | e |    |    |   |               |
|   | entire document from 'an  |   | d |    |    |   |               |
|   | executive point of view'  |   | t |    |    |   |               |
|   | to identify those         |   | o |    |    |   |               |
|   | functions which must      |   | t |    |    |   |               |
|   | absolutely be performed   |   | h |    |    |   |               |
|   | if the VISNs are to be    |   | e |    |    |   |               |
|   | successful. It would be   |   | C |    |    |   |               |
|   | much better to do a few   |   | N |    |    |   |               |
|   | tasks and do them well    |   | O |    |    |   |               |
|   | than to attempt too many  |   | u |    |    |   |               |
|   | tasks and, as a result,   |   | p |    |    |   |               |
|   | do them all poorly."      |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   | "The Region functions     |   | t |    |    |   |               |
|   | recommended to be         |   | h |    |    |   |               |
|   | transferred to VISNs are  |   | e |    |    |   |               |
|   | very vague. In keeping    |   | a |    |    |   |               |
|   | with the concept of       |   | c |    |    |   |               |
|   | management flexibility,   |   | t |    |    |   |               |
|   | the VISN Director should  |   | i |    |    |   |               |
|   | determine how best to     |   | v |    |    |   |               |
|   | accomplish necessary      |   | a |    |    |   |               |
|   | functions."               |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   | "We realize that the      |   | o |    |    |   |               |
|   | working group report does |   | n |    |    |   |               |
|   | not get to this level of  |   | d |    |    |   |               |
|   | functional detail, but we |   | a |    |    |   |               |
|   | thought the working group |   | t |    |    |   |               |
|   | should consider either:   |   | e |    |    |   |               |
|   | (1) mentioning the VISN   |   | . |    |    |   |               |
|   | formulary process as an   |   | T |    |    |   |               |
|   | example of a new function |   | h |    |    |   |               |
|   | (previously managed at a  |   | e |    |    |   |               |
|   | medical center) and/or    |   | s |    |    |   |               |
|   | (2) adding action items   |   | e |    |    |   |               |
|   | to the report which would |   | s |    |    |   |               |
|   | instill the VISN          |   | t |    |    |   |               |
|   | formulary into the first  |   | a |    |    |   |               |
|   | phase of VISN             |   | f |    |    |   |               |
|   | activation."              |   | f |    |    |   |               |
|   |                           |   | w |    |    |   |               |
|   | "Region staff should be   |   | i |    |    |   |               |
|   | included in the           |   | l |    |    |   |               |
|   | evaluation of Region      |   | l |    |    |   |               |
|   | functions to insure       |   | p |    |    |   |               |
|   | familiarity with subject  |   | a |    |    |   |               |
|   | matter."                  |   | r |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | v |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
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|   |                           |   | d |    |    |   |               |
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|   |                           |   | e |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | b |    |    |   |               |
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|   |                           |   | u |    |    |   |               |
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|   |                           |   | u |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "This report recommends   | \ | T |    |    |   |               |
| . | that Region employees be  | - | h |    |    |   |               |
| 2 | operationally realigned   | - | i |    |    |   |               |
| 6 | to the Chief Network      |   | s |    |    |   |               |
|   | Officer but continue to   |   | i |    |    |   |               |
|   | be paid from the Medical  |   | s |    |    |   |               |
|   | Care appropriation.       |   | s |    |    |   |               |
|   | Application of the        |   | u |    |    |   |               |
|   | support function versus   |   | e |    |    |   |               |
|   | direct operation rule in  |   | n |    |    |   |               |
|   | this case would require   |   | e |    |    |   |               |
|   | consideration of the      |   | e |    |    |   |               |
|   | function of these Region  |   | d |    |    |   |               |
|   | employees after they are  |   | s |    |    |   |               |
|   | realigned to the Chief    |   | c |    |    |   |               |
|   | Network Officer. If their |   | l |    |    |   |               |
|   | function would involve    |   | e |    |    |   |               |
|   | the operation of the VA   |   | a |    |    |   |               |
|   | system nationwide, this   |   | r |    |    |   |               |
|   | would be a support        |   | i |    |    |   |               |
|   | function which must be    |   | n |    |    |   |               |
|   | funded from MAMOE. If, on |   | t |    |    |   |               |
|   | the other hand, the       |   | e |    |    |   |               |
|   | function of these         |   | r |    |    |   |               |
|   | employees would involve   |   | p |    |    |   |               |
|   | the operation of VA       |   | r |    |    |   |               |
|   | facilities on a           |   | e |    |    |   |               |
|   | State-by-State,           |   | t |    |    |   |               |
|   | region-by-region, or      |   | a |    |    |   |               |
|   | facility-by-facility      |   | t |    |    |   |               |
|   | basis, this would be a    |   | i |    |    |   |               |
|   | direct operation function |   | o |    |    |   |               |
|   | which would have to be    |   | n |    |    |   |               |
|   | funded out of Medical     |   | . |    |    |   |               |
|   | Care funds. Before this   |   | T |    |    |   |               |
|   | report is issued,         |   | h |    |    |   |               |
|   | therefore, the function   |   | e |    |    |   |               |
|   | of these employees should |   | i |    |    |   |               |
|   | be examined."             |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | l |    |    |   |               |
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|   |                           |   | d |    |    |   |               |
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|   |                           |   | u |    |    |   |               |
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|   |                           |   | N |    |    |   |               |
|   |                           |   | O |    |    |   |               |
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|   |                           |   | p |    |    |   |               |
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|   |                           |   | . |    |    |   |               |
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|   |                           |   | d |    |    |   |               |
|   |                           |   | a |    |    |   |               |
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|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | D |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | g |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | b |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | - |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Seek expedited approval   |   |   |    |    | A |               |
| e | of the Decision Paper on  |   |   |    |    | / |               |
| f | the Special Placement     |   |   |    |    | D |               |
| N | Program from the Under    |   |   |    |    | / |               |
| o | Secretary for Health.     |   |   |    |    | O |               |
| ] |                           |   |   |    |    | ] |               |
| { |                           |   |   |    |    | { |               |
| . |                           |   |   |    |    | . |               |
| u |                           |   |   |    |    | u |               |
| n |                           |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| 7 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | expedite approval of      | C |   | 8/ |    |   |               |
| * | decision paper on special | h |   | 1/ |    |   |               |
| 2 | placement program         | i |   | 95 |    |   |               |
| . |                           | e |   |    |    |   |               |
| 2 |                           | f |   |    |    |   |               |
| 7 |                           | N |   |    |    |   |               |
| . |                           | e |   |    |    |   |               |
| 1 |                           | t |   |    |    |   |               |
|   |                           | w |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | k |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 3 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Implement the Special     |   |   |    |    | A |               |
| e | Placement Program at the  |   |   |    |    | / |               |
| f | end of the Congressional  |   |   |    |    | D |               |
| N | waiting period.           |   |   |    |    | / |               |
| o |                           |   |   |    |    | O |               |
| ] |                           |   |   |    |    | ] |               |
| { |                           |   |   |    |    | { |               |
| . |                           |   |   |    |    | . |               |
| u |                           |   |   |    |    | u |               |
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| 2 |                           |   |   |    |    |   |               |
| 8 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
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|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | implement special         | C |   | 8/ | 9/ |   |               |
| * | placement program         | h |   | 7/ | 7/ |   |               |
| 2 |                           | i |   | 95 | 95 |   |               |
| . |                           | e |   |    |    |   |               |
| 2 |                           | f |   |    |    |   |               |
| 8 |                           | N |   |    |    |   |               |
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|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | issue letter informing    | U |   | 8/ | 8  |   |               |
| * | Region employees of       | n |   | 7/ | /1 |   |               |
| 2 | office closures           | d |   | 95 | 7/ |   |               |
| . |                           | e |   |    | 95 |   |               |
| 2 |                           | r |   |    |    |   |               |
| 8 |                           | / |   |    |    |   |               |
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|   |                           | H |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | a |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | h |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 0 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | issue letter implementing | C |   | 8/ | 9/ |   |               |
| * | special placement program | h |   | 7/ | 7/ |   |               |
| 2 |                           | i |   | 95 | 95 |   |               |
| . |                           | e |   |    |    |   |               |
| 2 |                           | f |   |    |    |   |               |
| 8 |                           | N |   |    |    |   |               |
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|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 3 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | issue letter to all       | C |   | 8/ |    |   |               |
| * | facility Directors and    | h |   | 7/ |    |   |               |
| 2 | VAMC activities, Regional | i |   | 95 |    |   |               |
| . | Directors, OPCs and ROs   | e |   |    |    |   |               |
| 2 | with OPCs regarding       | f |   |    |    |   |               |
| 8 | provisions of special     | N |   |    |    |   |               |
| . | placement program         | e |   |    |    |   |               |
| 4 |                           | t |   |    |    |   |               |
|   |                           | w |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | k |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
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|   |                           | r |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 3 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | survey Region staff for   | R |   | 8  |    |   |               |
| * | preferences and mobility  | e |   | /2 |    |   |               |
| 2 |                           | g |   | 5/ |    |   |               |
| . |                           | i |   | 95 |    |   |               |
| 2 |                           | o |   |    |    |   |               |
| 8 |                           | n |   |    |    |   |               |
| . |                           | s |   |    |    |   |               |
| 5 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | Of the five comments      | A | V |    |    |   |               |
| . | received, most provided   | / | H |    |    |   |               |
| 2 | positive support to the   | D | A |    |    |   |               |
| 8 | outplacement efforts for  |   | w |    |    |   |               |
|   | Region staff. However,    |   | i |    |    |   |               |
|   | they added such comments  |   | l |    |    |   |               |
|   | as "\...will be difficult |   | l |    |    |   |               |
|   | due to downsizing of the  |   | r |    |    |   |               |
|   | work force in the federal |   | e |    |    |   |               |
|   | government as well as the |   | q |    |    |   |               |
|   | private sector, and       |   | u |    |    |   |               |
|   | without transfer of       |   | i |    |    |   |               |
|   | Region FTE. It also may   |   | r |    |    |   |               |
|   | be difficult to outplace  |   | e |    |    |   |               |
|   | Region staff in an        |   | f |    |    |   |               |
|   | expeditious manner under  |   | u |    |    |   |               |
|   | current and projected     |   | l |    |    |   |               |
|   | budgetary constraints.";  |   | l |    |    |   |               |
|   | "This \[outplacement\]    |   | c |    |    |   |               |
|   | has occurred in the past  |   | o |    |    |   |               |
|   | and is an effective       |   | o |    |    |   |               |
|   | benefit if outplacing     |   | p |    |    |   |               |
|   | staff is to be            |   | e |    |    |   |               |
|   | accomplished              |   | r |    |    |   |               |
|   | expeditiously, especially |   | a |    |    |   |               |
|   | with buy out authority    |   | t |    |    |   |               |
|   | unlikely. Otherwise, it   |   | i |    |    |   |               |
|   | may be difficult to place |   | o |    |    |   |               |
|   | staff at higher grades or |   | n |    |    |   |               |
|   | specialized expertise.";  |   | f |    |    |   |               |
|   | "May need to place the    |   | r |    |    |   |               |
|   | staff in Medical Centers  |   | o |    |    |   |               |
|   | or ensure buy-outs and    |   | m |    |    |   |               |
|   | early-outs are            |   | a |    |    |   |               |
|   | attractive, especially    |   | l |    |    |   |               |
|   | for grades GS-13 and      |   | l |    |    |   |               |
|   | above."                   |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
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|   |                           |   | h |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | V |    |    |   |               |
|   |                           |   | H |    |    |   |               |
|   |                           |   | A |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
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|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
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|   |                           |   | a |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "The Special Placement    | A | T |    |    |   |               |
| . | Program to assist staff   |   | h |    |    |   |               |
| 2 | with buy out and early    |   | i |    |    |   |               |
| 8 | out is commendable. Along |   | s |    |    |   |               |
|   | these same lines for      |   | s |    |    |   |               |
|   | those of us who are       |   | u |    |    |   |               |
|   | mobile, an electronic     |   | g |    |    |   |               |
|   | data base that would      |   | g |    |    |   |               |
|   | reveal housing for sale   |   | e |    |    |   |               |
|   | or rent by vacating VA    |   | s |    |    |   |               |
|   | employee, would expedite  |   | t |    |    |   |               |
|   | the move-relocation of    |   | i |    |    |   |               |
|   | the transferee."          |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | w |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | l |    |    |   |               |
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|   |                           |   | t |    |    |   |               |
|   |                           |   | o |    |    |   |               |
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|   |                           |   | h |    |    |   |               |
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|   |                           |   | a |    |    |   |               |
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|   |                           |   | t |    |    |   |               |
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|   |                           |   | a |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | g |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | ***Use Special Placement  |   |   |    |    | A |               |
| e | Program developed for     |   |   |    |    | / |               |
| f | region staff as a model   |   |   |    |    | D |               |
| N | for planned parallel      |   |   |    |    | / |               |
| o | efforts for Headquarters  |   |   |    |    | O |               |
| ] | employee outplacement.    |   |   |    |    | ] |               |
| { | (revised                  |   |   |    |    | { |               |
| . | recommendation)***        |   |   |    |    | . |               |
| u |                           |   |   |    |    | u |               |
| n |                           |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| 9 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Request specific          |   |   |    |    | A |               |
| e | "buy-out" (Voluntary      |   |   |    |    | / |               |
| f | Separation Incentive      |   |   |    |    | D |               |
| N | Payment) authority as an  |   |   |    |    | / |               |
| o | incentive for increasing  |   |   |    |    | O |               |
| ] | attrition.                |   |   |    |    | ] |               |
| { |                           |   |   |    |    | { |               |
| . |                           |   |   |    |    | . |               |
| u |                           |   |   |    |    | u |               |
| n |                           |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 3 |                           |   |   |    |    |   |               |
| 0 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | prepare buy-out authority | M |   | 8/ |    |   |               |
| * | request                   | a |   | 1/ |    |   |               |
| 2 |                           | n |   | 95 |    |   |               |
| . |                           | a |   |    |    |   |               |
| 3 |                           | g |   |    |    |   |               |
| 0 |                           | e |   |    |    |   |               |
| . |                           | m |   |    |    |   |               |
| 1 |                           | e |   |    |    |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | S |   |    |    |   |               |
|   |                           | u |   |    |    |   |               |
|   |                           | p |   |    |    |   |               |
|   |                           | p |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 6 |   |    |    |   |               |
|   |                           | 3 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | request buy-out authority | M |   | 8/ |    |   |               |
| * | (VSIP)                    | a |   | 7/ |    |   |               |
| 2 |                           | n |   | 95 |    |   |               |
| . |                           | a |   |    |    |   |               |
| 3 |                           | g |   |    |    |   |               |
| 0 |                           | e |   |    |    |   |               |
| . |                           | m |   |    |    |   |               |
| 2 |                           | e |   |    |    |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | S |   |    |    |   |               |
|   |                           | u |   |    |    |   |               |
|   |                           | p |   |    |    |   |               |
|   |                           | p |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 6 |   |    |    |   |               |
|   |                           | 3 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "Report references need   |   |   |    |    |   |               |
| . | for early out and buy out |   |   |    |    |   |               |
| 3 | authorities. Early out    |   |   |    |    |   |               |
| 0 | authority has been        |   |   |    |    |   |               |
|   | approved through 9/30/96; |   |   |    |    |   |               |
|   | buyouts would require     |   |   |    |    |   |               |
|   | legislation, and we do    |   |   |    |    |   |               |
|   | not anticipate favorable  |   |   |    |    |   |               |
|   | consideration from OMB at |   |   |    |    |   |               |
|   | this point."              |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Request an extension of   |   |   |    |    | A |               |
| e | the "Early Out" (VERA)    |   |   |    |    | / |               |
| f | authority.                |   |   |    |    | D |               |
| N |                           |   |   |    |    | / |               |
| o |                           |   |   |    |    | O |               |
| ] |                           |   |   |    |    | ] |               |
| { |                           |   |   |    |    | { |               |
| . |                           |   |   |    |    | . |               |
| u |                           |   |   |    |    | u |               |
| n |                           |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 3 |                           |   |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | request extension of      | M |   | 8/ |    |   |               |
| * | Voluntary Early           | a |   | 7/ |    |   |               |
| 2 | Retirement Authority      | n |   | 95 |    |   |               |
| . |                           | a |   |    |    |   |               |
| 3 |                           | g |   |    |    |   |               |
| 1 |                           | e |   |    |    |   |               |
| . |                           | m |   |    |    |   |               |
| 1 |                           | e |   |    |    |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | S |   |    |    |   |               |
|   |                           | u |   |    |    |   |               |
|   |                           | p |   |    |    |   |               |
|   |                           | p |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 6 |   |    |    |   |               |
|   |                           | 3 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Provide all Region        |   |   |    |    | A |               |
| e | employees waiting to      |   |   |    |    | / |               |
| f | relocate a "bona fide"    |   |   |    |    | D |               |
| N | job offer of assignment,  |   |   |    |    | / |               |
| o | at grade and pay          |   |   |    |    | O |               |
| ] | retention as a minimum,   |   |   |    |    | ] |               |
| { | to a position in VHA      |   |   |    |    | { |               |
| . | although not necessarily  |   |   |    |    | . |               |
| u | in accord with employee   |   |   |    |    | u |               |
| n | preferences, prior to use |   |   |    |    | n |               |
| d | of RIF procedures or      |   |   |    |    | d |               |
| e | other separation          |   |   |    |    | e |               |
| r | authorities.              |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| \ |                           |   |   |    |    |   |               |
| * |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 3 |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Remain cognizant of Labor |   |   |    |    | A |               |
| e | Management considerations |   |   |    |    | / |               |
| f | and the need to           |   |   |    |    | D |               |
| N | communicate with the VHA  |   |   |    |    | / |               |
| o | National Partnership      |   |   |    |    | O |               |
| ] | Council as employee       |   |   |    |    | ] |               |
| { | outplacement issues       |   |   |    |    | { |               |
| . | continue to evolve.       |   |   |    |    | . |               |
| u |                           |   |   |    |    | u |               |
| n |                           |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 3 |                           |   |   |    |    |   |               |
| 3 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | notify Partnership        | U |   |    |    |   |               |
| . | Council of program        | n |   |    |    |   |               |
| 3 | parameters                | d |   |    |    |   |               |
| 3 |                           | e |   |    |    |   |               |
| . |                           | r |   |    |    |   |               |
| 1 |                           | S |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | a |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | y |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | H |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | a |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | h |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 0 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "Labor partners are       | \ | T |    |    |   |               |
| . | indicated as              | - | h |    |    |   |               |
| 3 | stakeholders, but has     | - | e |    |    |   |               |
| 3 | anyone contacted them     |   | N |    |    |   |               |
|   | regarding the impact of   |   | a |    |    |   |               |
|   | eliminating some of the   |   | t |    |    |   |               |
|   | current regional          |   | i |    |    |   |               |
|   | functions (e.g., EEO,     |   | o |    |    |   |               |
|   | Fire and Safety,          |   | n |    |    |   |               |
|   | Industrial Hygiene)? For  |   | a |    |    |   |               |
|   | example, the AFGE         |   | l |    |    |   |               |
|   | National Agreement        |   | P |    |    |   |               |
|   | indicated Regional Safety |   | a |    |    |   |               |
|   | staff will conduct the    |   | r |    |    |   |               |
|   | annual OSH inspections.   |   | t |    |    |   |               |
|   | Should these positions be |   | n |    |    |   |               |
|   | dramatically reduced or   |   | e |    |    |   |               |
|   | eliminate altogether, how |   | r |    |    |   |               |
|   | will VHA honor its part   |   | s |    |    |   |               |
|   | of this agreement?"       |   | h |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | C |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | v |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | s |    |    |   |               |
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|   |                           |   | n |    |    |   |               |
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|   |                           |   | e |    |    |   |               |
|   |                           |   | V |    |    |   |               |
|   |                           |   | A |    |    |   |               |
|   |                           |   | M |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | n |    |    |   |               |
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|   |                           |   | I |    |    |   |               |
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|   |                           |   | d |    |    |   |               |
|   |                           |   | d |    |    |   |               |
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|   |                           |   | e |    |    |   |               |
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|   |                           |   | i |    |    |   |               |
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|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | g |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | x |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
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|   |                           |   | g |    |    |   |               |
|   |                           |   | a |    |    |   |               |
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|   |                           |   | r |    |    |   |               |
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|   |                           |   | m |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | No change is recommended  |   |   | O  |    |   |               |
| . | at this time.             |   |   | ng |    |   |               |
| 3 |                           |   |   | oi |    |   |               |
| 3 |                           |   |   | ng |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Immediately activate ADP  |   |   |    |    | A |               |
| e | Bulletin Board System to  |   |   |    |    | / |               |
| f | be accessed by all Region |   |   |    |    | D |               |
| N | and Regional Division     |   |   |    |    | / |               |
| o | Offices composed of the   |   |   |    |    | O |               |
| ] | following: an employment  |   |   |    |    | ] |               |
| { | survey instrument to      |   |   |    |    | { |               |
| . | state location and        |   |   |    |    | . |               |
| u | occupation preferences; a |   |   |    |    | u |               |
| n | resume library which may  |   |   |    |    | n |               |
| d | be reviewed by            |   |   |    |    | d |               |
| e | prospective employers;    |   |   |    |    | e |               |
| r | and, a list of applicable |   |   |    |    | r |               |
| l | VHA vacancies.            |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 3 |                           |   |   |    |    |   |               |
| 4 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | utilize IRM/ADP bulletin  | R |   | 8/ |    |   |               |
| * | board system              | e |   | 7/ |    |   |               |
| 2 |                           | g |   | 95 |    |   |               |
| . |                           | i |   |    |    |   |               |
| 3 |                           | o |   |    |    |   |               |
| 4 |                           | n |   |    |    |   |               |
| . |                           | s |   |    |    |   |               |
| 1 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Widely disseminate the    |   |   |    |    | A |               |
| e | Employee Handbook         |   |   |    |    | / |               |
| f | developed by the Office   |   |   |    |    | D |               |
| N | of Human Resource         |   |   |    |    | / |               |
| o | Management.               |   |   |    |    | O |               |
| ] |                           |   |   |    |    | ] |               |
| { |                           |   |   |    |    | { |               |
| . |                           |   |   |    |    | . |               |
| u |                           |   |   |    |    | u |               |
| n |                           |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 3 |                           |   |   |    |    |   |               |
| 5 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | distribute employee       | C |   | 8/ |    |   |               |
| * | handbook                  | h |   | 7/ |    |   |               |
| 2 |                           | i |   | 95 |    |   |               |
| . |                           | e |   |    |    |   |               |
| 3 |                           | f |   |    |    |   |               |
| 5 |                           | N |   |    |    |   |               |
| . |                           | e |   |    |    |   |               |
| 1 |                           | t |   |    |    |   |               |
|   |                           | w |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | k |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 3 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Activate Outplacement     |   |   |    |    | A |               |
| e | Centers and coordinate    |   |   |    |    | / |               |
| f | outplacement activities   |   |   |    |    | D |               |
| N | at all Region sites.      |   |   |    |    | / |               |
| o |                           |   |   |    |    | O |               |
| ] |                           |   |   |    |    | ] |               |
| { |                           |   |   |    |    | { |               |
| . |                           |   |   |    |    | . |               |
| u |                           |   |   |    |    | u |               |
| n |                           |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 3 |                           |   |   |    |    |   |               |
| 6 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| \ | activate outplacement     | C |   | 8/ |    |   |               |
| * | centers located at        | h |   | 7/ |    |   |               |
| 2 | Regions                   | i |   | 95 |    |   |               |
| . |                           | e |   |    |    |   |               |
| 3 |                           | f |   |    |    |   |               |
| 6 |                           | N |   |    |    |   |               |
| . |                           | e |   |    |    |   |               |
| 1 |                           | t |   |    |    |   |               |
|   |                           | w |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | k |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Develop an instrument,    |   |   |    |    | A |               |
| e | within existing automated |   |   |    |    | / |               |
| f | systems (i.e., FMS), for  |   |   |    |    | D |               |
| N | the Outplacement Center   |   |   |    |    | / |               |
| o | managers to estimate and  |   |   |    |    | O |               |
| ] | track costs for           |   |   |    |    | ] |               |
| { | outplacement of staff,    |   |   |    |    | { |               |
| . | relocation expenses,      |   |   |    |    | . |               |
| u | employee pay and benefits |   |   |    |    | u |               |
| n | consideration,            |   |   |    |    | n |               |
| d | counseling, training,     |   |   |    |    | d |               |
| e | etc.                      |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 3 |                           |   |   |    |    |   |               |
| 7 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | track and monitor costs   | C |   |    |    |   |               |
| . | of outplacement           | h |   |    |    |   |               |
| 3 |                           | i |   |    |    |   |               |
| 7 |                           | e |   |    |    |   |               |
| . |                           | f |   |    |    |   |               |
| 1 |                           | F |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | a |   |    |    |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | a |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 7 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Immediately appoint a     |   |   |    |    | A |               |
| e | multi-disciplinary        |   |   |    |    | / |               |
| f | Affiliation Task Force    |   |   |    |    | D |               |
| N | charged with reviewing    |   |   |    |    | / |               |
| o | issues identified in      |   |   |    |    | O |               |
| ] | response to the draft     |   |   |    |    | ] |               |
| { | discussion paper and      |   |   |    |    | { |               |
| . | developing plans for      |   |   |    |    | . |               |
| u | implementation of desired |   |   |    |    | u |               |
| n | strategies.               |   |   |    |    | n |               |
| d |                           |   |   |    |    | d |               |
| e |                           |   |   |    |    | e |               |
| r |                           |   |   |    |    | r |               |
| l |                           |   |   |    |    | l |               |
| i |                           |   |   |    |    | i |               |
| n |                           |   |   |    |    | n |               |
| e |                           |   |   |    |    | e |               |
| } |                           |   |   |    |    | } |               |
| * |                           |   |   |    |    | * |               |
| * |                           |   |   |    |    | * |               |
|   |                           |   |   |    |    |   |               |
| 2 |                           |   |   |    |    |   |               |
| . |                           |   |   |    |    |   |               |
| 3 |                           |   |   |    |    |   |               |
| 8 |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | appoint                   | U |   | 1  |    |   |               |
| . | multi-disciplinary task   | n |   | 2/ |    |   |               |
| 3 | force                     | d |   | 1/ |    |   |               |
| 8 |                           | e |   | 95 |    |   |               |
| . |                           | r |   |    |    |   |               |
| 1 |                           | S |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | a |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | y |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | o |   |    |    |   |               |
|   |                           | r |   |    |    |   |               |
|   |                           | H |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | a |   |    |    |   |               |
|   |                           | l |   |    |    |   |               |
|   |                           | t |   |    |    |   |               |
|   |                           | h |   |    |    |   |               |
|   |                           | ( |   |    |    |   |               |
|   |                           | 1 |   |    |    |   |               |
|   |                           | 0 |   |    |    |   |               |
|   |                           | ) |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | Of the 28 comments we     | \ |   |    |    |   |               |
| . | received on this          | - |   |    |    |   |               |
| 3 | recommendation, four      | - |   |    |    |   |               |
| 8 | comments supported        |   |   |    |    |   |               |
|   | Headquarters to manage    |   |   |    |    |   |               |
|   | the affiliations and      |   |   |    |    |   |               |
|   | educational               |   |   |    |    |   |               |
|   | opportunities; six        |   |   |    |    |   |               |
|   | comments recommended this |   |   |    |    |   |               |
|   | task to the VISNs; and    |   |   |    |    |   |               |
|   | two comments felt the VA  |   |   |    |    |   |               |
|   | Medical Centers in a      |   |   |    |    |   |               |
|   | better position to manage |   |   |    |    |   |               |
|   | the affiliations. There   |   |   |    |    |   |               |
|   | were many concerned with  |   |   |    |    |   |               |
|   | this subject. Specific    |   |   |    |    |   |               |
|   | comments are noted below. |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | AFFILIATIONS MANAGED AT   | D | W |    |    |   |               |
| . | HEADQUARTERS: "VA is      |   | h |    |    |   |               |
| 3 | responsible under law for | A | i |    |    |   |               |
| 8 | operating a national      |   | l |    |    |   |               |
|   | education program. The    | A | e |    |    |   |               |
|   | proposed change would     |   | t |    |    |   |               |
|   | fragment that program     |   | h |    |    |   |               |
|   | into 22 different         |   | i |    |    |   |               |
|   | operations, and would     |   | s |    |    |   |               |
|   | have VA effectively       |   | i |    |    |   |               |
|   | abandon key national      |   | s |    |    |   |               |
|   | responsibilities."        |   | t |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   | "The Thibault Committee   |   | u |    |    |   |               |
|   | Report and the *Vision    |   | e |    |    |   |               |
|   | for Change* both identify |   | , |    |    |   |               |
|   | research and academic     |   | a |    |    |   |               |
|   | affiliations as           |   | r |    |    |   |               |
|   | intertwined missions with |   | e |    |    |   |               |
|   | a national policy,        |   | o |    |    |   |               |
|   | planning and execution    |   | r |    |    |   |               |
|   | focus."                   |   | g |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   | "It is our suggestion     |   | n |    |    |   |               |
|   | that any decentralization |   | i |    |    |   |               |
|   | of this function receive  |   | z |    |    |   |               |
|   | a great deal of study and |   | a |    |    |   |               |
|   | be researched thoroughly. |   | t |    |    |   |               |
|   | Perhaps the function      |   | i |    |    |   |               |
|   | would be best suited in   |   | o |    |    |   |               |
|   | the new VISN system under |   | n |    |    |   |               |
|   | the direction of the      |   | s |    |    |   |               |
|   | Chief Network Officer."   |   | t |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | g |    |    |   |               |
|   |                           |   | y |    |    |   |               |
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+---+---------------------------+---+---+----+----+---+---------------+
| 2 | AFFILIATIONS MANAGED AT   | \ | T |    |    |   |               |
| . | VISNs: "Affiliation       | - | h |    |    |   |               |
| 3 | management I believe      | - | i |    |    |   |               |
| 8 | needs to be at the VISN   |   | s |    |    |   |               |
|   | Director level. I simply  | \ | i |    |    |   |               |
|   | do not see material value | - | s |    |    |   |               |
|   | added to level and        | - | s |    |    |   |               |
|   | distribution of resident  |   | u |    |    |   |               |
|   | and house staff slots, at | \ | e |    |    |   |               |
|   | the national level."      | - | w |    |    |   |               |
|   |                           | - | i |    |    |   |               |
|   | "Oversight of the         |   | l |    |    |   |               |
|   | affiliation process at    | \ | l |    |    |   |               |
|   | the VISN level would      | - | b |    |    |   |               |
|   | reduce duplication of     | - | e |    |    |   |               |
|   | paperwork for individual  |   | a |    |    |   |               |
|   | facilities who would be   | \ | d |    |    |   |               |
|   | affiliating with the same | - | d |    |    |   |               |
|   | schools. It would also    | - | r |    |    |   |               |
|   | assist schools in placing |   | e |    |    |   |               |
|   | students at the most      | \ | s |    |    |   |               |
|   | appropriate training      | - | s |    |    |   |               |
|   | sites to meet the         | - | e |    |    |   |               |
|   | students' training goals  |   | d |    |    |   |               |
|   | and interests. \... If    |   | b |    |    |   |               |
|   | training positions and    |   | y |    |    |   |               |
|   | funding are               |   | t |    |    |   |               |
|   | decentralized, an effort  |   | h |    |    |   |               |
|   | must be made to maintain  |   | e |    |    |   |               |
|   | the integrity of the      |   | p |    |    |   |               |
|   | Social Work graduate      |   | r |    |    |   |               |
|   | training program."        |   | o |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   | "Managing affiliations at |   | o |    |    |   |               |
|   | the VISN level will allow |   | s |    |    |   |               |
|   | a broad perspective of    |   | e |    |    |   |               |
|   | the needs and abilities   |   | d |    |    |   |               |
|   | of each VISN facility. It |   | t |    |    |   |               |
|   | will also take the        |   | a |    |    |   |               |
|   | pressure off the local    |   | s |    |    |   |               |
|   | facility when tough       |   | k |    |    |   |               |
|   | decisions need to be      |   | f |    |    |   |               |
|   | made."                    |   | o |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   | "If indeed, our budget    |   | c |    |    |   |               |
|   | scenario is as predicted  |   | e |    |    |   |               |
|   | for the next seven years, |   | . |    |    |   |               |
|   | support of education and  |   |   |    |    |   |               |
|   | research must be at the   |   | T |    |    |   |               |
|   | VISN level. Otherwise,    |   | h |    |    |   |               |
|   | "carve outs" will be      |   | e |    |    |   |               |
|   | established and the core  |   | s |    |    |   |               |
|   | pool of money will be     |   | a |    |    |   |               |
|   | artificially eroded, much |   | m |    |    |   |               |
|   | as it has been in the     |   | e |    |    |   |               |
|   | past."                    |   | a |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   | "VISN offices should play |   | g |    |    |   |               |
|   | a major role in fostering |   | u |    |    |   |               |
|   | cooperation with medical  |   | m |    |    |   |               |
|   | school affiliates; such   |   | e |    |    |   |               |
|   | cooperative efforts would |   | n |    |    |   |               |
|   | include education and     |   | t |    |    |   |               |
|   | research deemed essential |   | c |    |    |   |               |
|   | to the VHA mission."      |   | o |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   | "Suggest a formal         |   | l |    |    |   |               |
|   | point-of-contact within   |   | d |    |    |   |               |
|   | VISNs or VSSC to          |   | b |    |    |   |               |
|   | coordinate interaction    |   | e |    |    |   |               |
|   | with research entities    |   | m |    |    |   |               |
|   | and facilitate access to  |   | a |    |    |   |               |
|   | data sources."            |   | d |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | h |    |    |   |               |
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|   |                           |   | a |    |    |   |               |
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|   |                           |   | h |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | d |    |    |   |               |
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|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | AFFILIATIONS MANAGED AT   | \ | N |    |    |   |               |
| . | VAMCs: "Moving decision   | - | o |    |    |   |               |
| 3 | making regarding resident | - | t |    |    |   |               |
| 8 | education and research to |   | n |    |    |   |               |
|   | the VISN level carries    | A | e |    |    |   |               |
|   | sole risk. There is the   |   | c |    |    |   |               |
|   | potential to undermine    |   | e |    |    |   |               |
|   | individual medical center |   | s |    |    |   |               |
|   | relationships with their  |   | s |    |    |   |               |
|   | medical affiliates."      |   | a |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   | "I am concerned with the  |   | i |    |    |   |               |
|   | concept of the VISN       |   | l |    |    |   |               |
|   | Director being required   |   | y |    |    |   |               |
|   | to interpose that         |   | s |    |    |   |               |
|   | position between Deans    |   | o |    |    |   |               |
|   | and Department Chairmen   |   | i |    |    |   |               |
|   | of the professional       |   | f |    |    |   |               |
|   | schools and local VAMC    |   | s |    |    |   |               |
|   | management. Relationships |   | t |    |    |   |               |
|   | of this kind are built on |   | r |    |    |   |               |
|   | ongoing day-to-day        |   | u |    |    |   |               |
|   | contacts between local    |   | c |    |    |   |               |
|   | VAMC management and       |   | t |    |    |   |               |
|   | Service Chiefs with the   |   | u |    |    |   |               |
|   | appropriate officials of  |   | r |    |    |   |               |
|   | the professional          |   | e |    |    |   |               |
|   | schools."                 |   | d |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | o |    |    |   |               |
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|   |                           |   | T |    |    |   |               |
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|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | Several comments were     | A | T |    |    |   |               |
| . | concerned about changing  |   | o |    |    |   |               |
| 3 | the management of         | A | b |    |    |   |               |
| 8 | affiliations and added    |   | e |    |    |   |               |
|   | comments such as:         | \ | c |    |    |   |               |
|   |                           | - | o |    |    |   |               |
|   | "There is a discussion    | - | n |    |    |   |               |
|   | about Re-engineering VHA  |   | s |    |    |   |               |
|   | Education and Research    | A | i |    |    |   |               |
|   | Affiliation Agreement and |   | d |    |    |   |               |
|   | placing them in the       | A | e |    |    |   |               |
|   | VISNs. It seems to me     |   | r |    |    |   |               |
|   | that if this done it      | D | e |    |    |   |               |
|   | ought to be approached    |   | d |    |    |   |               |
|   | slowly and with caution.  |   | b |    |    |   |               |
|   | \... The ramifications    |   | y |    |    |   |               |
|   | and risks of undertaking  |   | t |    |    |   |               |
|   | such a huge               |   | h |    |    |   |               |
|   | re-engineering effort     |   | e |    |    |   |               |
|   | especially early in the   |   | T |    |    |   |               |
|   | life of VISNs seem        |   | a |    |    |   |               |
|   | considerable."            |   | s |    |    |   |               |
|   |                           |   | k |    |    |   |               |
|   | "The plan puts full       |   | F |    |    |   |               |
|   | authority for decisions   |   | o |    |    |   |               |
|   | about how these training  |   | r |    |    |   |               |
|   | funds will be utilized on |   | c |    |    |   |               |
|   | the VISN levels. This     |   | e |    |    |   |               |
|   | could give powerful       |   | . |    |    |   |               |
|   | influential professions   |   |   |    |    |   |               |
|   | on the VISN level the     |   | T |    |    |   |               |
|   | opportunity to direct     |   | h |    |    |   |               |
|   | funds in their preferred  |   | e |    |    |   |               |
|   | directions. The VA also   |   | W |    |    |   |               |
|   | need to plan on local     |   | o |    |    |   |               |
|   | facility and national     |   | r |    |    |   |               |
|   | level to meet future      |   | k |    |    |   |               |
|   | needs for health care     |   | G |    |    |   |               |
|   | experts."                 |   | r |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   | "In spite of the fear of  |   | u |    |    |   |               |
|   | lack of oversight, to put |   | p |    |    |   |               |
|   | a distance between the    |   | f |    |    |   |               |
|   | affiliate and VA          |   | e |    |    |   |               |
|   | executive will not solve  |   | l |    |    |   |               |
|   | any of the problems. It   |   | t |    |    |   |               |
|   | will put good             |   | i |    |    |   |               |
|   | functioning, mutually     |   | t |    |    |   |               |
|   | beneficial affiliations   |   | i |    |    |   |               |
|   | at risk."                 |   | m |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   | "There is concern that    |   | o |    |    |   |               |
|   | self-interest in larger   |   | r |    |    |   |               |
|   | VHA facilities within     |   | t |    |    |   |               |
|   | VISNs will result in bias |   | a |    |    |   |               |
|   | in distribution of        |   | n |    |    |   |               |
|   | resources including FTEs. |   | t |    |    |   |               |
|   | There is also concern     |   | t |    |    |   |               |
|   | that the power and        |   | o |    |    |   |               |
|   | influence of local        |   | f |    |    |   |               |
|   | universities could be     |   | u |    |    |   |               |
|   | underestimated. Local     |   | r |    |    |   |               |
|   | VHAs and Universities are |   | t |    |    |   |               |
|   | not always "equal         |   | h |    |    |   |               |
|   | partners". The ability to |   | e |    |    |   |               |
|   | recruit excellence        |   | r |    |    |   |               |
|   | faculties at VHAs has     |   | s |    |    |   |               |
|   | usually been a function   |   | t |    |    |   |               |
|   | of strength of            |   | u |    |    |   |               |
|   | affiliation agreements."  |   | d |    |    |   |               |
|   |                           |   | y |    |    |   |               |
|   | "Need to define           |   | t |    |    |   |               |
|   | educational role of       |   | h |    |    |   |               |
|   | Headquarters and local    |   | e |    |    |   |               |
|   | facilities to avoid       |   | r |    |    |   |               |
|   | activities that may be    |   | e |    |    |   |               |
|   | counterproductive in the  |   | l |    |    |   |               |
|   | outcome of education and  |   | a |    |    |   |               |
|   | research and avoid        |   | t |    |    |   |               |
|   | curtailing freedom."      |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   | "Professional and         |   | n |    |    |   |               |
|   | managerial training       |   | s |    |    |   |               |
|   | programs (for other than  |   | h |    |    |   |               |
|   | physicians and nurses)    |   | i |    |    |   |               |
|   | are not addressed in this |   | p |    |    |   |               |
|   | report which could place  |   | b |    |    |   |               |
|   | associated health trainee |   | e |    |    |   |               |
|   | leadership training       |   | t |    |    |   |               |
|   | programs at a significant |   | w |    |    |   |               |
|   | disadvantage."            |   | e |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   | "I would question the     |   | n |    |    |   |               |
|   | need to appoint           |   | a |    |    |   |               |
|   | [another]{.underline}     |   | l |    |    |   |               |
|   | group to study these      |   | l |    |    |   |               |
|   | issues at this time."     |   | t |    |    |   |               |
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+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "There should be an       | \ | T |    |    |   |               |
| . | ability to disseminate    | - | h |    |    |   |               |
| 3 | stipends to the field for | - | e |    |    |   |               |
| 8 | many programs, including  |   | p |    |    |   |               |
|   | Social Work."             |   | r |    |    |   |               |
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+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "The Federal Advisory     | \ | N |    |    |   |               |
| . | Committee Act requires    | - | o |    |    |   |               |
| 3 | Federal agencies to       | - | t |    |    |   |               |
| 8 | follow certain procedures |   | e |    |    |   |               |
|   | in establishing and using |   | d |    |    |   |               |
|   | advisory committees. The  |   | . |    |    |   |               |
|   | report suggests           |   |   |    |    |   |               |
|   | establishing an           |   |   |    |    |   |               |
|   | Interdisciplinary         |   |   |    |    |   |               |
|   | Academic Advisory         |   |   |    |    |   |               |
|   | Committee consisting of   |   |   |    |    |   |               |
|   | VA employees, affiliated  |   |   |    |    |   |               |
|   | institution               |   |   |    |    |   |               |
|   | representatives, veterans |   |   |    |    |   |               |
|   | service organizations,    |   |   |    |    |   |               |
|   | and others. The Committee |   |   |    |    |   |               |
|   | would provide guidance,   |   |   |    |    |   |               |
|   | counsel, and input for    |   |   |    |    |   |               |
|   | education and research    |   |   |    |    |   |               |
|   | activities. The Committee |   |   |    |    |   |               |
|   | would be subject to the   |   |   |    |    |   |               |
|   | Federal Advisory          |   |   |    |    |   |               |
|   | Committee Act. We         |   |   |    |    |   |               |
|   | recommend that the report |   |   |    |    |   |               |
|   | note the applicability of |   |   |    |    |   |               |
|   | this law to this          |   |   |    |    |   |               |
|   | Committee."               |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "One suggestion that may  | A | S |    |    |   |               |
| . | be helpful for using this |   | u |    |    |   |               |
| 3 | report most effectively   |   | b |    |    |   |               |
| 8 | would be to emphasize the |   | s |    |    |   |               |
|   | need for inter-rather     |   | t |    |    |   |               |
|   | than multi-disciplinary   |   | i |    |    |   |               |
|   | since the two concepts    |   | t |    |    |   |               |
|   | carry important           |   | u |    |    |   |               |
|   | distinctions in terms of  |   | t |    |    |   |               |
|   | functioning."             |   | e |    |    |   |               |
|   |                           |   | " |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | n |    |    |   |               |
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|   |                           |   | " |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "It is suggested that the | D | T |    |    |   |               |
| . | research strategy         |   | h |    |    |   |               |
| 3 | component be separated    |   | e |    |    |   |               |
| 8 | out and discussed         |   | A |    |    |   |               |
|   | explicitly."              |   | f |    |    |   |               |
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|   |                           |   | o |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | v |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | m |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "Recommend all sources of | D | N |    |    |   |               |
| . | funding for education and |   | o |    |    |   |               |
| 3 | training (i.e., RMECS,    | \ | t |    |    |   |               |
| 8 | CEC, CHEPS, GRECCs,etc.)  | - | i |    |    |   |               |
|   | be shifted to a common    | - | n |    |    |   |               |
|   | budget."                  |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   | "Tuition support funding  |   | e |    |    |   |               |
|   | should be expanded and    |   | p |    |    |   |               |
|   | made available to a wider |   | e |    |    |   |               |
|   | range of candidates while |   | r |    |    |   |               |
|   | flexibility is needed to  |   | v |    |    |   |               |
|   | move tuition              |   | i |    |    |   |               |
|   | reimbursement funding     |   | e |    |    |   |               |
|   | into tuition support. Do  |   | w |    |    |   |               |
|   | not restrict the funding  |   | o |    |    |   |               |
|   | to only clinical          |   | f |    |    |   |               |
|   | employees and expand the  |   | t |    |    |   |               |
|   | categories beyond managed |   | h |    |    |   |               |
|   | and primary care issues." |   | e |    |    |   |               |
|   |                           |   | A |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | f |    |    |   |               |
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|   |                           |   | t |    |    |   |               |
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|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | G |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | . |    |    |   |               |
|   |                           |   |   |    |    |   |               |
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|   |                           |   | o |    |    |   |               |
|   |                           |   | t |    |    |   |               |
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|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
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|   |                           |   | p |    |    |   |               |
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|   |                           |   | f |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | A |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | G |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | p |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | "I believe the VISN       |   | W |    |    |   |               |
| . | Activation report should  |   | h |    |    |   |               |
| 3 | focus on the patient care |   | i |    |    |   |               |
| 8 | issues which will consume |   | l |    |    |   |               |
|   | the VISN Directors and    |   | e |    |    |   |               |
|   | all of VHA in the next    |   | p |    |    |   |               |
|   | few years and not divert  |   | a |    |    |   |               |
|   | energy tilting at 'straw  |   | t |    |    |   |               |
|   | men.' "                   |   | i |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | t |    |    |   |               |
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|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
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|   |                           |   | n |    |    |   |               |
|   |                           |   | d |    |    |   |               |
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|   |                           |   | d |    |    |   |               |
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|   |                           |   | u |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | k |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | y |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | u |    |    |   |               |
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|   |                           |   | s |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | Change "multi" to         |   |   |    |    |   |               |
|   | "interdisciplinary".      |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+

+---+---------------------------+---+---+----+----+---+---------------+
| * | **[Recom                  |   |   |    |    | * | **[R          |
| * | mendation:]{.underline}** |   |   |    |    | * | emarks]{.unde |
| [ |                           |   |   |    |    | [ | rline}-K^2^** |
| R | Charge VISNs upon their   |   |   |    |    | A |               |
| e | activation with enhancing |   |   |    |    | / |               |
| f | education and research    |   |   |    |    | D |               |
| N | activities by: (a).       |   |   |    |    | / |               |
| o | Identifying mechanisms to |   |   |    |    | O |               |
| ] | become familiar with and  |   |   |    |    | ] |               |
| { | track the wide range of   |   |   |    |    | { |               |
| . | academic activities       |   |   |    |    | . |               |
| u | within their facilities;  |   |   |    |    | u |               |
| n | (b). Designing methods to |   |   |    |    | n |               |
| d | promote collaboration and |   |   |    |    | d |               |
| e | partnership between       |   |   |    |    | e |               |
| r | affiliates, the VISN and  |   |   |    |    | r |               |
| l | individual clinical care  |   |   |    |    | l |               |
| i | facilities within the     |   |   |    |    | i |               |
| n | VISN; (c). Implementing   |   |   |    |    | n |               |
| e | education realignments    |   |   |    |    | e |               |
| } | and constructing new      |   |   |    |    | } |               |
| * | affiliation agreements    |   |   |    |    | * |               |
| * | that are outgrowths of    |   |   |    |    | * |               |
|   | clinical resource         |   |   |    |    |   |               |
| 2 | realignments within the   |   |   |    |    |   |               |
| . | VISN. This should occur   |   |   |    |    |   |               |
| 3 | in consultation with      |   |   |    |    |   |               |
| 9 | Headquarters; (d).        |   |   |    |    |   |               |
|   | Developing strategies     |   |   |    |    |   |               |
|   | which encourage research  |   |   |    |    |   |               |
|   | activities, promoting     |   |   |    |    |   |               |
|   | growth and development    |   |   |    |    |   |               |
|   | and fostering cooperation |   |   |    |    |   |               |
|   | and sharing; and (e).     |   |   |    |    |   |               |
|   | Developing approaches for |   |   |    |    |   |               |
|   | Academic Health Centers   |   |   |    |    |   |               |
|   | and VISNs to jointly      |   |   |    |    |   |               |
|   | develop and integrate     |   |   |    |    |   |               |
|   | health delivery systems   |   |   |    |    |   |               |
|   | to maximize care for      |   |   |    |    |   |               |
|   | veterans and society.     |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Action Required**       | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   |                           |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Comments**              | * | * |    |    |   |               |
|   |                           | * | * |    |    |   |               |
|   |                           | A | R |    |    |   |               |
|   |                           | / | a |    |    |   |               |
|   |                           | D | t |    |    |   |               |
|   |                           | * | i |    |    |   |               |
|   |                           | * | o |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | * |    |    |   |               |
|   |                           |   | * |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | All seven comments we     | A | C |    |    |   |               |
| . | received expressed        |   | o |    |    |   |               |
| 3 | concern regarding         | A | n |    |    |   |               |
| 9 | research. Below are some  |   | s |    |    |   |               |
|   | of their comments:        | \ | i |    |    |   |               |
|   |                           | - | s |    |    |   |               |
|   | "The concept of           | - | t |    |    |   |               |
|   | continuing a strong basic |   | e |    |    |   |               |
|   | science component in our  | A | n |    |    |   |               |
|   | research program, with    |   | t |    |    |   |               |
|   | expanded activities in    | A | w |    |    |   |               |
|   | health services research  |   | i |    |    |   |               |
|   | directed at the care of   |   | t |    |    |   |               |
|   | veterans seems solid. It  |   | h |    |    |   |               |
|   | is vital that centrally   |   | r |    |    |   |               |
|   | managed peer review be    |   | e |    |    |   |               |
|   | retained."                |   | c |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   | "We want to strengthen    |   | m |    |    |   |               |
|   | our research mission      |   | m |    |    |   |               |
|   | through a variety of      |   | e |    |    |   |               |
|   | approaches\--including    |   | n |    |    |   |               |
|   | more                      |   | d |    |    |   |               |
|   | solicitations/requests    |   | e |    |    |   |               |
|   | for proposals. Also we    |   | d |    |    |   |               |
|   | need to ensure            |   | a |    |    |   |               |
|   | appropriate               |   | c |    |    |   |               |
|   | feedback/communication    |   | t |    |    |   |               |
|   | links toward getting best |   | i |    |    |   |               |
|   | practices research into   |   | o |    |    |   |               |
|   | health care practice. And |   | n |    |    |   |               |
|   | we need to publicize good |   | s |    |    |   |               |
|   | research results as a PR  |   | . |    |    |   |               |
|   | initiative."              |   |   |    |    |   |               |
|   |                           |   | T |    |    |   |               |
|   | "Although affiliations    |   | h |    |    |   |               |
|   | are certainly germane to  |   | e |    |    |   |               |
|   | the VA research project,  |   | r |    |    |   |               |
|   | we believe that the       |   | e |    |    |   |               |
|   | relationship of the       |   | c |    |    |   |               |
|   | research program to       |   | o |    |    |   |               |
|   | affiliations is           |   | m |    |    |   |               |
|   | significantly different   |   | m |    |    |   |               |
|   | from the relationship of  |   | e |    |    |   |               |
|   | the education program to  |   | n |    |    |   |               |
|   | affiliations."            |   | d |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   | "Lumping of research and  |   | d |    |    |   |               |
|   | education 'VA's Academic  |   | a |    |    |   |               |
|   | Mission' is confusing and |   | c |    |    |   |               |
|   | misleading, in that       |   | t |    |    |   |               |
|   | research has a broader    |   | i |    |    |   |               |
|   | purpose, including        |   | o |    |    |   |               |
|   | production of knowledge   |   | n |    |    |   |               |
|   | to help veteran patients  |   | d |    |    |   |               |
|   | and the veterans health   |   | o |    |    |   |               |
|   | care system."             |   | e |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   | "The impact on mission    |   | n |    |    |   |               |
|   | changes will profoundly   |   | o |    |    |   |               |
|   | impact existing           |   | t |    |    |   |               |
|   | affiliations."            |   | p |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | l |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | d |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | i |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | . |    |    |   |               |
|   |                           |   |   |    |    |   |               |
|   |                           |   | R |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | a |    |    |   |               |
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|   |                           |   | m |    |    |   |               |
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|   |                           |   | l |    |    |   |               |
|   |                           |   | y |    |    |   |               |
|   |                           |   | f |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | V |    |    |   |               |
|   |                           |   | I |    |    |   |               |
|   |                           |   | S |    |    |   |               |
|   |                           |   | N |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | t |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | n |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | o |    |    |   |               |
|   |                           |   | u |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | g |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | s |    |    |   |               |
|   |                           |   | e |    |    |   |               |
|   |                           |   | a |    |    |   |               |
|   |                           |   | r |    |    |   |               |
|   |                           |   | c |    |    |   |               |
|   |                           |   | h |    |    |   |               |
|   |                           |   | . |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
| 2 | ["Financial               | A | \ |    |    |   |               |
| . | Management]{.underline}   |   | - |    |    |   |               |
| 3 | \-- Suggest adding, after |   | - |    |    |   |               |
| 9 | last sentence, 'VISN      |   |   |    |    |   |               |
|   | Directors will pass       |   |   |    |    |   |               |
|   | through funding (and FTE) |   |   |    |    |   |               |
|   | for research              |   |   |    |    |   |               |
|   | programs/projects         |   |   |    |    |   |               |
|   | approved in HQ to medical |   |   |    |    |   |               |
|   | centers where funded      |   |   |    |    |   |               |
|   | investigators are         |   |   |    |    |   |               |
|   | located.' VISNs are       |   |   |    |    |   |               |
|   | included in the funding   |   |   |    |    |   |               |
|   | channel to ensure that    |   |   |    |    |   |               |
|   | these organizational      |   |   |    |    |   |               |
|   | units are fully informed  |   |   |    |    |   |               |
|   | of all funding flowing    |   |   |    |    |   |               |
|   | into their areas of       |   |   |    |    |   |               |
|   | jurisdiction. VISN        |   |   |    |    |   |               |
|   | Directors will            |   |   |    |    |   |               |
|   | responsible for ensuring  |   |   |    |    |   |               |
|   | a high quality research   |   |   |    |    |   |               |
|   | program."                 |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | **Proposed Revision**     | * |   | ** | ** |   |               |
|   |                           | * |   | Ta | Ac |   |               |
|   |                           | A |   | rg | tu |   |               |
|   |                           | c |   | et | al |   |               |
|   |                           | t |   | Da | Da |   |               |
|   |                           | i |   | te | te |   |               |
|   |                           | o |   | ** | ** |   |               |
|   |                           | n |   |    |    |   |               |
|   |                           | O |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | f |   |    |    |   |               |
|   |                           | i |   |    |    |   |               |
|   |                           | c |   |    |    |   |               |
|   |                           | e |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
|   |                           | * |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+
|   | No change is recommended  |   |   |    |    |   |               |
|   | at this time.             |   |   |    |    |   |               |
+---+---------------------------+---+---+----+----+---+---------------+