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

  -------------------- ---------------------------------------------- -- ------------------------- -----------------------------
  **[Ref               **INTRODUCTION**                                  **[A/D/O]{.underline}**   **[Remarks-K]{.underline}**
  No.]{.underline}**                                                                               

  -------------------- ---------------------------------------------- -- ------------------------- -----------------------------

+---+---------------------------+---+---------------+----+-------------+
|   | **General Comments**      | * | **Rationale** |    |             |
|   |                           | * |               |    |             |
|   |                           | A |               |    |             |
|   |                           | / |               |    |             |
|   |                           | D |               |    |             |
|   |                           | * |               |    |             |
|   |                           | * |               |    |             |
+---+---------------------------+---+---------------+----+-------------+
|   | **[The New Organizational |   | The intent of |    |             |
|   | Structure]{.underline}**  |   | the           |    |             |
|   |                           |   | Headquarters  |    |             |
|   | ¥ Several observations    |   | Restructuring |    |             |
|   | (5) were made regarding   |   | Workgroup was |    |             |
|   | the new organization      |   | to develop an |    |             |
|   | bearing a close           |   | o             |    |             |
|   | resemblance to the former |   | rganizational |    |             |
|   | one. Comments (4)         |   | structure     |    |             |
|   | emphasized that the       |   | reflecting    |    |             |
|   | organizational chart      |   | the *Vision   |    |             |
|   | looks like the old one,   |   | for Change*   |    |             |
|   | and depicts VHA as a      |   | document that |    |             |
|   | traditional hierarchy     |   | does change   |    |             |
|   | with lines of authority   |   | program       |    |             |
|   | denoting the offices with |   | elements such |    |             |
|   | greater influence and     |   | as the Office |    |             |
|   | administrative priority.  |   | of Policy,    |    |             |
|   | Even accepting that       |   | Planning, and |    |             |
|   | reengineering relies more |   | Performance   |    |             |
|   | on redefining             |   | (PPP), the    |    |             |
|   | responsibilities and      |   | Chief         |    |             |
|   | functions of offices and  |   | Information   |    |             |
|   | reshaping the             |   | Officer, and  |    |             |
|   | relationships among       |   | the Product   |    |             |
|   | operations, it appears    |   | Li            |    |             |
|   | that VHA is retaining the |   | nes/Strategic |    |             |
|   | old structure and         |   | Healthcare    |    |             |
|   | misplacing offices within |   | Groups        |    |             |
|   | the new hierarchy. This   |   | operation     |    |             |
|   | comment and others (7)    |   | within the    |    |             |
|   | expressed concern         |   | Office of     |    |             |
|   | regarding the size and    |   | Paitent Care  |    |             |
|   | placement of functions,   |   | Services.     |    |             |
|   | and concern that the new  |   | Whether       |    |             |
|   | HQ organization having    |   | employees are |    |             |
|   | little or no relationship |   | placed in     |    |             |
|   | to the VISNs and field    |   | boxes or      |    |             |
|   | organization.             |   | circles or    |    |             |
|   |                           |   | shown in      |    |             |
|   | ¥ Realizing the challenge |   | straight      |    |             |
|   | associated with critical  |   | lines, there  |    |             |
|   | reductions in operating   |   | is a          |    |             |
|   | budgets in the field for  |   | requirement   |    |             |
|   | the years ahead, several  |   | for some      |    |             |
|   | writers (5) expected a    |   | o             |    |             |
|   | concomitant downsizing or |   | rganizational |    |             |
|   | flattening of HQ to       |   | structure.    |    |             |
|   | reflect the realities of  |   |               |    |             |
|   | the new organization. One |   | The new       |    |             |
|   | writer emphasized that it |   | organzational |    |             |
|   | would have been helpful   |   | structure     |    |             |
|   | to understand the         |   | proposes a    |    |             |
|   | budgetary implication on  |   | role of HQ to |    |             |
|   | any proposed changes and  |   | provide staff |    |             |
|   | realignment of dollars    |   | support to    |    |             |
|   | that will occur.          |   | the field, to |    |             |
|   |                           |   | the VISNs, to |    |             |
|   | ¥ One VAMC director also  |   | the           |    |             |
|   | emphasized that a         |   | Secretary,    |    |             |
|   | flattening of the HQ      |   | and to        |    |             |
|   | organization would speed  |   | external      |    |             |
|   | up decision making for    |   | groups        |    |             |
|   | the field and shorten the |   | through an    |    |             |
|   | concurrence chain.        |   | integrated,   |    |             |
|   | Several writers (3) noted |   | inte          |    |             |
|   | that the proposed         |   | rdisciplinary |    |             |
|   | movement of positions and |   | model.        |    |             |
|   | functions horizontally    |   |               |    |             |
|   | within HQ does not        |   | The charge to |    |             |
|   | clearly support           |   | the workgroup |    |             |
|   | decentralization of       |   | was not to    |    |             |
|   | authority to operating    |   | reduce staff  |    |             |
|   | level (VISNs). One        |   | nor did it    |    |             |
|   | commentary also           |   | include       |    |             |
|   | emphasized that neither   |   | costing of    |    |             |
|   | does it clearly support   |   | various       |    |             |
|   | the key principles of the |   | scenarios.    |    |             |
|   | National Performance      |   | The 1996      |    |             |
|   | Review (i.e., cutting red |   | Budget        |    |             |
|   | tape and micro-management |   | constraint    |    |             |
|   | and empowering employees  |   | has impacted  |    |             |
|   | to get results by         |   | realignment,  |    |             |
|   | delegating authority and  |   | but it was    |    |             |
|   | responsibility).          |   | not a known   |    |             |
|   |                           |   | factor or an  |    |             |
|   |                           |   | ascribed      |    |             |
|   |                           |   | assumption of |    |             |
|   |                           |   | this group's  |    |             |
|   |                           |   | work efforts  |    |             |
|   |                           |   | and           |    |             |
|   |                           |   | d             |    |             |
|   |                           |   | eliberations. |    |             |
+---+---------------------------+---+---------------+----+-------------+
|   | **[Concern that current   |   | Commentary is |    |             |
|   | HQ FTE is only being      |   | consistent    |    |             |
|   | rearranged, and there is  |   | with many of  |    |             |
|   | no move to critically     |   | the Workgroup |    |             |
|   | review HQ or its out      |   | deliberations |    |             |
|   | placed field units for    |   | and           |    |             |
|   | reduction]{.underline}**  |   | discussions.  |    |             |
|   |                           |   |               |    |             |
|   | ¥ Commentaries (15)       |   |               |    |             |
|   | wholeheartedly agreed     |   |               |    |             |
|   | with and offered numerous |   |               |    |             |
|   | laudable statements       |   |               |    |             |
|   | regarding the workgroups  |   |               |    |             |
|   | focus at HQ integration , |   |               |    |             |
|   | streamlining and process  |   |               |    |             |
|   | reengineering, noting     |   |               |    |             |
|   | that the initial efforts  |   |               |    |             |
|   | of the HQ Restructuring   |   |               |    |             |
|   | Group were                |   |               |    |             |
|   | straight-forward and      |   |               |    |             |
|   | revealed a significant    |   |               |    |             |
|   | amount of work.           |   |               |    |             |
|   |                           |   |               |    |             |
|   | ¥ However, several        |   |               |    |             |
|   | observations (8) were     |   |               |    |             |
|   | made that no major        |   |               |    |             |
|   | reductions in FTE or      |   |               |    |             |
|   | tasks were evidenced.     |   |               |    |             |
|   | Rather than eliminating   |   |               |    |             |
|   | offices or functions, the |   |               |    |             |
|   | report retains many HQ    |   |               |    |             |
|   | offices with similar      |   |               |    |             |
|   | and/or related activities |   |               |    |             |
|   | that add to the           |   |               |    |             |
|   | fragmentation and         |   |               |    |             |
|   | duplication of effort.    |   |               |    |             |
|   |                           |   |               |    |             |
|   | ¥ Several writers (3)     |   |               |    |             |
|   | questioned the value or   |   |               |    |             |
|   | assignment of many out    |   |               |    |             |
|   | placed field units being  |   |               |    |             |
|   | denoted as HQ support,    |   |               |    |             |
|   | such as CMOPs. One writer |   |               |    |             |
|   | specifically indicated    |   |               |    |             |
|   | that only the out placed  |   |               |    |             |
|   | field units associated    |   |               |    |             |
|   | with the Office of        |   |               |    |             |
|   | Policy, Planning, and     |   |               |    |             |
|   | Performance were          |   |               |    |             |
|   | identified within the     |   |               |    |             |
|   | workgroup report, and     |   |               |    |             |
|   | questioned why only these |   |               |    |             |
|   | HQ support units were     |   |               |    |             |
|   | singled out for scrutiny  |   |               |    |             |
|   | and review when           |   |               |    |             |
|   | considerably larger       |   |               |    |             |
|   | offices with extensive    |   |               |    |             |
|   | field components were not |   |               |    |             |
|   | addressed. It was         |   |               |    |             |
|   | emphasized that all HQ    |   |               |    |             |
|   | organizations FTE levels  |   |               |    |             |
|   | should be examined well   |   |               |    |             |
|   | before January 1996.      |   |               |    |             |
|   |                           |   |               |    |             |
|   | ¥ One writer commented    |   |               |    |             |
|   | that the National Media   |   |               |    |             |
|   | Development Centers,      |   |               |    |             |
|   | Regional Medical          |   |               |    |             |
|   | Education Centers and     |   |               |    |             |
|   | other Academic Affairs    |   |               |    |             |
|   | field units need to be    |   |               |    |             |
|   | added to the list of out  |   |               |    |             |
|   | placed units supporting   |   |               |    |             |
|   | HQ.                       |   |               |    |             |
+---+---------------------------+---+---------------+----+-------------+
|   | **[Need for Continued     |   | Commentary is |    |             |
|   | Review and/or Study by    |   | consistent    |    |             |
|   | Additional                |   | with many of  |    |             |
|   | Workgroups]{.underline}** |   | the Workgroup |    |             |
|   |                           |   | deliberations |    |             |
|   | ¥ Several individuals (5) |   | and           |    |             |
|   | commented on the          |   | discussions.  |    |             |
|   | intricacy and complexity  |   |               |    |             |
|   | of the HQ organization,   |   |               |    |             |
|   | and the lack of           |   |               |    |             |
|   | definition of many of the |   |               |    |             |
|   | recommendations and       |   |               |    |             |
|   | action items. Although    |   |               |    |             |
|   | many writers supported    |   |               |    |             |
|   | and encouraged additional |   |               |    |             |
|   | task forces and           |   |               |    |             |
|   | committees to study the   |   |               |    |             |
|   | areas suggested in the    |   |               |    |             |
|   | report, an equal number   |   |               |    |             |
|   | of commentaries           |   |               |    |             |
|   | emphasized the need to    |   |               |    |             |
|   | eliminate or restrict     |   |               |    |             |
|   | ongoing committee work.   |   |               |    |             |
|   | Several writers (4)       |   |               |    |             |
|   | strongly emphasized that  |   |               |    |             |
|   | recommendations should be |   |               |    |             |
|   | implemented with course   |   |               |    |             |
|   | corrections as needed     |   |               |    |             |
|   | being identified and      |   |               |    |             |
|   | acted upon as the new     |   |               |    |             |
|   | organization evolves. One |   |               |    |             |
|   | VAMC Director also        |   |               |    |             |
|   | emphasized that it is     |   |               |    |             |
|   | important that those      |   |               |    |             |
|   | persons assigned          |   |               |    |             |
|   | responsibility for major  |   |               |    |             |
|   | HQ elements have the      |   |               |    |             |
|   | latitude and flexibility  |   |               |    |             |
|   | to alter the evolving     |   |               |    |             |
|   | structure as necessary.   |   |               |    |             |
+---+---------------------------+---+---------------+----+-------------+
|   | **[Composition of         |   | The Workgroup |    |             |
|   | Workgroups and/or Task    |   | agreed with   |    |             |
|   | Forces when these groups  |   | this concern, |    |             |
|   | are suggested to evaluate |   | and strongly  |    |             |
|   | a Program and it future   |   | believed that |    |             |
|   | or                        |   | ÔuserÕ input  |    |             |
|   | ganization]{.underline}** |   | on how HQ is  |    |             |
|   |                           |   | restructured  |    |             |
|   | ¥ Several writers (4)     |   | should        |    |             |
|   | commented on the wisdom   |   | emphasize the |    |             |
|   | of assigning Program      |   | new culture   |    |             |
|   | Directors (i.e., Chiefs   |   | of HQ as      |    |             |
|   | of Programs) to evaluate  |   | support to    |    |             |
|   | the need to continue the  |   | the field.    |    |             |
|   | program and or determine  |   | Adjustments   |    |             |
|   | staffing for a program    |   | in the report |    |             |
|   | for which they have major |   | have been     |    |             |
|   | responsibility. It was    |   | made to       |    |             |
|   | emphasized that these     |   | recommended   |    |             |
|   | individuals have the most |   | task force    |    |             |
|   | to lose (or win) to the   |   | composition   |    |             |
|   | evaluations of these      |   | to assure     |    |             |
|   | programs and proposals.   |   | field         |    |             |
|   | Thereby, the outcomes if  |   | r             |    |             |
|   | favorable to the Chief    |   | epresentation |    |             |
|   | might be questioned as    |   | at the level  |    |             |
|   | \'empire building\' or at |   | of VISN or    |    |             |
|   | least viewed as not an    |   | VAMC          |    |             |
|   | objective analysis. Thus, |   | directors, as |    |             |
|   | the use of an impartial   |   | appropriate.  |    |             |
|   | individual and/or         |   |               |    |             |
|   | organizational entity     |   |               |    |             |
|   | that did not have a stake |   |               |    |             |
|   | in the outcome was        |   |               |    |             |
|   | suggested when further    |   |               |    |             |
|   | program evaluation or     |   |               |    |             |
|   | assessment was            |   |               |    |             |
|   | recommended.              |   |               |    |             |
+---+---------------------------+---+---------------+----+-------------+
|   | **[Review and/or          |   | The HQ        |    |             |
|   | Incorporation of Comments |   | Restructuring |    |             |
|   | Received in Response to   |   | Workgroup met |    |             |
|   | Dissemination of Draft    |   | as a core     |    |             |
|   | Report]{.underline}**     |   | group prior   |    |             |
|   |                           |   | to the final  |    |             |
|   | ¥ Several writers (4)     |   | report. All   |    |             |
|   | expressed concern that    |   | comments      |    |             |
|   | their comments made       |   | received were |    |             |
|   | during interviews of      |   | reviewed in   |    |             |
|   | Program Officials and/or  |   | detail by the |    |             |
|   | submitted in response to  |   | appropriate   |    |             |
|   | the dissemination of the  |   | subgroups and |    |             |
|   | draft report did not      |   | taken into    |    |             |
|   | result in a change in the |   | c             |    |             |
|   | information or            |   | onsideration. |    |             |
|   | recommendations in this   |   |               |    |             |
|   | report. Additionally      |   |               |    |             |
|   | writers were uncertain if |   |               |    |             |
|   | their commentary had been |   |               |    |             |
|   | taken into consideration  |   |               |    |             |
|   | during the deliberative   |   |               |    |             |
|   | process of the workgroup  |   |               |    |             |
|   | since the final report    |   |               |    |             |
|   | did not discuss or        |   |               |    |             |
|   | reflect the issue,        |   |               |    |             |
|   | suggestions, or concern   |   |               |    |             |
|   | raised in their response. |   |               |    |             |
|   |                           |   |               |    |             |
|   | ¥ One writer, who also    |   |               |    |             |
|   | participated as a         |   |               |    |             |
|   | subgroup member,          |   |               |    |             |
|   | expressed astonishment    |   |               |    |             |
|   | that the final report     |   |               |    |             |
|   | reflected an issue that   |   |               |    |             |
|   | was neither an issue in   |   |               |    |             |
|   | the Subcommittee nor in   |   |               |    |             |
|   | Core committee            |   |               |    |             |
|   | discussions in which she  |   |               |    |             |
|   | participated. This writer |   |               |    |             |
|   | expressed concern that    |   |               |    |             |
|   | the report presented a    |   |               |    |             |
|   | minority opinion of the   |   |               |    |             |
|   | core committee.           |   |               |    |             |
+---+---------------------------+---+---------------+----+-------------+
|   | **[Implementation         |   | Commentary is |    |             |
|   | Planning and Timing of    |   | consistent    |    |             |
|   | Actions]{.underline}**    |   | with          |    |             |
|   |                           |   | workgroup     |    |             |
|   | ¥ Several writers (5)     |   | d             |    |             |
|   | commented on the          |   | eliberations. |    |             |
|   | importance of beginning   |   | As            |    |             |
|   | implementation planning   |   | appropriate,  |    |             |
|   | immediately. Concern was  |   | recommended   |    |             |
|   | expressed that the        |   | i             |    |             |
|   | October 1 beginning dates |   | mplementation |    |             |
|   | were, in many actions,    |   | dates have    |    |             |
|   | too late to begin         |   | been reviewed |    |             |
|   | important phases of the   |   | and revised.  |    |             |
|   | implementation activity.  |   | It is         |    |             |
|   | Other observations were   |   | emphasized    |    |             |
|   | made regarding the        |   | that dates    |    |             |
|   | ability of the various    |   | and/or        |    |             |
|   | organizational entities   |   | methods of    |    |             |
|   | to meet the target dates  |   | i             |    |             |
|   | given the complexity of   |   | mplementation |    |             |
|   | the issues presented.     |   | will be       |    |             |
|   | Several writers (7)       |   | determined    |    |             |
|   | recommended the critical  |   | and correlate |    |             |
|   | review of action dates    |   | with approval |    |             |
|   | because they were either  |   | and/or        |    |             |
|   | insufficient to allow     |   | concurrence   |    |             |
|   | appropriate opportunity   |   | of            |    |             |
|   | for review of an issue,   |   | recommended   |    |             |
|   | or not immediate enough   |   | actions, if   |    |             |
|   | to assure aggressive      |   | received, by  |    |             |
|   | implementation activity   |   | the Under     |    |             |
|   | resulting in significant  |   | Secretary for |    |             |
|   | change in HQ.             |   | Health.       |    |             |
|   |                           |   |               |    |             |
|   | ¥ Concern was expressed   |   | The charge to |    |             |
|   | regarding the impact of   |   | the workgroup |    |             |
|   | FY 96 MAMOE appropriation |   | was not to    |    |             |
|   | action and impact of FY   |   | reduce staff  |    |             |
|   | 97 implications. This     |   | nor did it    |    |             |
|   | writer recommended that   |   | include       |    |             |
|   | several exhibits be       |   | costing of    |    |             |
|   | prepared to help the USH  |   | various       |    |             |
|   | use the reorganization to |   | scenarios.    |    |             |
|   | minimize the operational  |   | The 1996      |    |             |
|   | impact of any staff       |   | Budget        |    |             |
|   | reductions. These         |   | constraint    |    |             |
|   | exhibits would assist     |   | has impacted  |    |             |
|   | decision making on the    |   | realignment,  |    |             |
|   | relative sizes of the     |   | but it was    |    |             |
|   | components of the         |   | not a known   |    |             |
|   | restructured HQ           |   | factor or an  |    |             |
|   | consistent with budgeted  |   | ascribed      |    |             |
|   | levels. The approved      |   | assumption of |    |             |
|   | allocations could be      |   | this group's  |    |             |
|   | shared with HQ Committee  |   | work efforts  |    |             |
|   | and subcommittees to      |   | and           |    |             |
|   | expand their reports to   |   | d             |    |             |
|   | suggest how targeted      |   | eliberations. |    |             |
|   | levels should be          |   |               |    |             |
|   | achieved. The             |   |               |    |             |
|   | reorganization and staff  |   |               |    |             |
|   | reductions should be      |   |               |    |             |
|   | treated as a unit         |   |               |    |             |
|   | conceptually even if      |   |               |    |             |
|   | implementation cannot be  |   |               |    |             |
|   | simultaneous for          |   |               |    |             |
|   | practical considerations. |   |               |    |             |
|   |                           |   |               |    |             |
|   | ¥ Comments (3) suggested  |   |               |    |             |
|   | that the report document  |   |               |    |             |
|   | more sharply compare and  |   |               |    |             |
|   | contrast functionally how |   |               |    |             |
|   | the proposed new          |   |               |    |             |
|   | organizational structure  |   |               |    |             |
|   | will differ from the      |   |               |    |             |
|   | current. A comprehensive  |   |               |    |             |
|   | chart listing             |   |               |    |             |
|   | organizational            |   |               |    |             |
|   | elements/functions        |   |               |    |             |
|   | (HQ)/FTE and current      |   |               |    |             |
|   | assignment, with proposed |   |               |    |             |
|   | disposition (i.e., VISNs, |   |               |    |             |
|   | VAMCs, HQ location) and   |   |               |    |             |
|   | projected assigned FTE,   |   |               |    |             |
|   | would provide a summary   |   |               |    |             |
|   | and bottom-line.          |   |               |    |             |
+---+---------------------------+---+---------------+----+-------------+
|   | **[Report                 |   | ¥Throughout   |    |             |
|   | Context]{.underline}**    |   | the Decision  |    |             |
|   |                           |   | Document the  |    |             |
|   | ¥ Several commentaries    |   | use of        |    |             |
|   | (3) noted that the use of |   | abbreviations |    |             |
|   | abbreviations in the      |   | has been      |    |             |
|   | report is extensive,      |   | limited.      |    |             |
|   | making the document       |   |               |    |             |
|   | somewhat challenging to   |   | **¥** The     |    |             |
|   | read for an individual    |   | questionnaire |    |             |
|   | not familiar with the     |   | referenced    |    |             |
|   | terms. The addition of a  |   | was utilized  |    |             |
|   | glossary of terms was     |   | by the        |    |             |
|   | requested.                |   | Healthcare    |    |             |
|   |                           |   | Programs      |    |             |
|   | ¥ One writer points out   |   | subgroup to   |    |             |
|   | that there are references |   | obtain        |    |             |
|   | in the report to a        |   | information   |    |             |
|   | questionnaire which was   |   | from program  |    |             |
|   | utilized. However, there  |   | officials in  |    |             |
|   | is no indication as to    |   | Clinical      |    |             |
|   | who these went to, what   |   | Affairs as    |    |             |
|   | they were about, and what |   | part of the   |    |             |
|   | were the outcomes?        |   | interview     |    |             |
|   |                           |   | process       |    |             |
|   |                           |   | described     |    |             |
|   |                           |   | within the    |    |             |
|   |                           |   | report.       |    |             |
+---+---------------------------+---+---------------+----+-------------+
|   | **[Organization of        |   | **¥** The     |    |             |
|   | Acknowledgments and       |   | subgroups     |    |             |
|   | Membership of             |   | referenced    |    |             |
|   | Subgroups]{.underline}**  |   | within this   |    |             |
|   |                           |   | section of    |    |             |
|   | ¥ One writer commented    |   | the report    |    |             |
|   | that the listing of       |   | were chaired  |    |             |
|   | participants in the HQ    |   | by members of |    |             |
|   | Restructuring Workgroup   |   | the core HQ   |    |             |
|   | and its subgroups did not |   | Restructuring |    |             |
|   | accurately represent the  |   | Workgroup as  |    |             |
|   | membership or             |   | follows:      |    |             |
|   | participative integration |   |               |    |             |
|   | of the subgroups to the   |   | \(1\) Robert  |    |             |
|   | core group. Although the  |   | Frymier, MD,  |    |             |
|   | membership of each        |   | chaired the   |    |             |
|   | subgroup was provided,    |   | Subgroup for  |    |             |
|   | the listing did not       |   | the Office of |    |             |
|   | indicate the chairs or    |   | the Under     |    |             |
|   | members of each subgroup  |   | Secretary for |    |             |
|   | who also served as        |   | Health and    |    |             |
|   | members of the core       |   | Policy,       |    |             |
|   | group.                    |   | Planning and  |    |             |
|   |                           |   | Performance;  |    |             |
|   | ¥ Another writer noted    |   | (2) Ronald    |    |             |
|   | that the titles for two   |   | Gebhart, MD,  |    |             |
|   | individuals listed as     |   |               |    |             |
|   | members of the workgroup  |   | chaired the   |    |             |
|   | was listed incorrectly.   |   | Subgroup for  |    |             |
|   |                           |   | Healthcare    |    |             |
|   |                           |   | Programs; (3) |    |             |
|   |                           |   | Smith Jenkins |    |             |
|   |                           |   | chaired the   |    |             |
|   |                           |   | Subgroup for  |    |             |
|   |                           |   | Support       |    |             |
|   |                           |   | Programs; and |    |             |
|   |                           |   | (4) Thomas    |    |             |
|   |                           |   | Hogan chaired |    |             |
|   |                           |   | the Subgroup  |    |             |
|   |                           |   | for           |    |             |
|   |                           |   | In            |    |             |
|   |                           |   | frastructure. |    |             |
+---+---------------------------+---+---------------+----+-------------+

  -------------------- ---------------------------------------------- -- ------------------------- -----------------------------
  **[Ref               **OFFICE OF THE UNDER SECRETARY FOR HEALTH        **[A/D/O]{.underline}**   **[Remarks-K]{.underline}**
  No.]{.underline}**   (USH) - Recommendations 1.1 through 1.13**                                  

  -------------------- ---------------------------------------------- -- ------------------------- -----------------------------

  --- ---------------------------- --------- ------------------ ----- --------------
      **General Comments**         **A/D**   **Rationale**            

      Concern was expressed        **D**     Availability of          
      regarding the new structure            services addressed       
      and reorganization plan. It            in new                   
      was emphasized that the                organizations.           
      diverse functions of the                                        
      Office of Policy, Planning,                                     
      and Performance cut across                                      
      many apparent needs of the                                      
      system. This writer pointed                                     
      out the VHA charges of                                          
      patient care, professional                                      
      education and research, and                                     
      noted that the policy                                           
      issues, strategic plans,                                        
      analysis and performance                                        
      measures are directed to                                        
      these charges. The writer                                       
      recommended a more                                              
      functional organization in                                      
      which the DUSH has a chief                                      
      of each of these areas in                                       
      his immediate office. Each                                      
      chief with offices of                                           
      planners, performance                                           
      measures, analyses and                                          
      policy would be focused on                                      
      the charge given that                                           
      particular chief.                                               

      One physician emphasizes               Noted an an issue        
      that the difficulties of               to be addressed as       
      reporting are clearly                  the new                  
      identified in the Issue                organization             
      Statement related to the               evolves.                 
      Office of the Under                                             
      Secretary for Health. Yet,                                      
      concern is expressed that                                       
      the method for solving this                                     
      issue is not clearly                                            
      addressed in the remainder                                      
      of the proposal and several                                     
      points of communication                                         
      between the VISN and                                            
      headquarters would seem                                         
      possible and may represent                                      
      the most efficient operating                                    
      model.                                                          

      One writer noted that the HQ           This                     
      report identifies as an                recommendation           
      issue the need to establish            supports the need        
      a well understood process              for specifically         
      for decision making. This              delineating the          
      individual expresses concern           roles and                
      that the report                        responsibilities         
      recommendations describe the           of the Office of         
      need to define the various             the USH. Although        
      roles of USH, DUSH, and the            not a specific           
      CNO, but notes that the                recommendation of        
      report does not propose a              this workgroup,          
      structure to facilitate                this commentary is       
      policy issue discussion and            noted as a viable        
      decisions. An option                   suggestion for           
      suggested is the                       consideration by         
      establishment of a formal              the DUSH or CNO as       
      policy board that meets                the new                  
      routinely to discuss issues            organization             
      of significance. The writer            evolves.                 
      emphasizes that establishing                                    
      a board with prescribed                                         
      formats for written                                             
      statements and analysis to                                      
      be presented before the                                         
      board and with prescribed                                       
      formal vehicles for                                             
      recording and promulgating                                      
      the decsions would go far in                                    
      structuring decisions and                                       
      discusssions necessary in                                       
      the day to day operations of                                    
      VHA.                                                            

      The Director, National                 Commentary               
      Veterans Service of the VFW            unclear.                 
      notes that it appears that                                      
      physician peer review is                                        
      centralized as opposed to                                       
      leaving it up to the field                                      
      to conduct this activity. He                                    
      expresses concern that this                                     
      seems to be in contravention                                    
      to the intention to                                             
      decentralize the management                                     
      function of VHA.                                                

      The Director, National                 This is addressed        
      Veterans Service for VFW               within the Office        
      expressed concern that there           of the Under             
      is no mention of interaction           Secretary for            
      with veterans service                  Health as part of        
      organizations within the               the functions            
      workgroup report. The VFW              aligned under the        
      considers it essential that            Chief of Staff. No       
      there be an individual or              changes have been        
      office specifically                    made to                  
      designated to serve as                 information noted        
      liaison between the USH and            in *Vision for           
      the VSOs.                              Change.*                 
  --- ---------------------------- --------- ------------------ ----- --------------

+---+---------------------------------------------+---+----+-------------+
| * | **[Recommendation:]{.underline}**           |   | *  | **[Re       |
| * |                                             |   | *[ | marks-K]{.u |
| [ | The Chief of Staff should continue          |   | A/ | nderline}** |
| R | integrating all the internal functions of   |   | D/ |             |
| e | the Office into a smooth, well-understood   |   | O] |             |
| f | process. Due to the number of staff in of   |   | {. |             |
| N | Office of the USH and because of the high   |   | un |             |
| o | volume of issues to be addressed in the     |   | de |             |
| . | transition, it may be helpful to detail     |   | rl |             |
| ] | someone to the Office of the USH for 60     |   | in |             |
| { | days to observe and make recommendations on |   | e} |             |
| . | how to set up the internal office           |   | ** |             |
| u | procedures to accommodate the needs of the  |   |    |             |
| n | new VHA organization and the operating      |   |    |             |
| d | styles of the new leadership. This          |   |    |             |
| e | individual can be assigned from within VHA  |   |    |             |
| r | or a consultant hired.                      |   |    |             |
| l |                                             |   |    |             |
| i |                                             |   |    |             |
| n |                                             |   |    |             |
| e |                                             |   |    |             |
| } |                                             |   |    |             |
| * |                                             |   |    |             |
| * |                                             |   |    |             |
|   |                                             |   |    |             |
| * |                                             |   |    |             |
| * |                                             |   |    |             |
| 1 |                                             |   |    |             |
| . |                                             |   |    |             |
| 1 |                                             |   |    |             |
| * |                                             |   |    |             |
| * |                                             |   |    |             |
+---+---------------------------------------------+---+----+-------------+

  ----------- ---------------------------- ---------- ---------- ---------- ----- --------------
              **Action Required**          **Action   **Target   **Actual         
                                           Office**   Date**     Date**           

  **1.1.1**   Either through a detail or   Chief of   NTE                         
              use of a consultant, review  Staff      12/1/95                     
              the internal operating                                              
              procedures of the Office of                                         
              the USH and recommend                                               
              further refinements to the                                          
              COS.                                                                

                                                                                  
  ----------- ---------------------------- ---------- ---------- ---------- ----- --------------

  --------- ---------------------------- --------- --------------- ----- --------------
            **Comments**                 **A/D**   **Rationale**         

  **1.1**   One writer expressed concern **D**     The use of the        
            with using the term at the             Chief of Staff        
            HQ level stating that the              title is very         
            term \"Chief of Staff\" has            common among          
            traditionally been                     bureaurcacy,          
            associated with a clinical             and in the VHA        
            position both at the VAMCs             is patterned to       
            and in the Regions. He                 mirror the use        
            recommended the use of other           of the title at       
            titles that might be                   the VA level          
            considered are \"Assistant             for a position        
            Chief Administrative                   with similar          
            Officer, Deputy Under                  functions.            
            Secretary, etc.\"                                            

                                                                         
  --------- ---------------------------- --------- --------------- ----- --------------

+---+---------------------------+-----+-----+-----+----+-------------+
|   | **Proposed Revision**     | **  | **  | **  |    |             |
|   |                           | Act | Tar | Act |    |             |
|   |                           | ion | get | ual |    |             |
|   |                           | Of  | Dat | Dat |    |             |
|   |                           | fic | e** | e** |    |             |
|   |                           | e** |     |     |    |             |
+---+---------------------------+-----+-----+-----+----+-------------+
| * | Technology assessment     | Off | C   |     |    |             |
| * | (high cost/high tech      | ice | omp |     |    |             |
| 1 | equipment, procedures,    | of  | let |     |    |             |
| . | and pharmaceuticals) is   | U   | ion |     |    |             |
| 0 | currently fragmented and  | SH, | of  |     |    |             |
| . | dealt with by a number of |     | rev |     |    |             |
| 1 | elements within VHA.      | Ch  | iew |     |    |             |
| * | Technology assessment     | ief | NTE |     |    |             |
| * | affects hundreds of       | of  |     |     |    |             |
|   | millions of dollars in    | St  | J   |     |    |             |
| * | expenditures, and the     | aff | anu |     |    |             |
| * | matter of where this      |     | ary |     |    |             |
| A | program belongs should be |     | 12, |     |    |             |
| d | determined. A process for |     | 1   |     |    |             |
| - | the ongoing management of |     | 996 |     |    |             |
| i | this matter should be     |     |     |     |    |             |
| t | determined at the         |     |     |     |    |             |
| i | National level. It is     |     |     |     |    |             |
| o | recommended that the DUSH |     |     |     |    |             |
| n | convene a                 |     |     |     |    |             |
| * | multidisciplinary task    |     |     |     |    |             |
| * | forced chaired by the     |     |     |     |    |             |
|   | COS, with participation   |     |     |     |    |             |
| * | of the CFO, CIO, Director |     |     |     |    |             |
| * | R&D, Chief PCS Officer    |     |     |     |    |             |
| O | and field representation, |     |     |     |    |             |
| t | to review this issue. A   |     |     |     |    |             |
| h | review should includes    |     |     |     |    |             |
| e | the scope of this matter  |     |     |     |    |             |
| r | and a recommendation for  |     |     |     |    |             |
| * | assignment of this        |     |     |     |    |             |
| * | function. (See Healthcare |     |     |     |    |             |
|   | Programs, General         |     |     |     |    |             |
|   | Comments).                |     |     |     |    |             |
+---+---------------------------+-----+-----+-----+----+-------------+

+---+---------------------------------------------+---+----+-------------+
| * | **[Recommendation:]{.underline}**           |   | *  | **[Re       |
| * |                                             |   | *[ | marks-K]{.u |
| [ | In the *Vision for Change,* it is           |   | A/ | nderline}** |
| R | recommended that this function be realigned |   | D/ |             |
| e | from the Chief Financial Officer (CFO) to   |   | O] |             |
| f | the Chief of Staff. After review, however,  |   | {. |             |
| N | it is recommended that the function of      |   | un |             |
| o | Office of Inspector General (OIG) and       |   | de |             |
| . | General Accounting Office (GAO) Liaison     |   | rl |             |
| ] | should be placed within the Office of       |   | in |             |
| { | Policy, Planning, and Performance (PPP)     |   | e} |             |
| . | because the function needs to be            |   | ** |             |
| u | coordinated with other performance          |   |    |             |
| n | measurement activities and with the Medical |   |    |             |
| d | Inspector (MI) function.                    |   |    |             |
| e |                                             |   |    |             |
| r |                                             |   |    |             |
| l |                                             |   |    |             |
| i |                                             |   |    |             |
| n |                                             |   |    |             |
| e |                                             |   |    |             |
| } |                                             |   |    |             |
| * |                                             |   |    |             |
| * |                                             |   |    |             |
|   |                                             |   |    |             |
| * |                                             |   |    |             |
| * |                                             |   |    |             |
| 1 |                                             |   |    |             |
| . |                                             |   |    |             |
| 2 |                                             |   |    |             |
| . |                                             |   |    |             |
| * |                                             |   |    |             |
| * |                                             |   |    |             |
+---+---------------------------------------------+---+----+-------------+

  ----------- ---------------------------- ---------- ---------- ---------- ----- --------------
              **Action Required**          **Action   **Target   **Actual         
                                           Office**   Date**     Date**           

  **1.2.1**   Realign the OIG/GAO liaison  Office of  10/1/95                     
              function from its current    USH                                    
              organizational location in                                          
              the Office of the CFO to the                                        
              Office of Policy, Planning,                                         
              and Performance (See also                                           
              actions 1.12 and 1.45.2 )                                           
  ----------- ---------------------------- ---------- ---------- ---------- ----- --------------

  --------- ---------------------------- --------- ---------------- ----- --------------
            **Comments**                 **A/D**   **Rationale**          

  **1.2**   One writer expressed         **D**     Placement of           
            reservation regarding this             this function          
            realignment of the OIG/GAO             within the             
            report coordination function           Office of PPP          
            into PPP. This writer                  does not               
            believes that the imposition           preclude access        
            of layers away from the key            to the Deputy          
            decision makers has created            Under Secretary        
            unnecessary gaps and lags in           for Health as          
            communication. It was also             required to deal       
            noted that the OIG/GAO                 with issues            
            should not report to the               requiring              
            Chief of Staff as suggested            immediate              
            in the *Vision for Change*,            attention.             
            as OIG/GAO needs immediate                                    
            access to the DUSH who has                                    
            been the key official                                         
            meeting with OIG and GAO                                      
            concerning VHA official                                       
            positions. The writer did                                     
            concede that if the Under                                     
            Secretarys office, including                                  
            PPP, operates in a                                            
            non-hierachical fashion,                                      
            placement in PPP will not be                                  
            problemmatic.                                                 

  **1.2**   The Deputy Asst Secretary    **D**     The OIG/GAO            
            for Financial Mgt does not             function is not        
            support the realignment of             limited to the         
            this function from the CFO             handling of            
            organization, emphasizing              financial audit        
            the focus on performance               related issues,        
            measurement. The varied                and includes           
            audit related activities               other clinical         
            coordinated and/or conducted           and                    
            by the CFO are cited in                administrative         
            support of the CFO as the              topics that cut        
            organization with the best             broadly across         
            knowledge to respond to IG             our healthcare         
            and GAO audits.                        system. A              
                                                   majority of            
                                                   these issues           
                                                   require                
                                                   coordination           
                                                   with the Office        
                                                   of Healthcare          
                                                   Inspections and        
                                                   the Medical            
                                                   Inspector.             
                                                   Placement within       
                                                   the Office of          
                                                   PPP provides for       
                                                   the optimal use        
                                                   of system wide         
                                                   performance            
                                                   measures as well       
                                                   to identify            
                                                   problems,              
                                                   activity trends,       
                                                   and monitor            
                                                   improvements.          
                                                   The expertise of       
                                                   individuals in         
                                                   the CFO will           
                                                   also continue to       
                                                   be available           
                                                   from staff as          
                                                   needed.                
  --------- ---------------------------- --------- ---------------- ----- --------------

  --- ---------------------------- ---------- ---------- ---------- ----- --------------
      **Proposed Revision**        **Action   **Target   **Actual         
                                   Office**   Date**     Date**           

                                                                          
  --- ---------------------------- ---------- ---------- ---------- ----- --------------

+---+---------------------------------------------+---+----+-------------+
| * | **[Recommendation:]{.underline}**           |   | *  | **[Re       |
| * |                                             |   | *[ | marks-K]{.u |
| [ | The Legislative Affairs function is also    |   | A/ | nderline}** |
| R | recommended to be placed within the Office  |   | D/ |             |
| e | of PPP for coordination with overall policy |   | O] |             |
| f | and planning activities.                    |   | {. |             |
| N |                                             |   | un |             |
| o |                                             |   | de |             |
| . |                                             |   | rl |             |
| ] |                                             |   | in |             |
| { |                                             |   | e} |             |
| . |                                             |   | ** |             |
| u |                                             |   |    |             |
| n |                                             |   |    |             |
| d |                                             |   |    |             |
| e |                                             |   |    |             |
| r |                                             |   |    |             |
| l |                                             |   |    |             |
| i |                                             |   |    |             |
| n |                                             |   |    |             |
| e |                                             |   |    |             |
| } |                                             |   |    |             |
| * |                                             |   |    |             |
| * |                                             |   |    |             |
|   |                                             |   |    |             |
| * |                                             |   |    |             |
| * |                                             |   |    |             |
| 1 |                                             |   |    |             |
| . |                                             |   |    |             |
| 3 |                                             |   |    |             |
| * |                                             |   |    |             |
| * |                                             |   |    |             |
+---+---------------------------------------------+---+----+-------------+

  ----------- ---------------------------- ---------- ---------- ---------- ----- --------------
              **Action Required**          **Action   **Target   **Actual         
                                           Office**   Date**     Date**           

  **1.3.1**   Move the Legislative Affairs Office of  10/1/95                     
              function from its current    USH                                    
              organizational location to                                          
              the Office of Policy,                                               
              Planning, and Performance.                                          

                                                                                  

                                                                                  
  ----------- ---------------------------- ---------- ---------- ---------- ----- --------------

  --------- ---------------------------- --------- --------------- ----- --------------
            **Comments**                 **A/D**   **Rationale**         

  **1.3**   The Director, National       **D**     Placement of          
            Veterans Service of the VFW            the Liaison           
            commented as follows,                  function in           
            \"Although we are uncertain,           this Office           
            it would appear the plan               does not              
            diminishes the legislative             diminish this         
            liaison capability of the              capability.           
            VHA.\"                                                       

  **1.3**   One writer comments that the           Commentary is         
            proposed placement of the              not                   
            legislative function within            inconsistent          
            the policy office of PPP               with report,          
            appears to be sound. This              and no change         
            writer notes that the report           in action is          
            itself is silent on the need           required. New         
            to rethink the legislative             Chief of PPP          
            function as it currently               can consider          
            exists within VHA. The                 suggestions for       
            writer suggests that rather            assessment of         
            than simply transfer an                functions of          
            existing function and staff            this program          
            to the Office of PPP, a new            after entry on        
            prospective legislative                duty.                 
            activity needs to be                                         
            designed and implemented.                                    
            This writer adds that VHA                                    
            needs to have a prospective                                  
            activity that ties its                                       
            strategy, priorities and                                     
            operations to an assessment                                  
            of legislative changes that                                  
            may be needed to reach its                                   
            objectives.                                                  

                                                                         
  --------- ---------------------------- --------- --------------- ----- --------------

  --- ---------------------------- ---------- ---------- ---------- ----- --------------
      **Proposed Revision**        **Action   **Target   **Actual         
                                   Office**   Date**     Date**           

                                                                          
  --- ---------------------------- ---------- ---------- ---------- ----- --------------

+---+---------------------------------------------+---+----+-------------+
| * | **[Recommendation:]{.underline}**           |   | *  | **[Re       |
| * |                                             |   | *[ | marks-K]{.u |
| [ | Establish an Office of Employee Education   |   | A/ | nderline}** |
| R | aligned within the Office of the USH, and   |   | D/ |             |
| e | also create the position of the Chief       |   | O] |             |
| f | Employee Education Officer reporting to the |   | {. |             |
| N | Deputy Under Secretary for Health (DUSH).   |   | un |             |
| o | This office will be field based, working    |   | de |             |
| . | with the VISNs, with a small staff          |   | rl |             |
| ] | component in HQ. The primary functions of   |   | in |             |
| { | this office will include: the creation of a |   | e} |             |
| . | learning organization; the design of        |   | ** |             |
| u | learning experiences for the work force to  |   |    |             |
| n | achieve the required cultural change and    |   |    |             |
| d | meet the education needs advanced by the    |   |    |             |
| e | Education and Training Workgroup; and the   |   |    |             |
| r | restructuring and integration of the        |   |    |             |
| l | existing VHA employee education network to  |   |    |             |
| i | maximize quality, efficiency, and cost      |   |    |             |
| n | effectiveness.                              |   |    |             |
| e |                                             |   |    |             |
| } |                                             |   |    |             |
| * |                                             |   |    |             |
| * |                                             |   |    |             |
|   |                                             |   |    |             |
| * |                                             |   |    |             |
| * |                                             |   |    |             |
| 1 |                                             |   |    |             |
| . |                                             |   |    |             |
| 4 |                                             |   |    |             |
| * |                                             |   |    |             |
| * |                                             |   |    |             |
+---+---------------------------------------------+---+----+-------------+

  ------------- ---------------------------- ---------- ---------- ---------- ----- --------------
                **Action Required**          **Action   **Target   **Actual         
                                             Office**   Date**     Date**           

  **1.4.1\***   Establish an Office of       Office of  **Aug. 1,                   
                Employee Education.          USH        1995**                      

  **1.4.2 \***  Establish a search process   Office of  **Aug. 1,                   
                to select the Chief Employee USH        1995**                      
                Education Officer.                                                  

                                                                                    
  ------------- ---------------------------- ---------- ---------- ---------- ----- --------------

  ----------- ---------------------------- --------- ----------------- ----- --------------
              **Comments**                 **A/D**   **Rationale**           

  **1.4.1**   Several requests (7) for               The VA Learning         
              further clarification of               University (VALU)       
              this office, particularly              has not been            
              regarding its relationship             committed to as         
              and/or link to and impact              yet. At time of         
              upon the proposed VA                   approval, these         
              Learning University. Also              issues will be          
              information was requested on           worked through by       
              the impact upon the RMECs              the Chief               
              and tuition support                    Employee                
              programs.                              Education               
                                                     Officer.                

  **1.4.1**   Writer supports employee     **A**     The workgroup           
              education, concurring with             agrees that this        
              an agency wide, systematic             is a function           
              approach to management                 consistent with         
              development, fiscal, A&MM,             the position of         
              and other \'core\' training            the new Chief           
              needs. It is envisioned,               Employee                
              however, that the VISN and             Education               
              facility directors will                Officer. This           
              develop employee specific              type of matter          
              needs training. The writer             should be               
              further recommends that VISN           explored by the         
              directors buy training needs           incumbent of this       
              from the RMECs aligned under           new position.           
              the Office of Employee                                         
              Education.                                                     

  **1.4**     The Director Education &     **A**     This commentary         
              Trng Ctr for Engineering &             is consistent           
              Construction Mgt. supports             with the report,        
              the consolidation of                   and the workgroup       
              education units to allow the           agrees with the         
              most efficient meeting of              premise of              
              national training needs. He            relignment of all       
              emphasizes that every effort           employee                
              should be made to assign all           education               
              of the training functions              functions. Police       
              that impact VHA to this                training can be         
              office in order to assure              explored for            
              efficient coordination. One            inclusion by the        
              function which he notes that           new Chief               
              is not being realigned is              Employee                
              VHA police training. One               Education               
              possible negative impact of            Officer.                
              realignment would be if                                        
              sufficient resources are not                                   
              available to meet                                              
              requirements. He also                                          
              emphasizes that training                                       
              needs that impact the entire                                   
              VA system would be                                             
              inefficient to be developed                                    
              at the VISN level because of                                   
              the reorganization and a                                       
              necessity for cultural                                         
              change training. He                                            
              recommends that the Chief                                      
              for this office be appointed                                   
              ASAP to provide leadership                                     
              to the education network and                                   
              establish training                                             
              priorities. (See also                                          
              commentary for 1.36).                                          

  **1.4**     One VAMC Director supported            Noted.                  
              consolidation stating it                                       
              makes sense to have all                                        
              education under one office.                                    
              He emphasized, however, that                                   
              there needs to be safeguards                                   
              to ensure the administrative                                   
              training resources are not                                     
              gobbled up by clinical                                         
              needs.                                                         

  **1.4.2**   One writer recommended that  **A**     Upon review, the        
              the Chief Employee Education           current                 
              Officer position should be             recommendation          
              retained as a HQ position              does require            
              with a strong staff                    clarification. A        
              component. She emphasized              revision of             
              that the existing education            recommendation          
              network is field based with            1.4 is provided         
              no dedicated HQ leadership             below.                  
              position resulting in the                                      
              fragmented system criticized                                   
              in the Morevec Report. She                                     
              questioned the disconnect of                                   
              elevating employee education                                   
              to the Office of the USH                                       
              only to decentralize                                           
              authority and accountability                                   
              to the field?                                                  

  **1.4.1**   The Chair of the Employee    **A**     Commentary is           
              Education Network supports             consistent with         
              the creation of Office of              our report.             
              Employee Education and the             Appointment of          
              establishment of the                   Chief Employee          
              position of the Chief                  Education Officer       
              Employee Education Officer             has been                
              reporting to the DUSH. He              recommended to be       
              recommends the immediate               effected ASAP. No       
              appointment of an interim              interim position        
              director to coordinate the             is under                
              transition efforts. He also            consideration.          
              emphasizes that the                                            
              functions of this office are                                   
              critical to the Transition                                     
              and require prompt                                             
              attention. Thus, the Office                                    
              should be established as                                       
              soon as possible.                                              

  **1.4**     One writer comments that               Noted. It is also       
              'the creation of a learning            emphasized that         
              organization' as a function            this HQ office          
              of the new employee                    will have the           
              education office appears to            support of other        
              be more of a goal than                 field based units       
              function. Similarly,                   (i.e., RMECs,           
              expecting this small staff             NMDCs, etc.)            
              office in HQ to 'design \...           already in place        
              learning experiences for the           to support the          
              work force to achieve the              VHA employee            
              required cultural change               education               
              \...' etc. may be                      goals/functions         
              unrealistic. An appropriate            referenced.             
              role and function of this                                      
              organization to serve as an                                    
              advocate and proponent of                                      
              employee eduction is not                                       
              addressed.                                                     

  **1.4**     The Director National Media            Many of these           
              Development Center comments            issues will be          
              that he has many questions             addressed upon          
              relating to formation of an            appointment of          
              Employee Education Office              the Chief               
              and how the resources of the           Employee                
              National Media Development             Education               
              Centers (NMDC) will be                 Officer.                
              utilized and fit within this                                   
              new structure.                                                 
  ----------- ---------------------------- --------- ----------------- ----- --------------

+---+---------------------------+-----+-----+-----+----+-------------+
|   | **Proposed Revision**     | **  | **  | **  |    |             |
|   |                           | Act | Tar | Act |    |             |
|   |                           | ion | get | ual |    |             |
|   |                           | Of  | Dat | Dat |    |             |
|   |                           | fic | e** | e** |    |             |
|   |                           | e** |     |     |    |             |
+---+---------------------------+-----+-----+-----+----+-------------+
| * | Establish an Office of    |     |     |     |    |             |
| * | Employee Education        |     |     |     |    |             |
| 1 | aligned within the Office |     |     |     |    |             |
| . | of the USH, and also      |     |     |     |    |             |
| 4 | create the position of    |     |     |     |    |             |
| * | the Chief Employee        |     |     |     |    |             |
| * | Education Officer         |     |     |     |    |             |
|   | reporting to the Deputy   |     |     |     |    |             |
| * | Under Secretary for       |     |     |     |    |             |
| * | Health (DUSH). This       |     |     |     |    |             |
| R | office will be            |     |     |     |    |             |
| e | headquarters based, with  |     |     |     |    |             |
| - | a small HQ staff          |     |     |     |    |             |
| v | component (i.e., 5-7      |     |     |     |    |             |
| i | FTEE). The primary        |     |     |     |    |             |
| s | functions of this office  |     |     |     |    |             |
| e | will include: the         |     |     |     |    |             |
| d | creation of a learning    |     |     |     |    |             |
| * | organization; the design  |     |     |     |    |             |
| * | of learning experiences   |     |     |     |    |             |
|   | for the work force to     |     |     |     |    |             |
|   | achieve the required      |     |     |     |    |             |
|   | cultural change and meet  |     |     |     |    |             |
|   | the education needs       |     |     |     |    |             |
|   | advanced by the Education |     |     |     |    |             |
|   | and Training Workgroup;   |     |     |     |    |             |
|   | and the restructuring and |     |     |     |    |             |
|   | integration of the        |     |     |     |    |             |
|   | existing VHA employee     |     |     |     |    |             |
|   | education network to      |     |     |     |    |             |
|   | maximize quality,         |     |     |     |    |             |
|   | efficiency, and cost      |     |     |     |    |             |
|   | effectiveness.            |     |     |     |    |             |
+---+---------------------------+-----+-----+-----+----+-------------+
|   |                           |     |     |     |    |             |
+---+---------------------------+-----+-----+-----+----+-------------+

+---+---------------------------------------------+---+----+-------------+
| * | **[Recommendation:]{.underline}**           |   | *  | **[Re       |
| * |                                             |   | *[ | marks-K]{.u |
| [ | Realign the functions of the Professional   |   | A/ | nderline}** |
| R | Affairs Staff (PAS) to other HQ offices,    |   | D/ |             |
| e | retaining only two functions in the Office  |   | O] |             |
| f | of the USH assigned to the Deputy Under     |   | {. |             |
| N | Secretary for Health. These two functions   |   | un |             |
| o | include the management of the Distinguished |   | de |             |
| . | Healthcare Executive Program (DHEP) and the |   | rl |             |
| ] | Special Medical Advisory Group (SMAG). The  |   | in |             |
| { | functions performed in support of the DHEP  |   | e} |             |
| . | and the SMAG are to be absorbed by          |   | ** |             |
| u | exisiting staff. All other functions        |   |    |             |
| n | formerly performed by the Professional      |   |    |             |
| d | Affairs Staff should be                     |   |    |             |
| e | transferred/realigned to other HQ offices.  |   |    |             |
| r |                                             |   |    |             |
| l |                                             |   |    |             |
| i |                                             |   |    |             |
| n |                                             |   |    |             |
| e |                                             |   |    |             |
| } |                                             |   |    |             |
| * |                                             |   |    |             |
| * |                                             |   |    |             |
|   |                                             |   |    |             |
| * |                                             |   |    |             |
| * |                                             |   |    |             |
| 1 |                                             |   |    |             |
| . |                                             |   |    |             |
| 5 |                                             |   |    |             |
| * |                                             |   |    |             |
| * |                                             |   |    |             |
+---+---------------------------------------------+---+----+-------------+

+---+---------------------------+-----+-----+-----+----+-------------+
|   | **Action Required**       | **  | **  | **  |    |             |
|   |                           | Act | Tar | Act |    |             |
|   |                           | ion | get | ual |    |             |
|   |                           | Of  | Dat | Dat |    |             |
|   |                           | fic | e** | e** |    |             |
|   |                           | e** |     |     |    |             |
+---+---------------------------+-----+-----+-----+----+-------------+
| * | Retain the functions of   | Off | O   |     |    |             |
| * | the DHEP and the SMAG     | ice | ct. |     |    |             |
| 1 | aligned within the Office | of  | 1,  |     |    |             |
| . | of the USH.               | USH | 1   |     |    |             |
| 5 |                           |     | 995 |     |    |             |
| . |                           |     |     |     |    |             |
| 1 |                           |     |     |     |    |             |
| * |                           |     |     |     |    |             |
| * |                           |     |     |     |    |             |
+---+---------------------------+-----+-----+-----+----+-------------+
| * | Transfer the staff (2.0   | Off | O   |     |    |             |
| * | FTE) and the functions of | ice | ct. |     |    |             |
| 1 | the Chief of Staff        | of  | 1,  |     |    |             |
| . | Selection Process and     | USH | 1   |     |    |             |
| 5 | Credentialing of HQ Title |     | 995 |     |    |             |
| . | 38 Staff to the           |     |     |     |    |             |
| 2 | Management and            |     |     |     |    |             |
| * | Administrative Support    |     |     |     |    |             |
| * | Office (MASO) aligned     |     |     |     |    |             |
|   | under the Chief           |     |     |     |    |             |
|   | Administrative Officer    |     |     |     |    |             |
|   | (CAO).                    |     |     |     |    |             |
+---+---------------------------+-----+-----+-----+----+-------------+
| * | Transfer the staff (3.0   | P   | O   |     |    |             |
| * | FTE) and the function of  | ati | ct. |     |    |             |
| 1 | the National              | ent | 1,  |     |    |             |
| . | Credentialing and         | C   | 1   |     |    |             |
| 5 | Privileging Policy to the | are | 995 |     |    |             |
| . | Office of Patient Care    |     |     |     |    |             |
| 3 | Service (PCS). This       | Se  |     |     |    |             |
| * | function includes Liaison | rvi |     |     |    |             |
| * | with State Licensing      | ces |     |     |    |             |
|   | Boards, National          |     |     |     |    |             |
|   | Practitioner Data Bank,   |     |     |     |    |             |
|   | Federation of State       |     |     |     |    |             |
|   | Medical Boards.           |     |     |     |    |             |
+---+---------------------------+-----+-----+-----+----+-------------+
| * | Transfer the Policy       | Off | O   |     |    |             |
| * | function related to       | ice | ct. |     |    |             |
| 1 | Medical Staff By-Laws to  | of  | 1,  |     |    |             |
| . | the Office of Policy,     | USH | 1   |     |    |             |
| 5 | Planning, and Performance |     | 995 |     |    |             |
| . | (PPP).                    |     |     |     |    |             |
| 4 |                           |     |     |     |    |             |
| * |                           |     |     |     |    |             |
| * |                           |     |     |     |    |             |
+---+---------------------------+-----+-----+-----+----+-------------+
| * | Transfer from the PAS the | Off | O   |     |    |             |
| * | function of the Chief of  | ice | ct. |     |    |             |
| 1 | Staff and Clinical        | of  | 1,  |     |    |             |
| . | Managers Training         | USH | 1   |     |    |             |
| 5 | Programs to the Office of |     | 995 |     |    |             |
| . | Employee Education.       |     |     |     |    |             |
| 5 |                           |     |     |     |    |             |
| * |                           |     |     |     |    |             |
| * |                           |     |     |     |    |             |
+---+---------------------------+-----+-----+-----+----+-------------+

  ----------- ---------------------------- --------- --------------- ----- --------------
              **Comments**                 **A/D**   **Rationale**         

  **1.5.1**   Clarification of DHEP,       **D**     **Noted**             
              renamed to Distinguished                                     
              Healthcare Scientist                                         
              Program. Suggests program                                    
              administration                                               
              responsibilities be                                          
              realigned to the Management                                  
              and Administrative Support                                   
              Office (MAS0). Since                                         
              participants                                                 
              organizationally assigned to                                 
              field VAMCs, visibility of                                   
              program not dependent on HQ                                  
              location but rather on                                       
              accomplishments of                                           
              individuals named.                                           

  **1.5.5**   Individuals (2) expressed    **D**     Funding is            
              concern whether funding to             issue for all         
              support these functions also           programs.             
              would be realigned or if               Irrespective of       
              these programs would now               realignment,          
              have to compete with other             programs are          
              employee education needs.              not assured of        
                                                     funding and           
                                                     will need to          
                                                     compete.              

  **1.5.3**   Two writers emphasized that  **D**                           
              credentialing and                                            
              privileging and especially                                   
              reprivileging are at the                                     
              heart of an integrated risk                                  
              management program. One                                      
              writer noted that the                                        
              National Practitioner Data                                   
              Bank and liaison with State                                  
              Licensing Boards are                                         
              frequently related to Tort                                   
              Claims or other risk events.                                 
              Another writer emphasized                                    
              that credentialling of                                       
              professionals must be judged                                 
              with the same criteria that                                  
              were used to recommend the                                   
              functional alignment of the                                  
              professional performance                                     
              measurement and the                                          
              professionals development of                                 
              medical by-laws. For these                                   
              reasons, a recommendation is                                 
              made to move this function                                   
              (i.e. National Credentialing                                 
              and Privileging Policy) to                                   
              the Office of PPP.                                           

                                                                           
  ----------- ---------------------------- --------- --------------- ----- --------------

  --- ---------------------------- ---------- ---------- ---------- ----- --------------
      **Proposed Revision**        **Action   **Target   **Actual         
                                   Office**   Date**     Date**           

                                                                          

                                                                          
  --- ---------------------------- ---------- ---------- ---------- ----- --------------

+---+---------------------------------------------+---+----+-------------+
| * | **[Recommendation:]{.underline}**           |   | *  | **[Re       |
| * |                                             |   | *[ | marks-K]{.u |
| [ | During the HQ transition period, realign    |   | A/ | nderline}** |
| R | the Administrative Support Office staff     |   | D/ |             |
| e | (3.0 FTE) to the Chief of Staff (C0S) with  |   | O] |             |
| f | permanent reassignment to the new HQ        |   | {. |             |
| N | Administration function aligned under the   |   | un |             |
| o | Chief Administrative Officer, Management    |   | de |             |
| . | and Administrative Support Office (MASO).   |   | rl |             |
| ] |                                             |   | in |             |
| { |                                             |   | e} |             |
| . |                                             |   | ** |             |
| u |                                             |   |    |             |
| n |                                             |   |    |             |
| d |                                             |   |    |             |
| e |                                             |   |    |             |
| r |                                             |   |    |             |
| l |                                             |   |    |             |
| i |                                             |   |    |             |
| n |                                             |   |    |             |
| e |                                             |   |    |             |
| } |                                             |   |    |             |
| * |                                             |   |    |             |
| * |                                             |   |    |             |
|   |                                             |   |    |             |
| * |                                             |   |    |             |
| * |                                             |   |    |             |
| 1 |                                             |   |    |             |
| . |                                             |   |    |             |
| 6 |                                             |   |    |             |
| * |                                             |   |    |             |
| * |                                             |   |    |             |
+---+---------------------------------------------+---+----+-------------+

  ----------- ---------------------------- ---------- ---------- ---------- ----- --------------
              **Action Required**          **Action   **Target   **Actual         
                                           Office**   Date**     Date**           

  **1.6.1**   Realign the Administrative   Office of  Jan. 12,                    
              Support Office (3.0 FTE)     USH, Chief 1996                        
              with the COS for a           of Staff                               
              transition period (NTE three                                        
              months) with permanent                                              
              reassignment to the MASO.                                           

                                                                                  

                                                                                  
  ----------- ---------------------------- ---------- ---------- ---------- ----- --------------

  ----- ---------------------------- ---------- ---------------- ---------- ---------- ----- --------------
        **Comments**                 **A/D**    **Rationale**                                

  1.6   One writer expresses concern            The transition                               
        that the recommendation to              period (NTE                                  
        transfer 3 FTE to the CAO is            three months)                                
        not self explanatory. The               has been                                     
        writer points out that the              suggested to                                 
        current functions of the                permit the new                               
        Administrative Support                  COS to make a                                
        Office are not discussed                determination of                             
        within the report. If the               administrative                               
        office is a component of the            support needs                                
        Professional Staff, it is               that may be                                  
        not clear. If the office of             ongoing in the                               
        the Under Secretary no                  new Office of                                
        longer requires three                   the USH. The                                 
        administrative support                  development of                               
        staff, the writer questions             functions                                    
        why these positions are not             required within                              
        identified for reduction                the new                                      
        rather than transfer.                   organization of                              
                                                the Office of                                
                                                the USH could                                
                                                not be                                       
                                                specifically                                 
                                                determined by                                
                                                the HQ                                       
                                                Restructuring                                
                                                Workgroup.                                   
                                                Specfics to                                  
                                                include                                      
                                                reductions of                                
                                                FTE levels are                               
                                                appropriate                                  
                                                between the USH                              
                                                and the                                      
                                                individuals                                  
                                                responsible                                  
                                                (i.e., the COS                               
                                                and/or CAO).                                 

        **Proposed Revision**        **Action                    **Target   **Actual         
                                     Office**                    Date**     Date**           
  ----- ---------------------------- ---------- ---------------- ---------- ---------- ----- --------------

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Establish staff support   |   |   |     |   |   | D/ |             |
| e | for the Chief Network     |   |   |     |   |   | O] |             |
| f | Officer (CNO) utilizing   |   |   |     |   |   | {. |             |
| N | some (i.e., the health    |   |   |     |   |   | un |             |
| o | system specialists and    |   |   |     |   |   | de |             |
| . | some others, NTE 10-12    |   |   |     |   |   | rl |             |
| ] | FTE) currently assigned   |   |   |     |   |   | in |             |
| { | to Operations.            |   |   |     |   |   | e} |             |
| . |                           |   |   |     |   |   | ** |             |
| u |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| r |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 7 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Transfer programmatic     | O |   | O   |   |   |    |             |
| * | staff currently in        | f |   | ct. |   |   |    |             |
| 1 | Operations to their       | f |   | 1,  |   |   |    |             |
| . | counterpart programmatic  | i |   | 1   |   |   |    |             |
| 7 | offices in new HQ         | c |   | 995 |   |   |    |             |
| . | organization.             | e |   |     |   |   |    |             |
| 1 |                           | o |   |     |   |   |    |             |
| * |                           | f |   |     |   |   |    |             |
| * |                           | U |   |     |   |   |    |             |
|   |                           | S |   |     |   |   |    |             |
|   |                           | H |   |     |   |   |    |             |
|   |                           | , |   |     |   |   |    |             |
|   |                           | C |   |     |   |   |    |             |
|   |                           | N |   |     |   |   |    |             |
|   |                           | O |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Identify and establish    | O |   | O   |   |   |    |             |
| * | CNO Support Staff within  | f |   | ct. |   |   |    |             |
| 1 | the Office of USH from    | f |   | 1,  |   |   |    |             |
| . | current Operations staff. | i |   | 1   |   |   |    |             |
| 7 |                           | c |   | 995 |   |   |    |             |
| . |                           | e |   |     |   |   |    |             |
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|   |                           | N |   |     |   |   |    |             |
|   |                           | O |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
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|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One comment requested     | * | A |     |   |   |    |             |
| * | clarification regarding   | * | s |     |   |   |    |             |
| 1 | the transfer of           | D | n |     |   |   |    |             |
| . | Operations staff to       | * | o |     |   |   |    |             |
| 7 | sucessor office by        | * | t |     |   |   |    |             |
| . | October 1, 1995, noting   |   | e |     |   |   |    |             |
| 1 | that the correlating      |   | d |     |   |   |    |             |
| * | increases in staff should |   | t |     |   |   |    |             |
| * | be reflected in the       |   | h |     |   |   |    |             |
|   | appropriate offices. An   |   | r |     |   |   |    |             |
|   | example provided was an   |   | o |     |   |   |    |             |
|   | increase of 2 FTE to be   |   | u |     |   |   |    |             |
|   | reflected in the Office   |   | g |     |   |   |    |             |
|   | of PPP. (Recommendation   |   | h |     |   |   |    |             |
|   | 1.13).                    |   | o |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer expressed      | * | W |     |   |   |    |             |
| * | concern for the           | * | e |     |   |   |    |             |
| 1 | feasibility of the        | D | s |     |   |   |    |             |
| . | suggested new             | * | t |     |   |   |    |             |
| 7 | organization in view of   | * | r |     |   |   |    |             |
| * | the MAMOE levels expected |   | o |     |   |   |    |             |
| * | for FY 1996. The writer   |   | n |     |   |   |    |             |
|   | recommended the           |   | g |     |   |   |    |             |
|   | elimination of the VISN   |   | l |     |   |   |    |             |
|   | teams and associated HSS  |   | y |     |   |   |    |             |
|   | staff in the CNO office.  |   | b |     |   |   |    |             |
|   | Given the                 |   | e |     |   |   |    |             |
|   | four-dimensional mission  |   | l |     |   |   |    |             |
|   | of HQ offices, he         |   | i |     |   |   |    |             |
|   | emphasized that there     |   | e |     |   |   |    |             |
|   | should be no need for a   |   | v |     |   |   |    |             |
|   | liaison function between  |   | e |     |   |   |    |             |
|   | VISN and health care      |   | t |     |   |   |    |             |
|   | facility staff and the    |   | h |     |   |   |    |             |
|   | HQ/Service center offices |   | a |     |   |   |    |             |
|   | that support them. (See   |   | t |     |   |   |    |             |
|   | also recommendation 1.    |   | t |     |   |   |    |             |
|   | 24).                      |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| 1 | One writer expressed      |   | N |     |   |   |    |             |
| . | concern that this         |   | o |     |   |   |    |             |
| 7 | recommendation to         |   | t |     |   |   |    |             |
|   | establish support for the |   | e |     |   |   |    |             |
|   | CNO does not follow from  |   | d |     |   |   |    |             |
|   | a discussion or analysis  |   | . |     |   |   |    |             |
|   | of CNO functions or       |   | S |     |   |   |    |             |
|   | activities. Justification |   | e |     |   |   |    |             |
|   | or explanations for the   |   | e |     |   |   |    |             |
|   | number or type of staff,  |   | r |     |   |   |    |             |
|   | and roles of these staff  |   | e |     |   |   |    |             |
|   | not clear. The writer     |   | v |     |   |   |    |             |
|   | expressed further concern |   | i |     |   |   |    |             |
|   | of whether roles were     |   | s |     |   |   |    |             |
|   | distinct from roles of    |   | e |     |   |   |    |             |
|   | VISN support teams. The   |   | d |     |   |   |    |             |
|   | writer also noted that    |   | r |     |   |   |    |             |
|   | the CNO support staff     |   | e |     |   |   |    |             |
|   | should not include either |   | c |     |   |   |    |             |
|   | a budget or planning      |   | o |     |   |   |    |             |
|   | function, since this is   |   | m |     |   |   |    |             |
|   | duplicative of other HQ   |   | m |     |   |   |    |             |
|   | functions and is not      |   | e |     |   |   |    |             |
|   | consistent with the       |   | n |     |   |   |    |             |
|   | mandate that all HQ       |   | d |     |   |   |    |             |
|   | elements must serve the   |   | a |     |   |   |    |             |
|   | field as customers. The   |   | t |     |   |   |    |             |
|   | writer added that the     |   | i |     |   |   |    |             |
|   | total staff size proposed |   | o |     |   |   |    |             |
|   | should be stated.         |   | n |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
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+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Establish staff support   |   |   |     |   |   |    |             |
| * | for the Chief Network     |   |   |     |   |   |    |             |
| 1 | Officer (CNO) utilizing   |   |   |     |   |   |    |             |
| . | some (i.e., the health    |   |   |     |   |   |    |             |
| 7 | system specialists and    |   |   |     |   |   |    |             |
| * | some others, NTE 10-12    |   |   |     |   |   |    |             |
| * | FTE) currently assigned   |   |   |     |   |   |    |             |
|   | to Operations. This group |   |   |     |   |   |    |             |
| * | would also be used in HQ  |   |   |     |   |   |    |             |
| * | VISN Support Teams.       |   |   |     |   |   |    |             |
| R |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| - |                           |   |   |     |   |   |    |             |
| v |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| s |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Realign the National      |   |   |     |   |   | D/ |             |
| e | Clinical Ethics Center at |   |   |     |   |   | O] |             |
| f | White River Junction,     |   |   |     |   |   | {. |             |
| N | from the AsCMD for        |   |   |     |   |   | un |             |
| o | Clinical Affairs, to the  |   |   |     |   |   | de |             |
| . | Deputy Under Secretary    |   |   |     |   |   | rl |             |
| ] | for Health (DUSH). Most   |   |   |     |   |   | in |             |
| { | of the functions handled  |   |   |     |   |   | e} |             |
| . | by this Center are        |   |   |     |   |   | ** |             |
| u | cross-cutting and relate  |   |   |     |   |   |    |             |
| n | to overall policy in VHA. |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| r |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 8 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Amend the policy and      | O |   | O   |   |   |    |             |
| * | procedures memorandum on  | f |   | ct. |   |   |    |             |
| 1 | the National Ethics       | f |   | 1,  |   |   |    |             |
| . | Center to realign it to   | i |   | 1   |   |   |    |             |
| 8 | report to the DUSH.       | c |   | 995 |   |   |    |             |
| . |                           | e |   |     |   |   |    |             |
| 1 |                           | o |   |     |   |   |    |             |
| * |                           | f |   |     |   |   |    |             |
| * |                           | U |   |     |   |   |    |             |
|   |                           | S |   |     |   |   |    |             |
|   |                           | H |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One commentary noted that | * | C |     |   |   |    |             |
| * | the National Ethics       | * | o |     |   |   |    |             |
| 1 | Center and the Center for | A | n |     |   |   |    |             |
| . | Clinical Ethical          | * | s |     |   |   |    |             |
| 8 | Decision-making in        | * | i |     |   |   |    |             |
| * | Portland should be        |   | s |     |   |   |    |             |
| * | considered a vital        |   | t |     |   |   |    |             |
|   | support resource. The     |   | e |     |   |   |    |             |
|   | degree and the severity   |   | n |     |   |   |    |             |
|   | of change being           |   | t |     |   |   |    |             |
|   | considered make it        |   | w |     |   |   |    |             |
|   | imperative that the       |   | i |     |   |   |    |             |
|   | ethical implications of   |   | t |     |   |   |    |             |
|   | specific change are not   |   | h |     |   |   |    |             |
|   | ignored.                  |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | N |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | q |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Business planning         |   |   |     |   |   | D/ |             |
| e | activities should be      |   |   |     |   |   | O] |             |
| f | coordinated by the DUSH.  |   |   |     |   |   | {. |             |
| N | The workgroup considered  |   |   |     |   |   | un |             |
| o | several offices (CNO,     |   |   |     |   |   | de |             |
| . | PPP, CFO) as possible     |   |   |     |   |   | rl |             |
| ] | locations for             |   |   |     |   |   | in |             |
| { | coordination of business  |   |   |     |   |   | e} |             |
| . | planning. While this is   |   |   |     |   |   | ** |             |
| u | recognized as primarily a |   |   |     |   |   |    |             |
| n | VISN function, it         |   |   |     |   |   |    |             |
| d | requires guidance and     |   |   |     |   |   |    |             |
| e | coordination at the       |   |   |     |   |   |    |             |
| r | Headquarters level. The   |   |   |     |   |   |    |             |
| l | DUSH, in conjunction with |   |   |     |   |   |    |             |
| i | the CNO, is the           |   |   |     |   |   |    |             |
| n | appropriate official to   |   |   |     |   |   |    |             |
| e | bring all aspects of this |   |   |     |   |   |    |             |
| } | function together in a    |   |   |     |   |   |    |             |
| * | unified HQ process.       |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 9 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The DUSH, in conjunction  | O |   | O   |   |   |    |             |
| * | with the CNO, should      | f |   | ct. |   |   |    |             |
| 1 | develop a plan for        | f |   | 1,  |   |   |    |             |
| . | initiating and            | i |   | 1   |   |   |    |             |
| 9 | coordinating a VISN-based | c |   | 995 |   |   |    |             |
| . | business planning         | e |   | or  |   |   |    |             |
| 1 | process.                  | o |   | soo |   |   |    |             |
| * |                           | f |   | ner |   |   |    |             |
| * |                           | U |   | if  |   |   |    |             |
|   |                           | S |   | pos |   |   |    |             |
|   |                           | H |   | sib |   |   |    |             |
|   |                           |   |   | le. |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Several writers (5)       | * | C |     |   |   |    |             |
| * | expressed concurrence     | * | o |     |   |   |    |             |
| 1 | with this action . Many   | A | n |     |   |   |    |             |
| . | offices have a stake and  | * | s |     |   |   |    |             |
| 9 | interest in business      | * | i |     |   |   |    |             |
| . | planning, and the issue   |   | s |     |   |   |    |             |
| 1 | of where the              |   | t |     |   |   |    |             |
| * | responsibility lies needs |   | e |     |   |   |    |             |
| * | to be definitively mapped |   | n |     |   |   |    |             |
|   | out.                      |   | t |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | N |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | q |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | R |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | D |     |   |   |    |             |
|   |                           |   | U |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
|   |                           |   | H |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | The Under Secretary for   |   |   |     |   |   | D/ |             |
| e | Health should appoint the |   |   |     |   |   | O] |             |
| f | head of the Office of     |   |   |     |   |   | {. |             |
| N | Policy, Planning, and     |   |   |     |   |   | un |             |
| o | Performance (PPP) as      |   |   |     |   |   | de |             |
| . | quickly as possible.      |   |   |     |   |   | rl |             |
| ] |                           |   |   |     |   |   | in |             |
| { |                           |   |   |     |   |   | e} |             |
| . |                           |   |   |     |   |   | ** |             |
| u |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| r |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| 0 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Initiate recruitment      | D |   | **A |   |   |    |             |
| * | activity in order to      | U |   | ug. |   |   |    |             |
| 1 | select a Chief of PPP as  | S |   | 1,  |   |   |    |             |
| . | soon as possible.         | H |   | 199 |   |   |    |             |
| 1 |                           |   |   | 5** |   |   |    |             |
| 0 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| \ |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Structure. There should   |   |   |     |   |   | D/ |             |
| e | be two groups within the  |   |   |     |   |   | O] |             |
| f | Office of Policy,         |   |   |     |   |   | {. |             |
| N | Planning, and             |   |   |     |   |   | un |             |
| o | Performance: (1)          |   |   |     |   |   | de |             |
| . | Strategic Planning and    |   |   |     |   |   | rl |             |
| ] | Policy, and (2)           |   |   |     |   |   | in |             |
| { | Performance Planning and  |   |   |     |   |   | e} |             |
| . | Monitoring. Specific task |   |   |     |   |   | ** |             |
| u | organization will include |   |   |     |   |   |    |             |
| n | the areas used in the     |   |   |     |   |   |    |             |
| d | functional analysis to    |   |   |     |   |   |    |             |
| e | include: Strategic        |   |   |     |   |   |    |             |
| r | Planning, Policy Analysis |   |   |     |   |   |    |             |
| l | and Legislation,          |   |   |     |   |   |    |             |
| i | Performance Planning and  |   |   |     |   |   |    |             |
| n | Systems Development,      |   |   |     |   |   |    |             |
| e | Evaluation and            |   |   |     |   |   |    |             |
| } | Inspection, Risk          |   |   |     |   |   |    |             |
| * | Management and            |   |   |     |   |   |    |             |
| * | Utilization Management.   |   |   |     |   |   |    |             |
|   | Discrete functional       |   |   |     |   |   |    |             |
| * | groupings of tasks within |   |   |     |   |   |    |             |
| * | the Office are not        |   |   |     |   |   |    |             |
| 1 | recommended to encourage  |   |   |     |   |   |    |             |
| . | the free flow of          |   |   |     |   |   |    |             |
| 1 | information and talent    |   |   |     |   |   |    |             |
| 1 | across functional         |   |   |     |   |   |    |             |
| * | boundaries.               |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Allow the new Chief of    | O |   | Co  |   |   |    |             |
| * | PPP to determine the      | f |   | mpl |   |   |    |             |
| 1 | timeline for subdividing  | f |   | ete |   |   |    |             |
| . | the office into two       | i |   | ti  |   |   |    |             |
| 1 | units: Strategic Planning | c |   | mel |   |   |    |             |
| 1 | and Policy, and           | e |   | ine |   |   |    |             |
| . | Performance Planning and  | o |   | d   |   |   |    |             |
| 1 | Monitoring.               | f |   | ete |   |   |    |             |
| * |                           | U |   | rmi |   |   |    |             |
| * |                           | S |   | nat |   |   |    |             |
|   |                           | H |   | ion |   |   |    |             |
|   |                           |   |   | wit |   |   |    |             |
|   |                           |   |   | hin |   |   |    |             |
|   |                           |   |   | 30  |   |   |    |             |
|   |                           |   |   | d   |   |   |    |             |
|   |                           |   |   | ays |   |   |    |             |
|   |                           |   |   | of  |   |   |    |             |
|   |                           |   |   | ap  |   |   |    |             |
|   |                           |   |   | poi |   |   |    |             |
|   |                           |   |   | ntm |   |   |    |             |
|   |                           |   |   | ent |   |   |    |             |
|   |                           |   |   | of  |   |   |    |             |
|   |                           |   |   | Ch  |   |   |    |             |
|   |                           |   |   | ief |   |   |    |             |
|   |                           |   |   | of  |   |   |    |             |
|   |                           |   |   | P   |   |   |    |             |
|   |                           |   |   | PP. |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | A group of commenters     | * | I |     |   |   |    |             |
| * | expressed concern         | * | t |     |   |   |    |             |
| 1 | regarding the structure   | D | i |     |   |   |    |             |
| . | of this office and        | * | s |     |   |   |    |             |
| 1 | emphasized the following, | * | n |     |   |   |    |             |
| 1 | \"The purpose of          |   | o |     |   |   |    |             |
| * | restructuring was to also |   | t |     |   |   |    |             |
| * | decentralize              |   | t |     |   |   |    |             |
|   | decision-making to the    |   | h |     |   |   |    |             |
|   | field. It would appear    |   | e |     |   |   |    |             |
|   | that by creating an       |   | e |     |   |   |    |             |
|   | Office of PPP, there is   |   | x |     |   |   |    |             |
|   | actually more             |   | p |     |   |   |    |             |
|   | centralization than       |   | e |     |   |   |    |             |
|   | decentralization. The PPP |   | c |     |   |   |    |             |
|   | office is very large and  |   | t |     |   |   |    |             |
|   | is faced with a daunting  |   | a |     |   |   |    |             |
|   | task. We do not believe   |   | t |     |   |   |    |             |
|   | it is ever a good idea to |   | i |     |   |   |    |             |
|   | have any one unit         |   | o |     |   |   |    |             |
|   | responsible for planning  |   | n |     |   |   |    |             |
|   | programs and monitoring   |   | t |     |   |   |    |             |
|   | the outcomes              |   | h |     |   |   |    |             |
|   | (performance) of these    |   | a |     |   |   |    |             |
|   | program. The two mission, |   | t |     |   |   |    |             |
|   | planning and performance, |   | t |     |   |   |    |             |
|   | can be too intertwined    |   | h |     |   |   |    |             |
|   | and raise the question of |   | e |     |   |   |    |             |
|   | conflict of interest. We  |   | r |     |   |   |    |             |
|   | do see the logic in       |   | e |     |   |   |    |             |
|   | combining Policy and      |   | w |     |   |   |    |             |
|   | Planning; however, we     |   | i |     |   |   |    |             |
|   | believe the Performance   |   | l |     |   |   |    |             |
|   | component should remain   |   | l |     |   |   |    |             |
|   | separate."                |   | b |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | z |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | - |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | k |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | , |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | O |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | P |     |   |   |    |             |
|   |                           |   | P |     |   |   |    |             |
|   |                           |   | P |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer expressed      | * | T |     |   |   |    |             |
| * | concern regarding the     | * | h |     |   |   |    |             |
| 1 | listing of current        | A | e |     |   |   |    |             |
| . | functions cited within    | * | s |     |   |   |    |             |
| 1 | the report that no longer | * | u |     |   |   |    |             |
| 1 | would be required at HQ.  |   | g |     |   |   |    |             |
| * | The commentary notes that |   | g |     |   |   |    |             |
| * | \"it is suggested that    |   | e |     |   |   |    |             |
|   | educational entities such |   | s |     |   |   |    |             |
|   | as the QMI should move to |   | t |     |   |   |    |             |
|   | the Chief Employee        |   | i |     |   |   |    |             |
|   | Education Officer. This   |   | o |     |   |   |    |             |
|   | seems reasonable on the   |   | n |     |   |   |    |             |
|   | face, but one of the      |   | i |     |   |   |    |             |
|   | reasons these components  |   | s |     |   |   |    |             |
|   | came to be in the first   |   | c |     |   |   |    |             |
|   | place was the large unmet |   | o |     |   |   |    |             |
|   | need in the system to     |   | n |     |   |   |    |             |
|   | address quality issues.   |   | s |     |   |   |    |             |
|   | Care should be taken that |   | i |     |   |   |    |             |
|   | when moving these         |   | s |     |   |   |    |             |
|   | components that           |   | t |     |   |   |    |             |
|   | responsiveness to needs   |   | e |     |   |   |    |             |
|   | of customers in HQ is     |   | n |     |   |   |    |             |
|   | maintained. This would    |   | t |     |   |   |    |             |
|   | seem to be especially     |   | w |     |   |   |    |             |
|   | important at this time    |   | i |     |   |   |    |             |
|   | when there is a great     |   | t |     |   |   |    |             |
|   | need to train staff in    |   | h |     |   |   |    |             |
|   | some new concepts of      |   | t |     |   |   |    |             |
|   | performance management    |   | h |     |   |   |    |             |
|   | and measurement           |   | e |     |   |   |    |             |
|   | systems.\"                |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | A |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | 3 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 2 |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | q |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
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|   |                           |   | s |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
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|   |                           |   | f |     |   |   |    |             |
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|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One commentary emphasizes |   | T |     |   |   |    |             |
| * | that with the transfer of |   | h |     |   |   |    |             |
| 1 | training and education    |   | e |     |   |   |    |             |
| . | activities to the field   |   | c |     |   |   |    |             |
| 1 | and to the Office of      |   | o |     |   |   |    |             |
| 1 | Employee Education, it is |   | m |     |   |   |    |             |
| * | not readily apparent why  |   | m |     |   |   |    |             |
| * | the identification of     |   | e |     |   |   |    |             |
|   | training needs and        |   | n |     |   |   |    |             |
|   | assistance in curriculum  |   | t |     |   |   |    |             |
|   | development should remain |   | i |     |   |   |    |             |
|   | in PPP. If the activity   |   | s |     |   |   |    |             |
|   | being retained is the     |   | c |     |   |   |    |             |
|   | same advisory function as |   | o |     |   |   |    |             |
|   | currently performed by    |   | n |     |   |   |    |             |
|   | existing program offices  |   | s |     |   |   |    |             |
|   | in the development of     |   | i |     |   |   |    |             |
|   | training programs, it may |   | s |     |   |   |    |             |
|   | be unnecessary to state   |   | t |     |   |   |    |             |
|   | this function explicitly. |   | e |     |   |   |    |             |
|   | As such, FTE to be moved  |   | n |     |   |   |    |             |
|   | to the Employee Education |   | t |     |   |   |    |             |
|   | from the QMO and QMI      |   | w |     |   |   |    |             |
|   | should be identified.     |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
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|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | A |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | 3 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 2 |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | F |     |   |   |    |             |
|   |                           |   | T |     |   |   |    |             |
|   |                           |   | E |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Western Region        | * | C |     |   |   |    |             |
| * | Information Management    | * | o |     |   |   |    |             |
| 1 | Group agrees that the     | A | m |     |   |   |    |             |
| . | Office of PPP at the      | * | m |     |   |   |    |             |
| 1 | level of the USH makes    | * | e |     |   |   |    |             |
| 1 | sense, in particular to   |   | n |     |   |   |    |             |
| * | integrate operational and |   | t |     |   |   |    |             |
| * | clinical planning efforts |   | a |     |   |   |    |             |
|   | that have traditionally   |   | r |     |   |   |    |             |
|   | been segmented.           |   | y |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
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|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | q |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Chair of the Employee | * | C |     |   |   |    |             |
| * | Education Network states  | * | o |     |   |   |    |             |
| 1 | support for a shift of    | A | m |     |   |   |    |             |
| . | education and training    | * | m |     |   |   |    |             |
| 1 | activities performed by   | * | e |     |   |   |    |             |
| 1 | the Quality Management    |   | n |     |   |   |    |             |
| * | Institute (QMI) and       |   | t |     |   |   |    |             |
| * | Quality Management        |   | a |     |   |   |    |             |
|   | Officer (QMO) to the      |   | r |     |   |   |    |             |
|   | Office of Employee        |   | y |     |   |   |    |             |
|   | Education is appropriate  |   | c |     |   |   |    |             |
|   | and on target. He notes   |   | o |     |   |   |    |             |
|   | that the OMI technically  |   | n |     |   |   |    |             |
|   | has been part of the      |   | s |     |   |   |    |             |
|   | Office of Academic        |   | i |     |   |   |    |             |
|   | Affairs but supported by  |   | s |     |   |   |    |             |
|   | the Office of Quality     |   | t |     |   |   |    |             |
|   | Management. This writer   |   | e |     |   |   |    |             |
|   | recommends that the QMI   |   | n |     |   |   |    |             |
|   | which has had quasi       |   | t |     |   |   |    |             |
|   | involvement in the        |   | w |     |   |   |    |             |
|   | Employee Education        |   | i |     |   |   |    |             |
|   | Network become a          |   | t |     |   |   |    |             |
|   | full-fledged member of    |   | h |     |   |   |    |             |
|   | the Network and be fully  |   | r |     |   |   |    |             |
|   | accountable to the Chief  |   | e |     |   |   |    |             |
|   | Employee Education        |   | p |     |   |   |    |             |
|   | Officer.                  |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | T |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
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|   |                           |   | p |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
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|   |                           |   | p |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
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|   |                           |   | Q |     |   |   |    |             |
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|   |                           |   | h |     |   |   |    |             |
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|   |                           |   | C |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
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|   |                           |   | e |     |   |   |    |             |
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|   |                           |   | d |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
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|   |                           |   | O |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | New Functions. Two sets   |   |   |     |   |   | D/ |             |
| e | of functions should be    |   |   |     |   |   | O] |             |
| f | added to the Office of    |   |   |     |   |   | {. |             |
| N | PPP beyond the general    |   |   |     |   |   | un |             |
| o | ones discussed in the     |   |   |     |   |   | de |             |
| . | Vision *for Change.*      |   |   |     |   |   | rl |             |
| ] | These are (a) the OIG/GAO |   |   |     |   |   | in |             |
| { | liaison function          |   |   |     |   |   | e} |             |
| . | originally proposed to    |   |   |     |   |   | ** |             |
| u | shift to the COS and (b)  |   |   |     |   |   |    |             |
| n | the Legislative programs  |   |   |     |   |   |    |             |
| d | function currently        |   |   |     |   |   |    |             |
| e | assigned to the Chief of  |   |   |     |   |   |    |             |
| r | Staff.                    |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| 2 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The OIG/GAO liaison       | O |   | O   |   |   |    |             |
| * | function includes the     | f |   | ct. |   |   |    |             |
| 1 | review and analysis of    | f |   | 1,  |   |   |    |             |
| . | OIG/GAO audits,           | i |   | 1   |   |   |    |             |
| 1 | developing the VHA        | c |   | 995 |   |   |    |             |
| 2 | position on them, and     | e |   |     |   |   |    |             |
| . | ensuring appropriate      | o |   |     |   |   |    |             |
| 1 | follow-up and corrective  | f |   |     |   |   |    |             |
| * | actions. The OIG/GAO,     | U |   |     |   |   |    |             |
| * | Quality Management (QM),  | S |   |     |   |   |    |             |
|   | and Medical Inspector     | H |   |     |   |   |    |             |
|   | (MI) functions will all   |   |   |     |   |   |    |             |
|   | be strengthened and       |   |   |     |   |   |    |             |
|   | economies achieved in     |   |   |     |   |   |    |             |
|   | certain data base and     |   |   |     |   |   |    |             |
|   | follow-up activities if   |   |   |     |   |   |    |             |
|   | they are organizationally |   |   |     |   |   |    |             |
|   | linked. This also         |   |   |     |   |   |    |             |
|   | requires that the scope   |   |   |     |   |   |    |             |
|   | of MI and QM activities   |   |   |     |   |   |    |             |
|   | be extended beyond        |   |   |     |   |   |    |             |
|   | clinical matters and      |   |   |     |   |   |    |             |
|   | would make the            |   |   |     |   |   |    |             |
|   | establishment of an       |   |   |     |   |   |    |             |
|   | Office of Clinical        |   |   |     |   |   |    |             |
|   | Efficacy with these       |   |   |     |   |   |    |             |
|   | functions unnecessary.    |   |   |     |   |   |    |             |
|   | (See also recommendation  |   |   |     |   |   |    |             |
|   | 1.2 and 1.45.2).          |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
|   | Add the OIG/GAO function  |   |   |     |   |   |    |             |
|   | to the Office of PPP.     |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Legislative programs  | O |   | O   |   |   |    |             |
| * | functions should be       | f |   | ct. |   |   |    |             |
| 1 | formally integrated into  | f |   | 1,  |   |   |    |             |
| . | the policy analysis       | i |   | 1   |   |   |    |             |
| 1 | functions of the Office   | c |   | 995 |   |   |    |             |
| 2 | of PPP. This would        | e |   |     |   |   |    |             |
| . | strengthen VHA            | o |   |     |   |   |    |             |
| 2 | legislative review. In    | f |   |     |   |   |    |             |
| * | particular, the           | U |   |     |   |   |    |             |
| * | identification of         | S |   |     |   |   |    |             |
|   | legislative initiatives   | H |   |     |   |   |    |             |
|   | and the analysis of       |   |   |     |   |   |    |             |
|   | legislative proposals of  |   |   |     |   |   |    |             |
|   | other organizations       |   |   |     |   |   |    |             |
|   | requires close            |   |   |     |   |   |    |             |
|   | interaction with policy   |   |   |     |   |   |    |             |
|   | analysis. With this       |   |   |     |   |   |    |             |
|   | function, the Office of   |   |   |     |   |   |    |             |
|   | PPP would assume the      |   |   |     |   |   |    |             |
|   | responsibility for        |   |   |     |   |   |    |             |
|   | preparing the DUSH and    |   |   |     |   |   |    |             |
|   | top VHA officials for     |   |   |     |   |   |    |             |
|   | hearings with associated  |   |   |     |   |   |    |             |
|   | scheduling and drafting   |   |   |     |   |   |    |             |
|   | responsibilities. (See    |   |   |     |   |   |    |             |
|   | also recommendation 1.3). |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
|   | Add the Legislative       |   |   |     |   |   |    |             |
|   | Program function to the   |   |   |     |   |   |    |             |
|   | Office of PPP.            |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | A general comment is that | * | C |     |   |   |    |             |
| * | it might be considered a  | * | o |     |   |   |    |             |
| 1 | conflict of interest to   | D | n |     |   |   |    |             |
| . | have the Medical          | * | s |     |   |   |    |             |
| 1 | Inspector (MI) and the    | * | i |     |   |   |    |             |
| 2 | OIG and GAO liaison       |   | d |     |   |   |    |             |
| . | function in the same      |   | e |     |   |   |    |             |
| 1 | office, especially if the |   | r |     |   |   |    |             |
| * | writes a report that      |   | a |     |   |   |    |             |
| * | needs a coordinated       |   | t |     |   |   |    |             |
|   | response. The writer      |   | i |     |   |   |    |             |
|   | suggests consideration of |   | o |     |   |   |    |             |
|   | another location for one  |   | n |     |   |   |    |             |
|   | of these functions.       |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
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|   |                           |   | f |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
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|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | T |     |   |   |    |             |
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|   |                           |   | x |     |   |   |    |             |
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|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | f |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
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|   |                           |   | t |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Initially, the Office of  |   |   |     |   |   | D/ |             |
| e | PPP should be comprised   |   |   |     |   |   | O] |             |
| f | of both HQ staff and the  |   |   |     |   |   | {. |             |
| N | field units currently     |   |   |     |   |   | un |             |
| o | reporting to it. In       |   |   |     |   |   | de |             |
| . | general, the workgroup    |   |   |     |   |   | rl |             |
| ] | believes that Strategic   |   |   |     |   |   | in |             |
| { | Planning and Policy       |   |   |     |   |   | e} |             |
| . | requires fewer staff than |   |   |     |   |   | ** |             |
| u | Performance Planning and  |   |   |     |   |   |    |             |
| n | Monitoring, and that      |   |   |     |   |   |    |             |
| d | Performance Planning and  |   |   |     |   |   |    |             |
| e | Monitoring requires fewer |   |   |     |   |   |    |             |
| r | staff than proposed in    |   |   |     |   |   |    |             |
| l | the initial assignment.   |   |   |     |   |   |    |             |
| i | These functions should be |   |   |     |   |   |    |             |
| n | re-evaluated for          |   |   |     |   |   |    |             |
| e | integration, elimination  |   |   |     |   |   |    |             |
| } | of duplication, and       |   |   |     |   |   |    |             |
| * | whether they need to be   |   |   |     |   |   |    |             |
| * | redistributed to other    |   |   |     |   |   |    |             |
|   | units and/or programs     |   |   |     |   |   |    |             |
| * | within HQ. All of these   |   |   |     |   |   |    |             |
| * | field based units         |   |   |     |   |   |    |             |
| 1 | identified to be          |   |   |     |   |   |    |             |
| . | realigned to the Office   |   |   |     |   |   |    |             |
| 1 | of PPP and those          |   |   |     |   |   |    |             |
| 3 | currently aligned with    |   |   |     |   |   |    |             |
| * | the Chief Financial       |   |   |     |   |   |    |             |
| * | Officer, such as the      |   |   |     |   |   |    |             |
|   | Management Science Group  |   |   |     |   |   |    |             |
|   | at Bedford, should be     |   |   |     |   |   |    |             |
|   | included as part of this  |   |   |     |   |   |    |             |
|   | review to determine their |   |   |     |   |   |    |             |
|   | need and placement in the |   |   |     |   |   |    |             |
|   | new organization.         |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Establish an Office of    | O |   | O   |   |   |    |             |
| * | PPP initially with units  | f |   | ct. |   |   |    |             |
| 1 | currently reporting to    | f |   | 1,  |   |   |    |             |
| . | it.                       | i |   | 1   |   |   |    |             |
| 1 |                           | c |   | 995 |   |   |    |             |
| 3 |                           | e |   |     |   |   |    |             |
| . |                           | o |   |     |   |   |    |             |
| 1 |                           | f |   |     |   |   |    |             |
| * |                           | U |   |     |   |   |    |             |
| * |                           | S |   |     |   |   |    |             |
|   |                           | H |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Prior to realignment of   | O |   | C   |   |   |    |             |
| * | new units, the new Chief  | f |   | omp |   |   |    |             |
| 1 | of PPP, in conjunction    | f |   | let |   |   |    |             |
| . | with the CFO, will        | i |   | ion |   |   |    |             |
| 1 | perform a critical        | c |   | by  |   |   |    |             |
| 3 | analysis and review of    | e |   | Jan |   |   |    |             |
| . | functions and staffing of | o |   | .1, |   |   |    |             |
| 2 | units under consideration | f |   | 1   |   |   |    |             |
| * | for realignment in the    | P |   | 996 |   |   |    |             |
| * | new office, including     | P |   |     |   |   |    |             |
|   | field units, with the     | P |   |     |   |   |    |             |
|   | goal of seamless          |   |   |     |   |   |    |             |
|   | integration and           |   |   |     |   |   |    |             |
|   | achievement of economies  |   |   |     |   |   |    |             |
|   | of scale.                 |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | All out placed field      | O |   | D   |   |   |    |             |
| * | units realigned to PPP    | f |   | own |   |   |    |             |
| 1 | should be assessed within | f |   | siz |   |   |    |             |
| . | six months with respect   | i |   | ing |   |   |    |             |
| 1 | to their continued        | c |   | com |   |   |    |             |
| 3 | existence, staffing, and  | e |   | ple |   |   |    |             |
| . | reporting relationship to | o |   | ted |   |   |    |             |
| 3 | the PPP.                  | f |   | by  |   |   |    |             |
| * |                           | P |   | M   |   |   |    |             |
| * |                           | P |   | ar. |   |   |    |             |
|   |                           | P |   | 19  |   |   |    |             |
|   |                           |   |   | 96. |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer expressed      | * | T |     |   |   |    |             |
| * | concern for the           | * | h |     |   |   |    |             |
| 1 | feasibility of the        | A | e |     |   |   |    |             |
| . | suggested new             | * | r |     |   |   |    |             |
| 1 | organization in view of   | * | e |     |   |   |    |             |
| 3 | the MAMOE levels expected |   | v |     |   |   |    |             |
| * | for FY 1996. This writer  |   | i |     |   |   |    |             |
| * | recommends elimination of |   | e |     |   |   |    |             |
|   | the redundacies and       |   | w |     |   |   |    |             |
|   | fragmentation in planning |   | t |     |   |   |    |             |
|   | through the merger of the |   | o |     |   |   |    |             |
|   | COO/CNO planning staff,   |   | b |     |   |   |    |             |
|   | Facility Planning         |   | e |     |   |   |    |             |
|   | functions, and the CFO    |   | u |     |   |   |    |             |
|   | Business Planning         |   | n |     |   |   |    |             |
|   | function with the Office  |   | d |     |   |   |    |             |
|   | of PPP.                   |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | k |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | C |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | P |     |   |   |    |             |
|   |                           |   | P |     |   |   |    |             |
|   |                           |   | P |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | j |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | C |     |   |   |    |             |
|   |                           |   | F |     |   |   |    |             |
|   |                           |   | O |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | C |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | E |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | E |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | O |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | N |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
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|   |                           |   | o |     |   |   |    |             |
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|   |                           |   | h |     |   |   |    |             |
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|   |                           |   | r |     |   |   |    |             |
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|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | q |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Several comments (4)      |   | T |     |   |   |    |             |
| * | addressed a concern for   |   | h |     |   |   |    |             |
| 1 | the need and timing of    |   | e |     |   |   |    |             |
| . | this critical analysis.   |   | t |     |   |   |    |             |
| 1 | The functions identified  |   | a |     |   |   |    |             |
| 3 | fall within the new PPP   |   | r |     |   |   |    |             |
| . | office, and the delay in  |   | g |     |   |   |    |             |
| 2 | reassignment of the staff |   | e |     |   |   |    |             |
| * | was commented as counter  |   | t |     |   |   |    |             |
| * | productive in             |   | d |     |   |   |    |             |
|   | accomplishing the tasks   |   | a |     |   |   |    |             |
|   | (i.e., strategic plans,   |   | t |     |   |   |    |             |
|   | performance plans, etc.)  |   | e |     |   |   |    |             |
|   | required from this        |   | a |     |   |   |    |             |
|   | office. One specific      |   | p |     |   |   |    |             |
|   | comment emphasized that   |   | p |     |   |   |    |             |
|   | the Planning Systems      |   | e |     |   |   |    |             |
|   | Group at Gainesville, the |   | a |     |   |   |    |             |
|   | Management Science Group  |   | r |     |   |   |    |             |
|   | at Bedford, and the staff |   | s |     |   |   |    |             |
|   | in the Office of the      |   | r |     |   |   |    |             |
|   | Director must be          |   | e |     |   |   |    |             |
|   | transferred with the      |   | a |     |   |   |    |             |
|   | appropriate functional    |   | s |     |   |   |    |             |
|   | responsibility on October |   | o |     |   |   |    |             |
|   | 1, 1995. The writer added |   | n |     |   |   |    |             |
|   | that an analysis          |   | a |     |   |   |    |             |
|   | performed by January 1,   |   | b |     |   |   |    |             |
|   | 1996 will not serve the   |   | l |     |   |   |    |             |
|   | organization well.        |   | e |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | h |     |   |   |    |             |
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|   |                           |   | P |     |   |   |    |             |
|   |                           |   | , |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
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|   |                           |   | d |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | d |     |   |   |    |             |
|   |                           |   | Õ |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | r |     |   |   |    |             |
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|   |                           |   | m |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
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|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | I |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
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|   |                           |   | w |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
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|   |                           |   | o |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
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|   |                           |   | d |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | , |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| 1 | One writer commented 'to  | A | T |     |   |   |    |             |
| . | establish a smaller, more |   | h |     |   |   |    |             |
| 1 | efficient, effective and  |   | i |     |   |   |    |             |
| 3 | exonomical organization'  |   | s |     |   |   |    |             |
|   | for the Office of PPP has |   | c |     |   |   |    |             |
|   | not been realized with    |   | o |     |   |   |    |             |
|   | the size of the           |   | m |     |   |   |    |             |
|   | organization and staff    |   | m |     |   |   |    |             |
|   | proposed by this report.  |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
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|   |                           |   | 3 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 2 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| 1 | One writer strongly       |   | N |     |   |   |    |             |
| . | emphasized concerns       |   | o |     |   |   |    |             |
| 1 | regarding the placement   |   | t |     |   |   |    |             |
| 3 | of the Management         |   | e |     |   |   |    |             |
|   | Sciences Group (MSG)      |   | d |     |   |   |    |             |
|   | located at Bedford from   |   | . |     |   |   |    |             |
|   | the CFO Office to the     |   | T |     |   |   |    |             |
|   | Office of PPP. This       |   | h |     |   |   |    |             |
|   | writer emphasized the     |   | e |     |   |   |    |             |
|   | historical decision       |   | r |     |   |   |    |             |
|   | making rationale for      |   | e |     |   |   |    |             |
|   | placement of the MSG to   |   | p |     |   |   |    |             |
|   | its current               |   | o |     |   |   |    |             |
|   | organizational alignment. |   | r |     |   |   |    |             |
|   | This writer also suggests |   | t |     |   |   |    |             |
|   | that if the MSG is not    |   | d |     |   |   |    |             |
|   | going to continue to      |   | o |     |   |   |    |             |
|   | focus on financial and    |   | e |     |   |   |    |             |
|   | budget issues, they       |   | s |     |   |   |    |             |
|   | should no longer exist as |   | n |     |   |   |    |             |
|   | a separate entity and     |   | o |     |   |   |    |             |
|   | their elimination should  |   | t |     |   |   |    |             |
|   | be considered. The writer |   | p |     |   |   |    |             |
|   | also noted merging the    |   | r |     |   |   |    |             |
|   | MSG with evaluation       |   | o |     |   |   |    |             |
|   | functions in HSR&D, the   |   | v |     |   |   |    |             |
|   | MDRC, and the National    |   | i |     |   |   |    |             |
|   | Center for Veterans       |   | d |     |   |   |    |             |
|   | Analysis and Statistics   |   | e |     |   |   |    |             |
|   | as options.               |   | a |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
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|   |                           |   | a |     |   |   |    |             |
|   |                           |   | k |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | ( |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | C |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | P |     |   |   |    |             |
|   |                           |   | P |     |   |   |    |             |
|   |                           |   | P |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | C |     |   |   |    |             |
|   |                           |   | F |     |   |   |    |             |
|   |                           |   | O |     |   |   |    |             |
|   |                           |   | ) |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Prior to realignment of   | O |   | C   |   |   |    |             |
| * | new units, the new Chief  | f |   | omp |   |   |    |             |
| 1 | of PPP, in conjunction    | f |   | let |   |   |    |             |
| . | with the CFO and the      | i |   | ion |   |   |    |             |
| 1 | Chief Employee Education  | c |   | by  |   |   |    |             |
| 3 | Officer, will perform a   | e |   |     |   |   |    |             |
| . | critical analysis and     | o |   | J   |   |   |    |             |
| 2 | review of functions and   | f |   | anu |   |   |    |             |
| * | staffing of units under   | U |   | ary |   |   |    |             |
| * | consideration for         | S |   | 1,  |   |   |    |             |
|   | realignment in the new    | H |   | 1   |   |   |    |             |
| * | office, including field   |   |   | 996 |   |   |    |             |
| * | units, with the goal of   |   |   |     |   |   |    |             |
| R | seamless integration and  |   |   |     |   |   |    |             |
| e | achievement of economies  |   |   |     |   |   |    |             |
| - | of scale. Field           |   |   |     |   |   |    |             |
| v | representation at the     |   |   |     |   |   |    |             |
| i | level of a VISN or VAMC   |   |   |     |   |   |    |             |
| s | director will also be     |   |   |     |   |   |    |             |
| e | included as Chairperson   |   |   |     |   |   |    |             |
| d | of the task force         |   |   |     |   |   |    |             |
| * | completing this review. A |   |   |     |   |   |    |             |
| * | report with               |   |   |     |   |   |    |             |
|   | recommendations will be   |   |   |     |   |   |    |             |
|   | provided to the DUSH.     |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

  -------------------- ------------------------- --------- ----------------------- -- ------------------------- ----------------------------- -------
  **[Ref               **HEALTHCARE PROGRAMS -                                        **[A/D/O]{.underline}**   **[Remarks-K]{.underline}**   
  No.]{.underline}**   Recommendations 1.14                                                                                                   
                       through 1.23**                                                                                                         

                       **General Comments**      **A/D**   **Rationale**                                                                      

                       One writer emphasized     **A**     Commentary makes a good                                                            
                       that both this report and           point. Technology                                                                  
                       the VISN report are                 assessment is currently                                                            
                       silent concerning                   fragmented and dealt                                                               
                       technology assessment               with by a number of                                                                
                       (high cost/high tech                elements within VHA. A                                                             
                       equipment, procedures,              process for the review                                                             
                       and pharmaceuticals).               of this matter should                                                              
                       Technology assessment               be determined at the                                                               
                       affects hundreds of                 National level. It is                                                              
                       million of dollars in               recommended that the                                                               
                       expenditures, and we                DUSH convene a                                                                     
                       recommend that the                  multidisciplinary task                                                             
                       reports address where               force to review this                                                               
                       technology should occur             issue. The group should                                                            
                       in VHA. Should it be                be chaired by the COS                                                              
                       under R&D? Should parts             with participation of                                                              
                       be addressed by the                 the CFO, CIO, Director                                                             
                       National Center for Cost            R&D, Chief PCS Officer                                                             
                       Containment? Should we              and field                                                                          
                       buy technology assessment           representation at the                                                              
                       products/reports                    level of VISN director.                                                            
                       off-the-shelf? Should it            See addition of action                                                             
                       be a local function?                1.0.1, under Office of                                                             
                       Finally, should VHA have            PPP, Chief of Staff.                                                               
                       a coordinating                                                                                                         
                       body/office/person for                                                                                                 
                       technology assessment to                                                                                               
                       reduce the potential for                                                                                               
                       redundancy.                                                                                                            

                       One writer recommended    **D**     The recommendation made                                                            
                       the inclusion of a                  by the workgroup                                                                   
                       detailed statement of               (reference 1.23) did                                                               
                       Research & Development HQ           not change the VHA                                                                 
                       functions within the                functions of R&D, and                                                              
                       report (Section IV.A.)              was limited to                                                                     
                       following the Issue                 realigning currenly                                                                
                       Statement, \'R&D has a              performed                                                                          
                       well defined mission as             Rehabilitation R&D                                                                 
                       stated in the *Vision for           functions. The space                                                               
                       Change.\'*                          constraints associated                                                             
                                                           with the final report                                                              
                                                           would not make                                                                     
                                                           inclusion of this type                                                             
                                                           of information                                                                     
                                                           feasiblewhen unrelated                                                             
                                                           to the                                                                             
                                                           action/recommendation                                                              
                                                           being proposed.                                                                    

                       Several writers (5)       **A**     This recommendation has                                                            
                       including the ACMD for              merit, and should be                                                               
                       Dentistry recommended a             considered by the Chief                                                            
                       multidisciplinary council           Patient Care Services                                                              
                       to support VISN and HQ              (PCS) Officer. See                                                                 
                       functions. Commentaries             added action 1.16.3                                                                
                       varied on the name of               which assigns this                                                                 
                       this council, but each              responsibility to the                                                              
                       writer emphasized the               Chief PCS Officer.                                                                 
                       potential for enhanced                                                                                                 
                       quality of service,                                                                                                    
                       program and professional                                                                                               
                       development.                                                                                                           
  -------------------- ------------------------- --------- ----------------------- -- ------------------------- ----------------------------- -------

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Patient Care Services     |   |   |     |   |   | D/ |             |
| e | will be structured to     |   |   |     |   |   | O] |             |
| f | have five Strategic       |   |   |     |   |   | {. |             |
| N | Healthcare Groups         |   |   |     |   |   | un |             |
| o | (SHG\'s) each responsible |   |   |     |   |   | de |             |
| . | for a cluster of product  |   |   |     |   |   | rl |             |
| ] | lines with a commonality  |   |   |     |   |   | in |             |
| { | of purpose. Each of the   |   |   |     |   |   | e} |             |
| . | Strategic Healthcare      |   |   |     |   |   | ** |             |
| u | Groups will address       |   |   |     |   |   |    |             |
| n | issues that involve the   |   |   |     |   |   |    |             |
| d | continuum of care,        |   |   |     |   |   |    |             |
| e | including both inpatient  |   |   |     |   |   |    |             |
| r | and outpatient settings.  |   |   |     |   |   |    |             |
| l | The five groups are       |   |   |     |   |   |    |             |
| i | Primary Care, Acute Care, |   |   |     |   |   |    |             |
| n | Geriatric/Extended Care,  |   |   |     |   |   |    |             |
| e | Rehabilitation, and       |   |   |     |   |   |    |             |
| } | Mental Health. Within     |   |   |     |   |   |    |             |
| * | Strategic Healthcare      |   |   |     |   |   |    |             |
| * | Groups are Product Lines. |   |   |     |   |   |    |             |
|   | Each Product Line         |   |   |     |   |   |    |             |
| * | consists of a related     |   |   |     |   |   |    |             |
| * | group of programs or      |   |   |     |   |   |    |             |
| 1 | services that meet the    |   |   |     |   |   |    |             |
| . | needs of a specific       |   |   |     |   |   |    |             |
| 1 | patient population. These |   |   |     |   |   |    |             |
| 4 | Product Lines will        |   |   |     |   |   |    |             |
| * | include, but are not      |   |   |     |   |   |    |             |
| * | limited to, the Special   |   |   |     |   |   |    |             |
|   | Programs as outlined in   |   |   |     |   |   |    |             |
|   | the*Vision for Change.*   |   |   |     |   |   |    |             |
|   | Other examples of product |   |   |     |   |   |    |             |
|   | lines within the          |   |   |     |   |   |    |             |
|   | Strategic Healthcare      |   |   |     |   |   |    |             |
|   | Groups could be the Organ |   |   |     |   |   |    |             |
|   | Transplant Program and    |   |   |     |   |   |    |             |
|   | programs integrating a    |   |   |     |   |   |    |             |
|   | medical and surgical      |   |   |     |   |   |    |             |
|   | focus, such as,           |   |   |     |   |   |    |             |
|   | cardiothoracic and        |   |   |     |   |   |    |             |
|   | neurologic programs.      |   |   |     |   |   |    |             |
|   | There will be no Clinical |   |   |     |   |   |    |             |
|   | Support product line as   |   |   |     |   |   |    |             |
|   | identified in the*Vision  |   |   |     |   |   |    |             |
|   | for Change*.              |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Operationalize Patient    | O |   | O   |   |   |    |             |
| * | Care Services through the | f |   | ct. |   |   |    |             |
| 1 | establishment of five     | f |   | 1,  |   |   |    |             |
| . | SHGs as defined, with     | i |   | 1   |   |   |    |             |
| 1 | each SHG responsible for  | c |   | 995 |   |   |    |             |
| 4 | a cluster of product      | e |   |     |   |   |    |             |
| . | lines. The five groups    | o |   |     |   |   |    |             |
| 1 | are Primary Care, Acute   | f |   |     |   |   |    |             |
| * | Care, Geriatric/Extended  | U |   |     |   |   |    |             |
| * | Care, Rehabilitation, and | S |   |     |   |   |    |             |
|   | Mental Health.            | H |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Several writers (3)       | * | A |     |   |   |    |             |
| * | recommend the realignment | * | l |     |   |   |    |             |
| 1 | of Readjustment           | D | t |     |   |   |    |             |
| . | Counseling, albeit        | * | h |     |   |   |    |             |
| 1 | politically sensitive,    | * | o |     |   |   |    |             |
| 4 | under Patient Care        |   | u |     |   |   |    |             |
| * | Services, assigning the   |   | g |     |   |   |    |             |
| * | Vet centers to their      |   | h |     |   |   |    |             |
|   | respective VISNs. It was  |   | t |     |   |   |    |             |
|   | emphasized that           |   | h |     |   |   |    |             |
|   | Readjustment Counseling   |   | i |     |   |   |    |             |
|   | should not be an          |   | s |     |   |   |    |             |
|   | independent office.       |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | ; |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Several writers (6)       | * | S |     |   |   |    |             |
| * | expressed difficulty in   | * | e |     |   |   |    |             |
| 1 | understanding the         | A | e |     |   |   |    |             |
| . | differentiation among the | * | c |     |   |   |    |             |
| 1 | five SHGs.                | * | l |     |   |   |    |             |
| 4 |                           |   | a |     |   |   |    |             |
| * | ¥One comment emphasized   |   | r |     |   |   |    |             |
| * | that there would be a lot |   | i |     |   |   |    |             |
|   | of overlap among these    |   | f |     |   |   |    |             |
|   | groups and strict         |   | i |     |   |   |    |             |
|   | adherence to them would   |   | c |     |   |   |    |             |
|   | result in continuuing     |   | a |     |   |   |    |             |
|   | fragmentation of patient  |   | t |     |   |   |    |             |
|   | care. A possible solution |   | i |     |   |   |    |             |
|   | recommended is to somehow |   | o |     |   |   |    |             |
|   | subordinate all groups to |   | n |     |   |   |    |             |
|   | the primary care          |   | o |     |   |   |    |             |
|   | discipline with cross     |   | f |     |   |   |    |             |
|   | fertilization as needed   |   | t |     |   |   |    |             |
|   | between others. Examples  |   | h |     |   |   |    |             |
|   | include mental health and |   | e |     |   |   |    |             |
|   | rehabilitation to overlap |   | s |     |   |   |    |             |
|   | geriatrics and extended   |   | t |     |   |   |    |             |
|   | care; acute care overlaps |   | r |     |   |   |    |             |
|   | to geriatrics or mental   |   | u |     |   |   |    |             |
|   | health.                   |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   | ¥Comments (4) noted that  |   | u |     |   |   |    |             |
|   | primary care and acute    |   | r |     |   |   |    |             |
|   | care as unique product    |   | e |     |   |   |    |             |
|   | lines may be in conflict  |   | o |     |   |   |    |             |
|   | with the stated SHGs role |   | f |     |   |   |    |             |
|   | in addressing the         |   | P |     |   |   |    |             |
|   | continuum of care in both |   | C |     |   |   |    |             |
|   | inpatient and outpatient  |   | S |     |   |   |    |             |
|   | settings. It was          |   | , |     |   |   |    |             |
|   | recommended that          |   | d |     |   |   |    |             |
|   | providing an operational  |   | e |     |   |   |    |             |
|   | definition of product     |   | f |     |   |   |    |             |
|   | line may assist to        |   | i |     |   |   |    |             |
|   | clarify this matter.      |   | n |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | 4 |     |   |   |    |             |
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|   |                           |   | a |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Another writer emphasized | * | S |     |   |   |    |             |
| * | that the SHG did not      | * | e |     |   |   |    |             |
| 1 | achieve an ideal product  | A | e |     |   |   |    |             |
| . | line approach, and        | * | c |     |   |   |    |             |
| 1 | suggested that product    | * | l |     |   |   |    |             |
| 4 | line management would be  |   | a |     |   |   |    |             |
| * | better served with        |   | r |     |   |   |    |             |
| * | definitions like primary  |   | i |     |   |   |    |             |
|   | care, tertiary care, long |   | f |     |   |   |    |             |
|   | term care, and            |   | i |     |   |   |    |             |
|   | rehabilitation with an    |   | c |     |   |   |    |             |
|   | exception that all        |   | a |     |   |   |    |             |
|   | product lines will        |   | t |     |   |   |    |             |
|   | involve multidisciplinary |   | i |     |   |   |    |             |
|   | approaches. Consideration |   | o |     |   |   |    |             |
|   | of a preventive care      |   | n |     |   |   |    |             |
|   | product line was also     |   | o |     |   |   |    |             |
|   | suggested.                |   | f |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | u |     |   |   |    |             |
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|   |                           |   | P |     |   |   |    |             |
|   |                           |   | C |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | d |     |   |   |    |             |
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|   |                           |   | s |     |   |   |    |             |
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|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | 4 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 2 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer suggested that | * | T |     |   |   |    |             |
| * | more information on how   | * | h |     |   |   |    |             |
| 1 | product lines work in     | D | e |     |   |   |    |             |
| . | other corporate settings  | * | f |     |   |   |    |             |
| 1 | was needed.               | * | i |     |   |   |    |             |
| 4 |                           |   | n |     |   |   |    |             |
| * |                           |   | a |     |   |   |    |             |
| * |                           |   | l |     |   |   |    |             |
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|   |                           |   | s |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer recognized     | * | C |     |   |   |    |             |
| * | that a tangential         | * | o |     |   |   |    |             |
| 1 | reference to a Pharmacy   | A | n |     |   |   |    |             |
| . | Benefits management (PBM) | * | c |     |   |   |    |             |
| 1 | product line had been     | * | u |     |   |   |    |             |
| 4 | made within the report.   |   | r |     |   |   |    |             |
| * | (1) A recommendation is   |   | t |     |   |   |    |             |
| * | made to incorporate an    |   | h |     |   |   |    |             |
|   | action item regarding PBM |   | a |     |   |   |    |             |
|   | in this report assuming   |   | t |     |   |   |    |             |
|   | that a decision has been  |   | c |     |   |   |    |             |
|   | made to establish PBM.    |   | o |     |   |   |    |             |
|   | The decision to           |   | n |     |   |   |    |             |
|   | incorporate certain       |   | s |     |   |   |    |             |
|   | functions (such as PBM)   |   | i |     |   |   |    |             |
|   | during the initial        |   | d |     |   |   |    |             |
|   | transition phase (to the  |   | e |     |   |   |    |             |
|   | new organization) would   |   | r |     |   |   |    |             |
|   | assure that significant   |   | a |     |   |   |    |             |
|   | product lines don\'t      |   | t |     |   |   |    |             |
|   | experience a period       |   | i |     |   |   |    |             |
|   | without representation    |   | o |     |   |   |    |             |
|   | and management, assist    |   | n |     |   |   |    |             |
|   | with integration with     |   | o |     |   |   |    |             |
|   | other offices, and assure |   | f |     |   |   |    |             |
|   | continuing attention to   |   | o |     |   |   |    |             |
|   | significant legislative   |   | t |     |   |   |    |             |
|   | issues related to the     |   | h |     |   |   |    |             |
|   | product line. (2) In the  |   | e |     |   |   |    |             |
|   | same context, no action   |   | r |     |   |   |    |             |
|   | item/milestone is         |   | p |     |   |   |    |             |
|   | contained within the      |   | r |     |   |   |    |             |
|   | report that addresses     |   | o |     |   |   |    |             |
|   | when VHA would identify   |   | d |     |   |   |    |             |
|   | other product lines noted |   | u |     |   |   |    |             |
|   | in the report (i.e.,      |   | c |     |   |   |    |             |
|   | transplant,               |   | t |     |   |   |    |             |
|   | cardiothoracic, and       |   | l |     |   |   |    |             |
|   | neurologic programs). A   |   | i |     |   |   |    |             |
|   | recommendation is made    |   | n |     |   |   |    |             |
|   | that these areas be       |   | e |     |   |   |    |             |
|   | addressed now to assure   |   | s |     |   |   |    |             |
|   | continuity and            |   | i |     |   |   |    |             |
|   | integration and to        |   | s |     |   |   |    |             |
|   | prevent future \"turf\"   |   | a |     |   |   |    |             |
|   | issues.                   |   | v |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | G.V. (Sonny) Montgomery   | * | T |     |   |   |    |             |
| * | (Ranking Member of the    | * | h |     |   |   |    |             |
| 1 | CVA) indicated surprise   | A | e |     |   |   |    |             |
| . | that the proposed         | * | q |     |   |   |    |             |
| 1 | reorganization of Central | * | u |     |   |   |    |             |
| 4 | Office makes no specific  |   | e |     |   |   |    |             |
| * | provision for carrying    |   | s |     |   |   |    |             |
| * | out the board range of    |   | t |     |   |   |    |             |
|   | activities currently      |   | i |     |   |   |    |             |
|   | managed by Pharmacy       |   | o |     |   |   |    |             |
|   | Service. He cites the     |   | n |     |   |   |    |             |
|   | magnitude of VA           |   | o |     |   |   |    |             |
|   | pharmaceutical            |   | f |     |   |   |    |             |
|   | expenditures of \$1       |   | p |     |   |   |    |             |
|   | billion annually which    |   | h |     |   |   |    |             |
|   | makes inexplicable a      |   | a |     |   |   |    |             |
|   | restructuring which would |   | r |     |   |   |    |             |
|   | appear to fragment or     |   | m |     |   |   |    |             |
|   | eliminate the centralized |   | a |     |   |   |    |             |
|   | expertise of a HQ team of |   | c |     |   |   |    |             |
|   | pharmacists. While that   |   | y |     |   |   |    |             |
|   | group need not function   |   | e |     |   |   |    |             |
|   | as a Pharmacy Service,    |   | m |     |   |   |    |             |
|   | the failure to maintain   |   | p |     |   |   |    |             |
|   | an office or support      |   | h |     |   |   |    |             |
|   | group to focus            |   | a |     |   |   |    |             |
|   | consistently on           |   | s |     |   |   |    |             |
|   | pharmaceutical costs and  |   | i |     |   |   |    |             |
|   | cost increases, drug      |   | s |     |   |   |    |             |
|   | utilization, and quality  |   | h |     |   |   |    |             |
|   | would represent a major   |   | a |     |   |   |    |             |
|   | step backward in his      |   | s |     |   |   |    |             |
|   | opinion. He emphasizes    |   | b |     |   |   |    |             |
|   | that existing law does    |   | e |     |   |   |    |             |
|   | call for a Central Office |   | e |     |   |   |    |             |
|   | Pharmacy Service, and     |   | n |     |   |   |    |             |
|   | Congress has had          |   | a |     |   |   |    |             |
|   | sufficient concern over   |   | d |     |   |   |    |             |
|   | VA costs in procuring     |   | d |     |   |   |    |             |
|   | drugs to enact drug       |   | r |     |   |   |    |             |
|   | pricing legislation. He   |   | e |     |   |   |    |             |
|   | notes that the law is not |   | s |     |   |   |    |             |
|   | self executing, it        |   | s |     |   |   |    |             |
|   | requires monitoring and   |   | e |     |   |   |    |             |
|   | reporting; and imposes    |   | d |     |   |   |    |             |
|   | ongoing responsibilities  |   | . |     |   |   |    |             |
|   | on VA.                    |   | T |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | P |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | B |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | M |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
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|   |                           |   | t |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
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|   |                           |   | t |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
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|   |                           |   | b |     |   |   |    |             |
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|   |                           |   | m |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
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|   |                           |   | e |     |   |   |    |             |
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|   |                           |   | b |     |   |   |    |             |
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|   |                           |   | g |     |   |   |    |             |
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|   |                           |   | S |     |   |   |    |             |
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|   |                           |   | v |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
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|   |                           |   | O |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
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|   |                           |   | i |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | ( |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | 4 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 2 |     |   |   |    |             |
|   |                           |   | ) |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Director, Blind       | * | T |     |   |   |    |             |
| * | Rehabilitation Service    | * | h |     |   |   |    |             |
| 1 | questioned the intent of  | D | e |     |   |   |    |             |
| . | the definition given for  | * | d |     |   |   |    |             |
| 1 | Special Programs. He      | * | i |     |   |   |    |             |
| 4 | comments that, \"The      |   | s |     |   |   |    |             |
| * | statement indicates that  |   | t |     |   |   |    |             |
| * | all VISNs will be         |   | r |     |   |   |    |             |
|   | required to be able to    |   | i |     |   |   |    |             |
|   | provide access to an      |   | b |     |   |   |    |             |
|   | inpatient Blind           |   | u |     |   |   |    |             |
|   | Rehabilitation Program,   |   | t |     |   |   |    |             |
|   | regardless of whether     |   | i |     |   |   |    |             |
|   | they have one of the      |   | o |     |   |   |    |             |
|   | programs in their VISN.\" |   | n |     |   |   |    |             |
|   | He asks, How broad a      |   | o |     |   |   |    |             |
|   | definition is the term    |   | f |     |   |   |    |             |
|   | \'access\' and could      |   | s |     |   |   |    |             |
|   | access be interpreted as  |   | c |     |   |   |    |             |
|   | meaning \'to non-VA blind |   | a |     |   |   |    |             |
|   | rehabilitation program or |   | r |     |   |   |    |             |
|   | contracting for services  |   | c |     |   |   |    |             |
|   | from private sector       |   | e |     |   |   |    |             |
|   | facilities, especially    |   | r |     |   |   |    |             |
|   | when these outside        |   | e |     |   |   |    |             |
|   | programs do not equal the |   | s |     |   |   |    |             |
|   | quality of the inpatient  |   | o |     |   |   |    |             |
|   | VA program?               |   | u |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
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|   |                           |   | g |     |   |   |    |             |
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|   |                           |   | m |     |   |   |    |             |
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|   |                           |   | , |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | j |     |   |   |    |             |
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|   |                           |   | t |     |   |   |    |             |
|   |                           |   | B |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | R |     |   |   |    |             |
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|   |                           |   | b |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | I |     |   |   |    |             |
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|   |                           |   | r |     |   |   |    |             |
|   |                           |   | - |     |   |   |    |             |
|   |                           |   | V |     |   |   |    |             |
|   |                           |   | I |     |   |   |    |             |
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|   |                           |   | N |     |   |   |    |             |
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|   |                           |   | l |     |   |   |    |             |
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|   |                           |   | p |     |   |   |    |             |
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|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | h |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | b |     |   |   |    |             |
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|   |                           |   | r |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | d |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
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|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | V |     |   |   |    |             |
|   |                           |   | I |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
|   |                           |   | N |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
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|   |                           |   | r |     |   |   |    |             |
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|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
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|   |                           |   | i |     |   |   |    |             |
|   |                           |   | z |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Several writers (5)       | * | A |     |   |   |    |             |
| * | endorsed the concept of   | * | l |     |   |   |    |             |
| 1 | the Office of Patient     | D | t |     |   |   |    |             |
| . | Care Services, noting     | * | h |     |   |   |    |             |
| 1 | that the five SHGs        | * | o |     |   |   |    |             |
| 4 | proposed very well        |   | u |     |   |   |    |             |
| * | emulate the product lines |   | g |     |   |   |    |             |
| * | at many of the VAMCs and  |   | h |     |   |   |    |             |
|   | provides representation   |   | t |     |   |   |    |             |
|   | to the core providers of  |   | h |     |   |   |    |             |
|   | clinical services. One    |   | i |     |   |   |    |             |
|   | writer did question the   |   | s |     |   |   |    |             |
|   | need to retain the        |   | r |     |   |   |    |             |
|   | separateness of some      |   | e |     |   |   |    |             |
|   | programs, such as         |   | c |     |   |   |    |             |
|   | Veterans Outreach and its |   | o |     |   |   |    |             |
|   | centers; and a suggestion |   | m |     |   |   |    |             |
|   | was made that further     |   | m |     |   |   |    |             |
|   | review of this            |   | e |     |   |   |    |             |
|   | distinction be made as    |   | n |     |   |   |    |             |
|   | the new organization      |   | d |     |   |   |    |             |
|   | evolves.                  |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
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|   |                           |   | f |     |   |   |    |             |
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|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
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|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer in HQ          | * | T |     |   |   |    |             |
| * | expressed concerns for    | * | h |     |   |   |    |             |
| 1 | the diminishing           | A | e |     |   |   |    |             |
| . | visibility of the         | * | s |     |   |   |    |             |
| 1 | professional services     | * | e |     |   |   |    |             |
| 4 | component at the HQ level |   | s |     |   |   |    |             |
| * | that may ultimately       |   | u |     |   |   |    |             |
| * | de-stablize the health    |   | g |     |   |   |    |             |
|   | care system. In response  |   | g |     |   |   |    |             |
|   | this writer recommends    |   | e |     |   |   |    |             |
|   | the creation of two new   |   | s |     |   |   |    |             |
|   | organizational components |   | t |     |   |   |    |             |
|   | ; (1) a Professional      |   | i |     |   |   |    |             |
|   | Accountability Council to |   | o |     |   |   |    |             |
|   | include representation    |   | n |     |   |   |    |             |
|   | from Social Work Service  |   | s |     |   |   |    |             |
|   | and other core services , |   | s |     |   |   |    |             |
|   | and (2) an                |   | h |     |   |   |    |             |
|   | interdisciplinary Program |   | o |     |   |   |    |             |
|   | Office for Family and     |   | u |     |   |   |    |             |
|   | Community Services. It    |   | l |     |   |   |    |             |
|   | was emphasizes that the   |   | d |     |   |   |    |             |
|   | consolidation of this     |   | b |     |   |   |    |             |
|   | program into a Family and |   | e |     |   |   |    |             |
|   | Community \'product       |   | c |     |   |   |    |             |
|   | line\' of services would  |   | o |     |   |   |    |             |
|   | promote system wide       |   | n |     |   |   |    |             |
|   | expansion and marketing   |   | s |     |   |   |    |             |
|   | of a vital customer       |   | i |     |   |   |    |             |
|   | service.                  |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
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|   |                           |   | C |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
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|   |                           |   | f |     |   |   |    |             |
|   |                           |   | P |     |   |   |    |             |
|   |                           |   | C |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
|   |                           |   | O |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
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|   |                           |   | i |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | 4 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 2 |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | 6 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 3 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Several writers (2)       | * | N |     |   |   |    |             |
| * | emphasized that the       | * | o |     |   |   |    |             |
| 1 | SHG-product lines have    | D | t |     |   |   |    |             |
| . | long been utilized within | * | a |     |   |   |    |             |
| 1 | the VA in an              | * | w |     |   |   |    |             |
| 4 | interdisciplinary         |   | a |     |   |   |    |             |
| * | approach, emphasizing     |   | r |     |   |   |    |             |
| * | that this is not a new    |   | e |     |   |   |    |             |
|   | concept and is only a     |   | o |     |   |   |    |             |
|   | title change. A writer    |   | f |     |   |   |    |             |
|   | emphasizes that VHA       |   | a |     |   |   |    |             |
|   | product lines have        |   | n |     |   |   |    |             |
|   | functioned without the    |   | y |     |   |   |    |             |
|   | destruction of discipline |   | c |     |   |   |    |             |
|   | specific identity. The    |   | o |     |   |   |    |             |
|   | writer further notes that |   | n |     |   |   |    |             |
|   | many private medical      |   | t |     |   |   |    |             |
|   | centers in the New        |   | e |     |   |   |    |             |
|   | Orleans area are now      |   | m |     |   |   |    |             |
|   | returning to discipline   |   | p |     |   |   |    |             |
|   | specific product lines,   |   | o |     |   |   |    |             |
|   | with an interdisciplinary |   | r |     |   |   |    |             |
|   | approach to patient care. |   | a |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | o |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+-----+-----+-----+----+-------------+
|   | **Proposed Revisions**    | **  | **  | **  |    |             |
|   |                           | Act | Tar | Act |    |             |
|   |                           | ion | get | ual |    |             |
|   |                           | Of  | Dat | Dat |    |             |
|   |                           | fic | e** | e** |    |             |
|   |                           | e** |     |     |    |             |
+---+---------------------------+-----+-----+-----+----+-------------+
| * | **Patient Care Services** |     |     |     |    |             |
| * | will be structured to     |     |     |     |    |             |
| 1 | have five Strategic       |     |     |     |    |             |
| . | Healthcare Groups (SHGs)  |     |     |     |    |             |
| 1 | each responsible for a    |     |     |     |    |             |
| 4 | cluster of product lines  |     |     |     |    |             |
| * | with a commonality of     |     |     |     |    |             |
| * | purpose.                  |     |     |     |    |             |
|   |                           |     |     |     |    |             |
| * | ¥ **Each of the SHGs**    |     |     |     |    |             |
| * | will address issues that  |     |     |     |    |             |
| R | involve the continuum of  |     |     |     |    |             |
| e | care, including both      |     |     |     |    |             |
| - | inpatient and outpatient  |     |     |     |    |             |
| v | settings. The five groups |     |     |     |    |             |
| i | are Primary Care, Acute   |     |     |     |    |             |
| s | Care, Geriatric/Extended  |     |     |     |    |             |
| e | Care, Rehabilitation, and |     |     |     |    |             |
| d | Mental Health.            |     |     |     |    |             |
| * |                           |     |     |     |    |             |
| * | ¥ **Strategic Healthcare  |     |     |     |    |             |
|   | Groups** at the HQ level  |     |     |     |    |             |
|   | exist to coordinate       |     |     |     |    |             |
|   | aspects of patient care   |     |     |     |    |             |
|   | that have a common        |     |     |     |    |             |
|   | purpose. Many aspects of  |     |     |     |    |             |
|   | patient care will involve |     |     |     |    |             |
|   | several or all of the     |     |     |     |    |             |
|   | SHGs. This will           |     |     |     |    |             |
|   | necessitate constant      |     |     |     |    |             |
|   | dialogue between and      |     |     |     |    |             |
|   | among the SHGs to develop |     |     |     |    |             |
|   | performance goals,        |     |     |     |    |             |
|   | policy, best practices,   |     |     |     |    |             |
|   | and outcome measures that |     |     |     |    |             |
|   | improve patient care to   |     |     |     |    |             |
|   | our veterans.             |     |     |     |    |             |
|   |                           |     |     |     |    |             |
|   | ¥ **Within Strategic      |     |     |     |    |             |
|   | Healthcare Groups are     |     |     |     |    |             |
|   | Product Lines.** Each     |     |     |     |    |             |
|   | Product Line consists of  |     |     |     |    |             |
|   | a related group of        |     |     |     |    |             |
|   | programs or services that |     |     |     |    |             |
|   | meet the needs of a       |     |     |     |    |             |
|   | specific patient          |     |     |     |    |             |
|   | population. The existence |     |     |     |    |             |
|   | of **Special Programs**   |     |     |     |    |             |
|   | within VHA is one of its  |     |     |     |    |             |
|   | strengths. These areas of |     |     |     |    |             |
|   | exceptional interest and  |     |     |     |    |             |
|   | expertise reflect, to a   |     |     |     |    |             |
|   | large extent, what makes  |     |     |     |    |             |
|   | care to veterans unique.  |     |     |     |    |             |
|   | Each of the Special       |     |     |     |    |             |
|   | Programs as outlined in   |     |     |     |    |             |
|   | the *Vision for Change*   |     |     |     |    |             |
|   | will be retained. They    |     |     |     |    |             |
|   | will be located           |     |     |     |    |             |
|   | organizationally in one   |     |     |     |    |             |
|   | of the SHGs. By having a  |     |     |     |    |             |
|   | \"home\" in a SHG those   |     |     |     |    |             |
|   | Special Programs that     |     |     |     |    |             |
|   | meet the related needs of |     |     |     |    |             |
|   | the veteran can best      |     |     |     |    |             |
|   | coordinate their efforts. |     |     |     |    |             |
|   | These Product Lines will  |     |     |     |    |             |
|   | include, but are not      |     |     |     |    |             |
|   | limited to, the Special   |     |     |     |    |             |
|   | Programs as outlined in   |     |     |     |    |             |
|   | the *Vision for Change.*  |     |     |     |    |             |
|   | Other examples of product |     |     |     |    |             |
|   | lines within the          |     |     |     |    |             |
|   | Strategic Healthcare      |     |     |     |    |             |
|   | Groups could be the Organ |     |     |     |    |             |
|   | Transplant Program and    |     |     |     |    |             |
|   | programs integrating a    |     |     |     |    |             |
|   | medical and surgical      |     |     |     |    |             |
|   | focus, such as,           |     |     |     |    |             |
|   | cardiothoracic and        |     |     |     |    |             |
|   | neurologic programs. The  |     |     |     |    |             |
|   | product lines as          |     |     |     |    |             |
|   | described above obviate   |     |     |     |    |             |
|   | the need for the Clinical |     |     |     |    |             |
|   | Support product line as   |     |     |     |    |             |
|   | identified in the *Vision |     |     |     |    |             |
|   | for Change*.              |     |     |     |    |             |
+---+---------------------------+-----+-----+-----+----+-------------+
| * | The new Chief of Patient  | P   | NTE |     |    |             |
| * | Care Services, in         | ati | 30  |     |    |             |
| 1 | conjunction with SLG      | ent | d   |     |    |             |
| . | leaders, will identify a  | C   | ays |     |    |             |
| 1 | process for the           | are | f   |     |    |             |
| 4 | identification of other   | Se  | rom |     |    |             |
| . | product lines for         | rvi | a   |     |    |             |
| 2 | implemen-tation upon      | ces | ppt |     |    |             |
| * | approval of the USH.      |     | of  |     |    |             |
| * | Consideration of other    |     | the |     |    |             |
|   | product lines should      |     | Ch  |     |    |             |
| * | include the review of     |     | ief |     |    |             |
| * | proposals for Pharmacy    |     | PCS |     |    |             |
| A | Management Benefits,      |     |     |     |    |             |
| d | Family and Community      |     |     |     |    |             |
| - | Service, and Preventive   |     |     |     |    |             |
| d | Care.                     |     |     |     |    |             |
| i |                           |     |     |     |    |             |
| t |                           |     |     |     |    |             |
| i |                           |     |     |     |    |             |
| o |                           |     |     |     |    |             |
| n |                           |     |     |     |    |             |
| * |                           |     |     |     |    |             |
| * |                           |     |     |     |    |             |
+---+---------------------------+-----+-----+-----+----+-------------+
| * | The Women Veterans        | D   | De  |     |    |             |
| * | Program has developed     | USH | ter |     |    |             |
| 1 | over the years under the  |     | -mi |     |    |             |
| . | guidance and              |     | nat |     |    |             |
| 1 | encouragement of the      |     | ion |     |    |             |
| 4 | Office of Public Health   |     | NTE |     |    |             |
| . | and Environmental         |     | 9/  |     |    |             |
| 3 | Hazards. As a Special     |     | 30/ |     |    |             |
| * | Program, it would best    |     | 96. |     |    |             |
| * | fit in the new            |     |     |     |    |             |
|   | organization in one of    |     |     |     |    |             |
| * | the Strategic Healthcare  |     |     |     |    |             |
| * | Groups, specifically      |     |     |     |    |             |
| A | primary care. As an       |     |     |     |    |             |
| d | emerging Special program  |     |     |     |    |             |
| - | the need for              |     |     |     |    |             |
| d | organizational change is  |     |     |     |    |             |
| i | not as great as the need  |     |     |     |    |             |
| t | to nurture its            |     |     |     |    |             |
| i | development. No action is |     |     |     |    |             |
| o | recommended at this time  |     |     |     |    |             |
| n | to realign this program.  |     |     |     |    |             |
| * | Consideration should be   |     |     |     |    |             |
| * | given at some future time |     |     |     |    |             |
|   | to moving the Women       |     |     |     |    |             |
|   | Veterans Program to the   |     |     |     |    |             |
|   | Primary Care SHG. See     |     |     |     |    |             |
|   | also recommendation 1.19. |     |     |     |    |             |
+---+---------------------------+-----+-----+-----+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | The Strategic Healthcare  |   |   |     |   |   | D/ |             |
| e | Group (SHG) staff will    |   |   |     |   |   | O] |             |
| f | function in an            |   |   |     |   |   | {. |             |
| N | interdisciplinary,        |   |   |     |   |   | un |             |
| o | collaborative manner both |   |   |     |   |   | de |             |
| . | within each Strategic     |   |   |     |   |   | rl |             |
| ] | Healthcare Group and      |   |   |     |   |   | in |             |
| { | across Strategic          |   |   |     |   |   | e} |             |
| . | Healthcare Groups. The    |   |   |     |   |   | ** |             |
| u | core function of each     |   |   |     |   |   |    |             |
| n | Strategic Healthcare      |   |   |     |   |   |    |             |
| d | Group are to: (1) Support |   |   |     |   |   |    |             |
| e | the Secretary and the USH |   |   |     |   |   |    |             |
| r | by providing clinical     |   |   |     |   |   |    |             |
| l | expertise, drafting       |   |   |     |   |   |    |             |
| i | testimony and by          |   |   |     |   |   |    |             |
| n | preparing legislative     |   |   |     |   |   |    |             |
| e | proposals, budget         |   |   |     |   |   |    |             |
| } | proposals (in conjunction |   |   |     |   |   |    |             |
| * | with the VISNs),          |   |   |     |   |   |    |             |
| * | background and position   |   |   |     |   |   |    |             |
|   | papers; (2) Respond to    |   |   |     |   |   |    |             |
| * | correspondence and        |   |   |     |   |   |    |             |
| * | inquiries from Congress,  |   |   |     |   |   |    |             |
| 1 | GAO, OIG, other federal   |   |   |     |   |   |    |             |
| . | agencies, Veterans        |   |   |     |   |   |    |             |
| 1 | Service Organizations,    |   |   |     |   |   |    |             |
| 5 | and establish             |   |   |     |   |   |    |             |
| * | partnerships with both    |   |   |     |   |   |    |             |
| * | public and private        |   |   |     |   |   |    |             |
|   | organizations; (3)        |   |   |     |   |   |    |             |
|   | Develop and contribute to |   |   |     |   |   |    |             |
|   | their Product Lines by    |   |   |     |   |   |    |             |
|   | establishing performance  |   |   |     |   |   |    |             |
|   | goals, policy, best       |   |   |     |   |   |    |             |
|   | practices, and outcome    |   |   |     |   |   |    |             |
|   | measures to determine     |   |   |     |   |   |    |             |
|   | effectiveness; and (4)    |   |   |     |   |   |    |             |
|   | Support the VISN by       |   |   |     |   |   |    |             |
|   | serving as a consultant   |   |   |     |   |   |    |             |
|   | and determine             |   |   |     |   |   |    |             |
|   | effectiveness; and (4)    |   |   |     |   |   |    |             |
|   | Support the VISN by       |   |   |     |   |   |    |             |
|   | serving as a consultant   |   |   |     |   |   |    |             |
|   | and providing a           |   |   |     |   |   |    |             |
|   | clearinghouse function,   |   |   |     |   |   |    |             |
|   | when appropriate.         |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Develop performance       | C |   | N   |   |   |    |             |
| * | objectives and/or group   | h |   | ov. |   |   |    |             |
| 1 | charters for each SHG,    | i |   | 1,  |   |   |    |             |
| . | and performance standards | e |   | 1   |   |   |    |             |
| 1 | for each staff member of  | f |   | 995 |   |   |    |             |
| 5 | the Patient Service       | P |   |     |   |   |    |             |
| . | Group.                    | a |   |     |   |   |    |             |
| 1 |                           | t |   |     |   |   |    |             |
| * |                           | i |   |     |   |   |    |             |
| * |                           | e |   |     |   |   |    |             |
|   |                           | n |   |     |   |   |    |             |
|   |                           | t |   |     |   |   |    |             |
|   |                           | C |   |     |   |   |    |             |
|   |                           | a |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | S |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | v |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | c |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | s |   |     |   |   |    |             |
|   |                           | ( |   |     |   |   |    |             |
|   |                           | P |   |     |   |   |    |             |
|   |                           | C |   |     |   |   |    |             |
|   |                           | S |   |     |   |   |    |             |
|   |                           | ) |   |     |   |   |    |             |
|   |                           | O |   |     |   |   |    |             |
|   |                           | f |   |     |   |   |    |             |
|   |                           | f |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | c |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Develop an operating      | C |   | Nov |   |   |    |             |
| * | budget for each SHG. For  | h |   | .1, |   |   |    |             |
| 1 | example, these groups     | i |   | 1   |   |   |    |             |
| . | need to be able to bring  | e |   | 995 |   |   |    |             |
| 1 | in field-based people to  | f |   |     |   |   |    |             |
| 5 | deal with specific        | P |   |     |   |   |    |             |
| . | issues.                   | C |   |     |   |   |    |             |
| 2 |                           | S |   |     |   |   |    |             |
| * |                           | O |   |     |   |   |    |             |
| * |                           | f |   |     |   |   |    |             |
|   |                           | f |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | c |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Members of each SHG, in   | P |   | N   |   |   |    |             |
| * | conjunction with the      | a |   | ov. |   |   |    |             |
| 1 | Chief PCS Officer**,**    | t |   | 15, |   |   |    |             |
| . | will make recommendations | i |   | 1   |   |   |    |             |
| 1 | regarding adjustments in  | e |   | 995 |   |   |    |             |
| 5 | the membership of each    | n |   |     |   |   |    |             |
| . | SHG.                      | t |   |     |   |   |    |             |
| 3 |                           | C |   |     |   |   |    |             |
| * |                           | a |   |     |   |   |    |             |
| * |                           | r |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | S |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | v |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | c |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | s |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Each SHG should formulate | P |   | J   |   |   |    |             |
| * | a strategic plan after    | a |   | an. |   |   |    |             |
| 1 | group members and leaders | t |   | 12, |   |   |    |             |
| . | have received necessary   | i |   | 1   |   |   |    |             |
| 1 | training.                 | e |   | 996 |   |   |    |             |
| 5 |                           | n |   |     |   |   |    |             |
| . |                           | t |   |     |   |   |    |             |
| 4 |                           | C |   |     |   |   |    |             |
| * |                           | a |   |     |   |   |    |             |
| * |                           | r |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | S |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | v |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | c |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | s |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Director, PM&RS       | * | T |     |   |   |    |             |
| * | provided a sampling of    | * | h |     |   |   |    |             |
| 1 | activities to define how  | A | e |     |   |   |    |             |
| . | its decentralized program | * | i |     |   |   |    |             |
| 1 | operation, now in         | * | n |     |   |   |    |             |
| 5 | Memphis, functions in     |   | f |     |   |   |    |             |
| * | concert with the          |   | o |     |   |   |    |             |
| * | description of the SHG.   |   | r |     |   |   |    |             |
|   | He also emphasized that   |   | m |     |   |   |    |             |
|   | the services provided     |   | a |     |   |   |    |             |
|   | were far beyond those     |   | t |     |   |   |    |             |
|   | proposed for the          |   | i |     |   |   |    |             |
|   | discipline-specific       |   | o |     |   |   |    |             |
|   | leaders (in 1.18)., and   |   | n |     |   |   |    |             |
|   | questioned if they would  |   | i |     |   |   |    |             |
|   | be limited to the narrow  |   | s |     |   |   |    |             |
|   | scope described. He       |   | h |     |   |   |    |             |
|   | questioned also if staff  |   | e |     |   |   |    |             |
|   | of the SHG would include  |   | l |     |   |   |    |             |
|   | decentralized service     |   | p |     |   |   |    |             |
|   | staff such as PM&RS.      |   | f |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | , |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
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|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | f |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
|   |                           |   | T |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
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|   |                           |   | r |     |   |   |    |             |
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|   |                           |   | H |     |   |   |    |             |
|   |                           |   | G |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | u |     |   |   |    |             |
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|   |                           |   | u |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
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|   |                           |   | v |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer requested      | * | T |     |   |   |    |             |
| * | clarification regarding   | * | h |     |   |   |    |             |
| 1 | performance evaluation    | D | e |     |   |   |    |             |
| . | for staff of the SHG.     | * | f |     |   |   |    |             |
| 1 | This writer notes that    | * | u |     |   |   |    |             |
| 5 | the functions of SHGs     |   | n |     |   |   |    |             |
| . | listed within the report  |   | c |     |   |   |    |             |
| 1 | imply that every SHG      |   | t |     |   |   |    |             |
| * | staff person will be      |   | i |     |   |   |    |             |
| * | evaluated on performance  |   | o |     |   |   |    |             |
|   | of at least two major     |   | n |     |   |   |    |             |
|   | functions, including VISN |   | s |     |   |   |    |             |
|   | support. She points out   |   | o |     |   |   |    |             |
|   | that this appears         |   | f |     |   |   |    |             |
|   | inconsistent with         |   | S |     |   |   |    |             |
|   | information provided for  |   | H |     |   |   |    |             |
|   | the VISN HQ support teams |   | G |     |   |   |    |             |
|   | that states one staff     |   | s |     |   |   |    |             |
|   | from each SHG will be     |   | l |     |   |   |    |             |
|   | selected for each VISN    |   | i |     |   |   |    |             |
|   | support team.             |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
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|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
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|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
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|   |                           |   | V |     |   |   |    |             |
|   |                           |   | I |     |   |   |    |             |
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|   |                           |   | H |     |   |   |    |             |
|   |                           |   | Q |     |   |   |    |             |
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|   |                           |   | s |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One commentary requested  | * | T |     |   |   |    |             |
| * | clarification asking,     | * | h |     |   |   |    |             |
| 1 | \'to whom will            | D | e |     |   |   |    |             |
| . | recommendations be made,  | * | r |     |   |   |    |             |
| 1 | i.e., DUSH, USH, etc.?\'  | * | e |     |   |   |    |             |
| 5 |                           |   | c |     |   |   |    |             |
| . |                           |   | o |     |   |   |    |             |
| 3 |                           |   | m |     |   |   |    |             |
| * |                           |   | m |     |   |   |    |             |
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|   |                           |   | m |     |   |   |    |             |
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|   |                           |   | h |     |   |   |    |             |
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|   |                           |   | C |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
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|   |                           |   | C |     |   |   |    |             |
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|   |                           |   | O |     |   |   |    |             |
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|   |                           |   | c |     |   |   |    |             |
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|   |                           |   | r |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One commentary suggested  | * | T |     |   |   |    |             |
| * | that an action item be    | * | h |     |   |   |    |             |
| 1 | added which permits the   | A | e |     |   |   |    |             |
| . | Chief PCS Officer to      | * | c |     |   |   |    |             |
| 1 | determine the most        | * | o |     |   |   |    |             |
| 5 | appropriate staffing mix  |   | m |     |   |   |    |             |
| * | of the SHG. This may      |   | m |     |   |   |    |             |
| * | include assignment of a   |   | e |     |   |   |    |             |
|   | professional to more than |   | n |     |   |   |    |             |
|   | one SHG.                  |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
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|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
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|   |                           |   | m |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | 7 |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | 7 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 2 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One individual noted that | * | T |     |   |   |    |             |
| * | the functions identified  | * | h |     |   |   |    |             |
| 1 | for SHGs appear           | D | e |     |   |   |    |             |
| . | appropriate. However,     | * | t |     |   |   |    |             |
| 1 | this writer questioned    | * | r |     |   |   |    |             |
| 5 | the constant referral to  |   | e |     |   |   |    |             |
| * | interdisciplinary         |   | n |     |   |   |    |             |
| * | activities, at this time, |   | d |     |   |   |    |             |
|   | does not appear           |   | t |     |   |   |    |             |
|   | reasonable under the      |   | o |     |   |   |    |             |
|   | present organizational    |   | s |     |   |   |    |             |
|   | structure of American     |   | u |     |   |   |    |             |
|   | Medicine.                 |   | p |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | r |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
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|   |                           |   | c |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | r |     |   |   |    |             |
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|   |                           |   | s |     |   |   |    |             |
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|   |                           |   | s |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | d |     |   |   |    |             |
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|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | J |     |   |   |    |             |
|   |                           |   | C |     |   |   |    |             |
|   |                           |   | A |     |   |   |    |             |
|   |                           |   | H |     |   |   |    |             |
|   |                           |   | O |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Request for clarification | * | T |     |   |   |    |             |
| * | as to how this SHG        | * | h |     |   |   |    |             |
| 1 | strategic plan differs    | A | i |     |   |   |    |             |
| . | from the VHA strategic    | * | s |     |   |   |    |             |
| 1 | plan and from the VISN    | * | i |     |   |   |    |             |
| 5 | Business Plans            |   | s |     |   |   |    |             |
| . |                           |   | a |     |   |   |    |             |
| 4 |                           |   | n |     |   |   |    |             |
| * |                           |   | e |     |   |   |    |             |
| * |                           |   | x |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | i |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | V |     |   |   |    |             |
|   |                           |   | H |     |   |   |    |             |
|   |                           |   | A |     |   |   |    |             |
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|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | h |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
|   |                           |   | H |     |   |   |    |             |
|   |                           |   | G |     |   |   |    |             |
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|   |                           |   | o |     |   |   |    |             |
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|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | u |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
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|   |                           |   | s |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| D | Composition of the SHGs:  | * | I |     |   |   |    |             |
| i |                           | * | t |     |   |   |    |             |
| a | ¥Numerous (18) comments   | A | i |     |   |   |    |             |
| - | received indicated that a | * | s |     |   |   |    |             |
| g | specific professional     | * | r |     |   |   |    |             |
| r | and/or technical group    |   | e |     |   |   |    |             |
| a | (i.e., nurses, social     |   | c |     |   |   |    |             |
| m | workers, dentists,        |   | o |     |   |   |    |             |
|   | pharmacists, chaplains,   |   | g |     |   |   |    |             |
|   | rehabilitation            |   | n |     |   |   |    |             |
|   | professionals,            |   | i |     |   |   |    |             |
|   | dietitians, laboratory    |   | z |     |   |   |    |             |
|   | and radiology staff,      |   | e |     |   |   |    |             |
|   | etc.) had not been        |   | d |     |   |   |    |             |
|   | included or depicted in   |   | t |     |   |   |    |             |
|   | the SHG. Several writers  |   | h |     |   |   |    |             |
|   | (9) emphasized that the   |   | a |     |   |   |    |             |
|   | omission and/or exclusion |   | t |     |   |   |    |             |
|   | of their specific         |   | t |     |   |   |    |             |
|   | professional group would  |   | h |     |   |   |    |             |
|   | be met by opposition from |   | e |     |   |   |    |             |
|   | the specific organization |   | s |     |   |   |    |             |
|   | representing the interest |   | e |     |   |   |    |             |
|   | of the discipline or the  |   | v |     |   |   |    |             |
|   | absence would impede the  |   | a |     |   |   |    |             |
|   | continuity/quality of     |   | r |     |   |   |    |             |
|   | patient care. ¥Other      |   | i |     |   |   |    |             |
|   | commentaries requested    |   | o |     |   |   |    |             |
|   | further clarification of  |   | u |     |   |   |    |             |
|   | how the discipline        |   | s |     |   |   |    |             |
|   | specific membership for   |   | S |     |   |   |    |             |
|   | each SHG would be         |   | H |     |   |   |    |             |
|   | determined. One writer    |   | G |     |   |   |    |             |
|   | requested clarification   |   | s |     |   |   |    |             |
|   | on whether the SHGs       |   | w |     |   |   |    |             |
|   | membership would include  |   | i |     |   |   |    |             |
|   | decentralized service     |   | l |     |   |   |    |             |
|   | staff, such as PM&RS.     |   | l |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | q |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
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|   |                           |   | o |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
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|   |                           |   | p |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
|   |                           |   | T |     |   |   |    |             |
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|   |                           |   | i |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
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|   |                           |   | h |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | 5 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 3 |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
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|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | *Staffing***:** A Chief   |   |   |     |   |   | D/ |             |
| e | Patient Care Services     |   |   |     |   |   | O] |             |
| f | (PCS) Officer will        |   |   |     |   |   | {. |             |
| N | coordinate the activity   |   |   |     |   |   | un |             |
| o | of all groups within      |   |   |     |   |   | de |             |
| . | Patient Care Services.    |   |   |     |   |   | rl |             |
| ] | The Office of the Patient |   |   |     |   |   | in |             |
| { | Care Services will        |   |   |     |   |   | e} |             |
| . | consist of staff from     |   |   |     |   |   | ** |             |
| u | Clinical Affairs and      |   |   |     |   |   |    |             |
| n | those members moved from  |   |   |     |   |   |    |             |
| d | the Professional Affairs  |   |   |     |   |   |    |             |
| e | section in the Office of  |   |   |     |   |   |    |             |
| r | the Under Secretary for   |   |   |     |   |   |    |             |
| l | Health (10 FTEE). This    |   |   |     |   |   |    |             |
| i | person will also          |   |   |     |   |   |    |             |
| n | facilitate PCS activities |   |   |     |   |   |    |             |
| e | both with the other units |   |   |     |   |   |    |             |
| } | within Healthcare         |   |   |     |   |   |    |             |
| * | Programs (i.e., Office of |   |   |     |   |   |    |             |
| * | Academic Affairs,         |   |   |     |   |   |    |             |
|   | Readjustment Counseling,  |   |   |     |   |   |    |             |
| * | Research and Development, |   |   |     |   |   |    |             |
| * | and Public                |   |   |     |   |   |    |             |
| 1 | Health/Environmental      |   |   |     |   |   |    |             |
| . | Hazards) and with the     |   |   |     |   |   |    |             |
| 1 | Support Programs.         |   |   |     |   |   |    |             |
| 6 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Select the Chief Patient  | D |   | For |   |   |    |             |
| * | Care Services Officer who | e |   | ap  |   |   |    |             |
| 1 | will have responsibility  | p |   | poi |   |   |    |             |
| . | to coordinate the         | u |   | ntm |   |   |    |             |
| 1 | activity of all groups    | t |   | ent |   |   |    |             |
| 6 | within Patient Care       | y |   | NTE |   |   |    |             |
| . | Services.                 | U |   | O   |   |   |    |             |
| 1 |                           | n |   | ct. |   |   |    |             |
| * |                           | d |   | 1,  |   |   |    |             |
| * |                           | e |   | 1   |   |   |    |             |
|   |                           | r |   | 995 |   |   |    |             |
|   |                           | S |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | c |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | t |   |     |   |   |    |             |
|   |                           | a |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | y |   |     |   |   |    |             |
|   |                           | f |   |     |   |   |    |             |
|   |                           | o |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | H |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | a |   |     |   |   |    |             |
|   |                           | l |   |     |   |   |    |             |
|   |                           | t |   |     |   |   |    |             |
|   |                           | h |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Establish the Office of   | D |   | O   |   |   |    |             |
| * | the PCS with staff from   | e |   | ct. |   |   |    |             |
| 1 | Clinical Affairs and      | p |   | 15, |   |   |    |             |
| . | those members aligned     | u |   | 1   |   |   |    |             |
| 1 | from the PAS not to       | t |   | 995 |   |   |    |             |
| 6 | exceed 10.0 FTEE.         | y |   |     |   |   |    |             |
| . |                           | U |   |     |   |   |    |             |
| 2 |                           | n |   |     |   |   |    |             |
| * |                           | d |   |     |   |   |    |             |
| * |                           | e |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | S |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | c |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | t |   |     |   |   |    |             |
|   |                           | a |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | y |   |     |   |   |    |             |
|   |                           | f |   |     |   |   |    |             |
|   |                           | o |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | H |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | a |   |     |   |   |    |             |
|   |                           | l |   |     |   |   |    |             |
|   |                           | t |   |     |   |   |    |             |
|   |                           | h |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One comment indicated     | * | T |     |   |   |    |             |
| * | that the chief of patient | * | h |     |   |   |    |             |
| 1 | care should have within   | A | e |     |   |   |    |             |
| . | his/her office experts in | * | o |     |   |   |    |             |
| 1 | the clinical disciplines  | * | p |     |   |   |    |             |
| 6 | which have been shown to  |   | t |     |   |   |    |             |
| . | be essential in           |   | i |     |   |   |    |             |
| 2 | maintaining the high      |   | o |     |   |   |    |             |
| * | quality of care.          |   | n |     |   |   |    |             |
| * |                           |   | s |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
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|   |                           |   | q |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Several comments (5) were | * | N |     |   |   |    |             |
| * | made regarding the Chief  | * | o |     |   |   |    |             |
| 1 | Patient Care Services     | A | s |     |   |   |    |             |
| . | Officer position not      | * | p |     |   |   |    |             |
| 1 | being limited to          | * | e |     |   |   |    |             |
| 6 | physicians. One writer    |   | c |     |   |   |    |             |
| . | recommended that this     |   | i |     |   |   |    |             |
| 1 | position should be        |   | f |     |   |   |    |             |
| * | occupied by a nurse.      |   | i |     |   |   |    |             |
| * |                           |   | c |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | k |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
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+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Comments (3) were         | * | T |     |   |   |    |             |
| * | received objecting to the | * | h |     |   |   |    |             |
| 1 | function assigned to the  | A | e |     |   |   |    |             |
| . | Chief Patient Care        | * | c |     |   |   |    |             |
| 1 | Services (PCS) Officer    | * | o |     |   |   |    |             |
| 6 | for the triage of         |   | m |     |   |   |    |             |
| . | discipline-specific       |   | m |     |   |   |    |             |
| 1 | issues and serving as the |   | e |     |   |   |    |             |
| * | initial contact from      |   | n |     |   |   |    |             |
| * | professsional             |   | t |     |   |   |    |             |
|   | ogranizations. It was     |   | a |     |   |   |    |             |
|   | noted that this created   |   | r |     |   |   |    |             |
|   | an additonal              |   | y |     |   |   |    |             |
|   | administrative layer,     |   | h |     |   |   |    |             |
|   | described as burdensome   |   | a |     |   |   |    |             |
|   | and having the potential  |   | s |     |   |   |    |             |
|   | to could cause            |   | m |     |   |   |    |             |
|   | communication problems    |   | e |     |   |   |    |             |
|   | delaying action on        |   | r |     |   |   |    |             |
|   | critical issues.          |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | , |     |   |   |    |             |
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+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One Chief of Social Work  | * | T |     |   |   |    |             |
| * | Service questions the     | * | h |     |   |   |    |             |
| 1 | need for a Chief Patient  | D | e |     |   |   |    |             |
| . | Care Services Officer,    | * | C |     |   |   |    |             |
| 1 | noting that the product   | * | h |     |   |   |    |             |
| 6 | lines are the core of the |   | i |     |   |   |    |             |
| . | system. The writer        |   | e |     |   |   |    |             |
| 1 | questioned that if this   |   | f |     |   |   |    |             |
| * | is to become an important |   | P |     |   |   |    |             |
| * | function why would        |   | C |     |   |   |    |             |
|   | another layer be added    |   | S |     |   |   |    |             |
|   | between the USH and the   |   | O |     |   |   |    |             |
|   | Strategic Healthcare      |   | f |     |   |   |    |             |
|   | Groups?                   |   | f |     |   |   |    |             |
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+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
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|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
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|   |                           | c |   |     | * |   |    |             |
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|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Chief PCS Officer     | P |   | J   |   |   |    |             |
| * | will review proposals for | a |   | an. |   |   |    |             |
| 1 | the establishment of a    | t |   | 12, |   |   |    |             |
| . | multidisciplinary         | i |   | 1   |   |   |    |             |
| 1 | council(s) to support HQ  | e |   | 996 |   |   |    |             |
| 6 | and VISN functions. The   | n |   |     |   |   |    |             |
| . | establishment of          | t |   |     |   |   |    |             |
| 3 | council(s) should         | C |   |     |   |   |    |             |
| * | emphasize quality of      | a |   |     |   |   |    |             |
| * | service, program, and     | r |   |     |   |   |    |             |
|   | professional development  | e |   |     |   |   |    |             |
| * | in addition to addressing | S |   |     |   |   |    |             |
| * | concerns related to the   | e |   |     |   |   |    |             |
| A | lessening visibility of   | r |   |     |   |   |    |             |
| d | professional              | v |   |     |   |   |    |             |
| - | services/disciplines as   | i |   |     |   |   |    |             |
| d | components in VHA         | c |   |     |   |   |    |             |
| i | decision making.          | e |   |     |   |   |    |             |
| t | Recommendations regarding | s |   |     |   |   |    |             |
| i | establishment will be     |   |   |     |   |   |    |             |
| o | made to the DUSH.         |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | There will be a leader of |   |   |     |   |   | D/ |             |
| e | each Strategic Healthcare |   |   |     |   |   | O] |             |
| f | Group who will be         |   |   |     |   |   | {. |             |
| N | appointed by the Deputy   |   |   |     |   |   | un |             |
| o | Under Secretary for       |   |   |     |   |   | de |             |
| . | Health (DUSH) and who may |   |   |     |   |   | rl |             |
| ] | be selected from any      |   |   |     |   |   | in |             |
| { | discipline. However, in   |   |   |     |   |   | e} |             |
| . | aggregate, these leaders  |   |   |     |   |   | ** |             |
| u | should represent a        |   |   |     |   |   |    |             |
| n | diversity of professional |   |   |     |   |   |    |             |
| d | disciplines. All          |   |   |     |   |   |    |             |
| e | Strategic Healthcare      |   |   |     |   |   |    |             |
| r | Groups will consist of a  |   |   |     |   |   |    |             |
| l | core interdisciplinary    |   |   |     |   |   |    |             |
| i | team supplemented, as     |   |   |     |   |   |    |             |
| n | appropriate to the needs  |   |   |     |   |   |    |             |
| e | of the group\'s product   |   |   |     |   |   |    |             |
| } | lines, by staff from      |   |   |     |   |   |    |             |
| * | additional disciplines.   |   |   |     |   |   |    |             |
| * | The staff of the          |   |   |     |   |   |    |             |
|   | Strategic Healthcare      |   |   |     |   |   |    |             |
| * | Groups will come from     |   |   |     |   |   |    |             |
| * | current Clinical Affairs  |   |   |     |   |   |    |             |
| 1 | and will consist of 10 to |   |   |     |   |   |    |             |
| . | 20 FTEE per Group.        |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| 7 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Designate a leader for    | D |   | O   |   |   |    |             |
| * | each Strategic Healthcare | e |   | ct. |   |   |    |             |
| 1 | Group.                    | p |   | 15, |   |   |    |             |
| . |                           | u |   | 1   |   |   |    |             |
| 1 |                           | t |   | 995 |   |   |    |             |
| 7 |                           | y |   |     |   |   |    |             |
| . |                           | U |   |     |   |   |    |             |
| 1 |                           | n |   |     |   |   |    |             |
| * |                           | d |   |     |   |   |    |             |
| * |                           | e |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | S |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | c |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | t |   |     |   |   |    |             |
|   |                           | a |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | y |   |     |   |   |    |             |
|   |                           | f |   |     |   |   |    |             |
|   |                           | o |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | H |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | a |   |     |   |   |    |             |
|   |                           | l |   |     |   |   |    |             |
|   |                           | t |   |     |   |   |    |             |
|   |                           | h |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Assign present members of | C |   | N   |   |   |    |             |
| * | Clinical Affairs to the   | h |   | ov. |   |   |    |             |
| 1 | five SHGs, such that each | i |   | 1,  |   |   |    |             |
| . | team consists of a core   | e |   | 1   |   |   |    |             |
| 1 | interdisciplinary         | f |   | 995 |   |   |    |             |
| 7 | composition of no more    | , |   |     |   |   |    |             |
| . | than 10 to 20 FTEE per    | P |   |     |   |   |    |             |
| 2 | SHG.                      | a |   |     |   |   |    |             |
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+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Develop a plan, in        | C |   | N   |   |   |    |             |
| * | conjunction with the      | h |   | ov. |   |   |    |             |
| 1 | Management &              | i |   | 1,  |   |   |    |             |
| . | Administration Support    | e |   | 1   |   |   |    |             |
| 1 | Office (MASO), to assist  | f |   | 995 |   |   |    |             |
| 7 | those former Clinical     | , |   |     |   |   |    |             |
| . | Affairs staff who prefer  | P |   |     |   |   |    |             |
| 2 | to be placed elsewhere.   | a |   |     |   |   |    |             |
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+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
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|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Several writers (3)       |   | T |     |   |   |    |             |
| * | emphasized concerns that  |   | h |     |   |   |    |             |
| 1 | the proposed time frames  |   | e |     |   |   |    |             |
| . | appear to be unrealistic  |   | U |     |   |   |    |             |
| 1 | to accomplish well        |   | S |     |   |   |    |             |
| 7 | thought out changes in    |   | H |     |   |   |    |             |
| . | our massive system. Some  |   | h |     |   |   |    |             |
| * | functions can not be      |   | a |     |   |   |    |             |
| * | shifted until staff are   |   | s |     |   |   |    |             |
|   | identified and assigned.  |   | i |     |   |   |    |             |
|   | A recommendation that at  |   | n |     |   |   |    |             |
|   | least one month span of   |   | d |     |   |   |    |             |
|   | time between each of      |   | i |     |   |   |    |             |
|   | these major actions be    |   | c |     |   |   |    |             |
|   | considered as a more      |   | a |     |   |   |    |             |
|   | appropriate target.       |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer expressed      | * | W |     |   |   |    |             |
| * | concerns that the teams   | * | h |     |   |   |    |             |
| 1 | would become silos in and | D | i |     |   |   |    |             |
| . | of themselves if a fair   | * | l |     |   |   |    |             |
| 1 | representation of         | * | e |     |   |   |    |             |
| 7 | services were not         |   | i |     |   |   |    |             |
| * | assured. The presence of  |   | t |     |   |   |    |             |
| * | a variety of disciplines  |   | i |     |   |   |    |             |
|   | was emphasized as a means |   | s |     |   |   |    |             |
|   | to eliminate parochialism |   | p |     |   |   |    |             |
|   | and implement a true team |   | o |     |   |   |    |             |
|   | approach. However beyond  |   | s |     |   |   |    |             |
|   | team training, the writer |   | s |     |   |   |    |             |
|   | requested that the        |   | i |     |   |   |    |             |
|   | workgroup identify a      |   | b |     |   |   |    |             |
|   | means to effectively      |   | l |     |   |   |    |             |
|   | change behavior.          |   | e |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
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+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | A VAMC Director           | * | S |     |   |   |    |             |
| * | recommended that the      | * | e |     |   |   |    |             |
| 1 | Chief Patient Care        | D | e |     |   |   |    |             |
| . | Services Officer (PCSO)   | * | r |     |   |   |    |             |
| 1 | nominate leaders for each | * | e |     |   |   |    |             |
| 7 | SHG for concurrence by    |   | v |     |   |   |    |             |
| . | the DUSH.                 |   | i |     |   |   |    |             |
| 1 |                           |   | s |     |   |   |    |             |
| * |                           |   | e |     |   |   |    |             |
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|   |                           |   | r |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | 7 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer requested      |   | R |     |   |   |    |             |
| * | clarification of the      |   | e |     |   |   |    |             |
| 1 | organizational            |   | c |     |   |   |    |             |
| . | relationship of the Chief |   | o |     |   |   |    |             |
| 1 | Patient Care Services     |   | m |     |   |   |    |             |
| 7 | Officer (PCSO) and the    |   | m |     |   |   |    |             |
| * | SHG directors. This       |   | e |     |   |   |    |             |
| * | writer also expressed     |   | n |     |   |   |    |             |
|   | concern regarding the new |   | d |     |   |   |    |             |
|   | roles and number of staff |   | a |     |   |   |    |             |
|   | currently assigned to     |   | t |     |   |   |    |             |
|   | Clinical Affairs that     |   | i |     |   |   |    |             |
|   | will be reassigned to the |   | o |     |   |   |    |             |
|   | newly created PCS Office  |   | n |     |   |   |    |             |
|   | and the SHG teams. The    |   | 1 |     |   |   |    |             |
|   | commentary requested      |   | . |     |   |   |    |             |
|   | clarification of what all |   | 1 |     |   |   |    |             |
|   | these people will be      |   | 7 |     |   |   |    |             |
|   | doing, and emphasized     |   | a |     |   |   |    |             |
|   | that the benefits to be   |   | n |     |   |   |    |             |
|   | obtained by out placing   |   | d |     |   |   |    |             |
|   | the SHG directors are     |   | a |     |   |   |    |             |
|   | more than offset by       |   | c |     |   |   |    |             |
|   | creating a large central  |   | t |     |   |   |    |             |
|   | bureaucracy in HQ to      |   | i |     |   |   |    |             |
|   | support each of these     |   | o |     |   |   |    |             |
|   | directors.                |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | 7 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
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|   |                           |   | 7 |     |   |   |    |             |
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|   |                           |   | d |     |   |   |    |             |
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|   |                           |   | m |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
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|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | 8 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | T |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
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|   |                           |   | e |     |   |   |    |             |
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|   |                           |   | S |     |   |   |    |             |
|   |                           |   | H |     |   |   |    |             |
|   |                           |   | G |     |   |   |    |             |
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|   |                           |   | d |     |   |   |    |             |
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|   |                           |   | d |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
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|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
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|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | There will be a leader of |   |   |     |   |   |    |             |
| * | each Strategic Healthcare |   |   |     |   |   |    |             |
| 1 | Group (SHG) who will be   |   |   |     |   |   |    |             |
| . | appointed by theChief     |   |   |     |   |   |    |             |
| 1 | Patient Care Services     |   |   |     |   |   |    |             |
| 7 | (PCS) Officer, in         |   |   |     |   |   |    |             |
| * | conjuntion with the       |   |   |     |   |   |    |             |
| * | Deputy Under Secretary    |   |   |     |   |   |    |             |
|   | for Health (DUSH), who    |   |   |     |   |   |    |             |
| * | may be selected from any  |   |   |     |   |   |    |             |
| * | discipline. However, in   |   |   |     |   |   |    |             |
| R | aggregate, these leaders  |   |   |     |   |   |    |             |
| e | should represent a        |   |   |     |   |   |    |             |
| - | diversity of professional |   |   |     |   |   |    |             |
| v | disciplines. All          |   |   |     |   |   |    |             |
| i | Strategic Healthcare      |   |   |     |   |   |    |             |
| s | Groups will consist of a  |   |   |     |   |   |    |             |
| e | core interdisciplinary    |   |   |     |   |   |    |             |
| d | team supplemented, as     |   |   |     |   |   |    |             |
| * | appropriate to the needs  |   |   |     |   |   |    |             |
| * | of the group\'s product   |   |   |     |   |   |    |             |
|   | lines, by staff from      |   |   |     |   |   |    |             |
|   | additional disciplines.   |   |   |     |   |   |    |             |
|   | The staff of the          |   |   |     |   |   |    |             |
|   | Strategic Healthcare      |   |   |     |   |   |    |             |
|   | Groups may come from      |   |   |     |   |   |    |             |
|   | current Clinical Affairs  |   |   |     |   |   |    |             |
|   | and will represent a      |   |   |     |   |   |    |             |
|   | limited number of core    |   |   |     |   |   |    |             |
|   | staff. Each SHG will be   |   |   |     |   |   |    |             |
|   | augmented by field based  |   |   |     |   |   |    |             |
|   | expert panel groups.      |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Chief PCS Officer, in | D |   | O   |   |   |    |             |
| * | conjunction with the      | U |   | ct. |   |   |    |             |
| 1 | DUSH, will designate a    | S |   | 15, |   |   |    |             |
| . | leader for each SHG.      | H |   | 1   |   |   |    |             |
| 1 |                           |   |   | 995 |   |   |    |             |
| 7 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| R |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| - |                           |   |   |     |   |   |    |             |
| v |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| s |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Chief PCS Officer     | C |   | N   |   |   |    |             |
| * | will assign present       | h |   | ov. |   |   |    |             |
| 1 | member of Clinical        | i |   | 1,  |   |   |    |             |
| . | Affairs to the five SHGs, | e |   | 1   |   |   |    |             |
| 1 | such that each team       | f |   | 995 |   |   |    |             |
| 7 | consists of a core        | P |   |     |   |   |    |             |
| . | interdisciplinary         | C |   |     |   |   |    |             |
| 2 | composition.              | S |   |     |   |   |    |             |
| * |                           | O |   |     |   |   |    |             |
| * |                           | f |   |     |   |   |    |             |
|   |                           | f |   |     |   |   |    |             |
| * |                           | i |   |     |   |   |    |             |
| * |                           | c |   |     |   |   |    |             |
| R |                           | e |   |     |   |   |    |             |
| e |                           | r |   |     |   |   |    |             |
| - |                           |   |   |     |   |   |    |             |
| v |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| s |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | In the development of     |   |   |     |   |   | D/ |             |
| e | this plan, options are    |   |   |     |   |   | O] |             |
| f | presented regarding       |   |   |     |   |   | {. |             |
| N | placement of              |   |   |     |   |   | un |             |
| o | discipline-specific       |   |   |     |   |   | de |             |
| . | offices. The benefits of  |   |   |     |   |   | rl |             |
| ] | discipline-specific       |   |   |     |   |   | in |             |
| { | leaders at Headquarters   |   |   |     |   |   | e} |             |
| . | were not as strong as the |   |   |     |   |   | ** |             |
| u | need to break down the    |   |   |     |   |   |    |             |
| n | discipline-specific       |   |   |     |   |   |    |             |
| d | \"stovepipes\" that had   |   |   |     |   |   |    |             |
| e | developed over the years. |   |   |     |   |   |    |             |
| r | While the workgroup       |   |   |     |   |   |    |             |
| l | believes that there are   |   |   |     |   |   |    |             |
| i | definitive advantages to  |   |   |     |   |   |    |             |
| n | locating the discipline   |   |   |     |   |   |    |             |
| e | specific leaders in the   |   |   |     |   |   |    |             |
| } | field, it also recognizes |   |   |     |   |   |    |             |
| * | that this approach should |   |   |     |   |   |    |             |
| * | be flexible, and reflect  |   |   |     |   |   |    |             |
|   | personal circumstances    |   |   |     |   |   |    |             |
| * | and changing              |   |   |     |   |   |    |             |
| * | organizational needs. The |   |   |     |   |   |    |             |
| 1 | placement of the          |   |   |     |   |   |    |             |
| . | discipline specific       |   |   |     |   |   |    |             |
| 1 | leader is recommended in  |   |   |     |   |   |    |             |
| 8 | the following descending  |   |   |     |   |   |    |             |
| * | order: (1) Discipline     |   |   |     |   |   |    |             |
| * | specific leaders should   |   |   |     |   |   |    |             |
|   | be located in the field.  |   |   |     |   |   |    |             |
|   | (2) Senior staff          |   |   |     |   |   |    |             |
|   | currently serving in HQ   |   |   |     |   |   |    |             |
|   | as discipline specific    |   |   |     |   |   |    |             |
|   | leaders may be permitted  |   |   |     |   |   |    |             |
|   | to request to remain in   |   |   |     |   |   |    |             |
|   | HQ until their current    |   |   |     |   |   |    |             |
|   | appointments expire. (3)  |   |   |     |   |   |    |             |
|   | It is understood that the |   |   |     |   |   |    |             |
|   | USH always reserves the   |   |   |     |   |   |    |             |
|   | flexibility to appoint    |   |   |     |   |   |    |             |
|   | the discipline specific   |   |   |     |   |   |    |             |
|   | leader in HQ depending on |   |   |     |   |   |    |             |
|   | the needs of the          |   |   |     |   |   |    |             |
|   | discipline, the           |   |   |     |   |   |    |             |
|   | availability of a         |   |   |     |   |   |    |             |
|   | superior candidate, or    |   |   |     |   |   |    |             |
|   | other factors. In order   |   |   |     |   |   |    |             |
|   | to determine who remains  |   |   |     |   |   |    |             |
|   | in Headquarters and who   |   |   |     |   |   |    |             |
|   | is to be returned to the  |   |   |     |   |   |    |             |
|   | field, there would be a   |   |   |     |   |   |    |             |
|   | requirement that a        |   |   |     |   |   |    |             |
|   | workplan be developed     |   |   |     |   |   |    |             |
|   | that specifies projects,  |   |   |     |   |   |    |             |
|   | products and desired      |   |   |     |   |   |    |             |
|   | outcomes. The decision    |   |   |     |   |   |    |             |
|   | would be based upon which |   |   |     |   |   |    |             |
|   | location best serves the  |   |   |     |   |   |    |             |
|   | interest of VHA.          |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The DUSH will approve     | O |   | F   |   |   |    |             |
| * | discipline-specific       | f |   | eb. |   |   |    |             |
| 1 | leaders, who will be      | f |   | 1,  |   |   |    |             |
| . | field-based and will      | i |   | 1   |   |   |    |             |
| 1 | function similar to the   | c |   | 996 |   |   |    |             |
| 8 | current decentralized     | e |   |     |   |   |    |             |
| . | Service Directors. These  | o |   |     |   |   |    |             |
| 1 | discipline specific       | f |   |     |   |   |    |             |
| * | leaders will have two     | U |   |     |   |   |    |             |
| * | major functions in their  | S |   |     |   |   |    |             |
|   | national roles \--        | H |   |     |   |   |    |             |
|   | liaison with national     |   |   |     |   |   |    |             |
|   | professional              |   |   |     |   |   |    |             |
|   | organizations and         |   |   |     |   |   |    |             |
|   | coordination of           |   |   |     |   |   |    |             |
|   | discipline-specific       |   |   |     |   |   |    |             |
|   | issues.                   |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Identify changes in field | D |   | To  |   |   |    |             |
| * | based placement of        | U |   | be  |   |   |    |             |
| 1 | discipline specific       | S |   | d   |   |   |    |             |
| . | leaders, if indicated,    | H |   | ete |   |   |    |             |
| 1 | upon development and      |   |   | rmi |   |   |    |             |
| 8 | review of the workplan.   |   |   | ned |   |   |    |             |
| . |                           |   |   | as  |   |   |    |             |
| 2 |                           |   |   | nee |   |   |    |             |
| * |                           |   |   | ded |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Concerns (4) were         |   | T |     |   |   |    |             |
| * | expressed that the        |   | h |     |   |   |    |             |
| 1 | statement regarding       |   | e |     |   |   |    |             |
| . | discipline-specific       |   | s |     |   |   |    |             |
| 1 | leaders would infer that  |   | e |     |   |   |    |             |
| 8 | the reference is to only  |   | p |     |   |   |    |             |
| * | title-38 appointees.      |   | o |     |   |   |    |             |
| * | Thereby excluding other   |   | s |     |   |   |    |             |
|   | clinical professionals    |   | i |     |   |   |    |             |
|   | (i.e. physical and        |   | t |     |   |   |    |             |
|   | occupational therapy,     |   | i |     |   |   |    |             |
|   | social work, dietitians,  |   | o |     |   |   |    |             |
|   | etc.). Suggestions (6)    |   | n |     |   |   |    |             |
|   | were made that further    |   | s |     |   |   |    |             |
|   | clarification as to       |   | a |     |   |   |    |             |
|   | qualifications, role,     |   | r |     |   |   |    |             |
|   | function, and the process |   | e |     |   |   |    |             |
|   | for the selection of      |   | n |     |   |   |    |             |
|   | these leaders should be   |   | o |     |   |   |    |             |
|   | provided.                 |   | t |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | 3 |     |   |   |    |             |
|   |                           |   | 8 |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Several writers (10)      | * | T |     |   |   |    |             |
| * | believed that directors   | * | h |     |   |   |    |             |
| 1 | of the major clinical     | D | e |     |   |   |    |             |
| . | disciplines should be     | * | o |     |   |   |    |             |
| 1 | retained in HQ. Comments  | * | p |     |   |   |    |             |
| 8 | cited in support of       |   | t |     |   |   |    |             |
| * | retaining these leaders   |   | i |     |   |   |    |             |
| * | in HQ include more        |   | o |     |   |   |    |             |
|   | focused function for      |   | n |     |   |   |    |             |
|   | patient care, the need    |   | o |     |   |   |    |             |
|   | for representation in     |   | f |     |   |   |    |             |
|   | each product line         |   | r |     |   |   |    |             |
|   | section, direct           |   | e |     |   |   |    |             |
|   | consultation with USH,    |   | t |     |   |   |    |             |
|   | and organizational        |   | a |     |   |   |    |             |
|   | examples correlating to   |   | i |     |   |   |    |             |
|   | university hospitals. The |   | n |     |   |   |    |             |
|   | Nurse Organization of     |   | i |     |   |   |    |             |
|   | Veterans Affairs (NOVA)   |   | n |     |   |   |    |             |
|   | also cited co-location in |   | g |     |   |   |    |             |
|   | Washington DC as          |   | o |     |   |   |    |             |
|   | essential to interface    |   | r |     |   |   |    |             |
|   | with nurse professional   |   | p |     |   |   |    |             |
|   | associations and to       |   | l |     |   |   |    |             |
|   | advance the DVA           |   | a |     |   |   |    |             |
|   | legislative agenda for    |   | c |     |   |   |    |             |
|   | patient care. Specific    |   | e |     |   |   |    |             |
|   | commentary (19) from      |   | m |     |   |   |    |             |
|   | nurses throughout the     |   | e |     |   |   |    |             |
|   | field was also received   |   | n |     |   |   |    |             |
|   | affirming the need for a  |   | t |     |   |   |    |             |
|   | \'nurse\' leader and/or   |   | o |     |   |   |    |             |
|   | executive at HQ level     |   | f |     |   |   |    |             |
|   | with appropriate staff    |   | t |     |   |   |    |             |
|   | support.                  |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
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|   |                           |   | H |     |   |   |    |             |
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|   |                           |   | d |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Concerns (5) were         |   | T |     |   |   |    |             |
| * | expressed regarding       |   | h |     |   |   |    |             |
| 1 | communication linkages    |   | e |     |   |   |    |             |
| . | with field based leaders  |   | s |     |   |   |    |             |
| 1 | and how these leaders     |   | e |     |   |   |    |             |
| 8 | would access information  |   | c |     |   |   |    |             |
| * | necessary to keep them    |   | o |     |   |   |    |             |
| * | abreast of current        |   | n |     |   |   |    |             |
|   | issues. The authority for |   | c |     |   |   |    |             |
|   | decision making, level of |   | e |     |   |   |    |             |
|   | HQ support to these field |   | r |     |   |   |    |             |
|   | based leaders, and the    |   | n |     |   |   |    |             |
|   | participation of current  |   | s |     |   |   |    |             |
|   | decentralized Service     |   | w |     |   |   |    |             |
|   | Directors to interact     |   | e |     |   |   |    |             |
|   | with other HQ offices     |   | r |     |   |   |    |             |
|   | were cited as cautionary  |   | e |     |   |   |    |             |
|   | and problematic unless    |   | a |     |   |   |    |             |
|   | the communication issues  |   | d |     |   |   |    |             |
|   | were thoughtfully         |   | d |     |   |   |    |             |
|   | addressed. Other          |   | r |     |   |   |    |             |
|   | individuals (4) expressed |   | e |     |   |   |    |             |
|   | concern with the impact   |   | s |     |   |   |    |             |
|   | and effectiveness of a    |   | s |     |   |   |    |             |
|   | field based leader, and   |   | e |     |   |   |    |             |
|   | the duality of his/her    |   | d |     |   |   |    |             |
|   | functions and their       |   | i |     |   |   |    |             |
|   | ability to also meet      |   | n |     |   |   |    |             |
|   | competing                 |   | w |     |   |   |    |             |
|   | responsibilities at their |   | o |     |   |   |    |             |
|   | local VAMC.               |   | r |     |   |   |    |             |
|   |                           |   | k |     |   |   |    |             |
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|   |                           |   | a |     |   |   |    |             |
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|   |                           |   | a |     |   |   |    |             |
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|   |                           |   | l |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | A question was raised     | * | T |     |   |   |    |             |
| * | regarding who will have   | * | h |     |   |   |    |             |
| 1 | responsibility for        | A | e |     |   |   |    |             |
| . | developing the workplan   | * | w |     |   |   |    |             |
| 1 | referenced?               | * | o |     |   |   |    |             |
| 8 |                           |   | r |     |   |   |    |             |
| * |                           |   | k |     |   |   |    |             |
| * |                           |   | p |     |   |   |    |             |
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|   |                           |   | y |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
|   |                           |   | A |     |   |   |    |             |
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|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Several individuals       |   | T |     |   |   |    |             |
| * | (Dentistry, Social Work,  |   | h |     |   |   |    |             |
| 1 | Nursing, Pharmacy,        |   | i |     |   |   |    |             |
| . | Chaplain, and others)     |   | s |     |   |   |    |             |
| 1 | expressed concerns (15)   |   | m |     |   |   |    |             |
| 8 | regarding whether         |   | a |     |   |   |    |             |
| * | representation of their   |   | t |     |   |   |    |             |
| * | particular discipline     |   | t |     |   |   |    |             |
|   | would continue to be      |   | e |     |   |   |    |             |
|   | represented by a          |   | r |     |   |   |    |             |
|   | designated leader. Many   |   | i |     |   |   |    |             |
|   | individuals (3) believed  |   | s |     |   |   |    |             |
|   | it would be more          |   | n |     |   |   |    |             |
|   | representative to have    |   | o |     |   |   |    |             |
|   | mandated positions for    |   | t |     |   |   |    |             |
|   | each of the major         |   | a |     |   |   |    |             |
|   | disciplines.              |   | p |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
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|   |                           |   | v |     |   |   |    |             |
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|   |                           |   | y |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
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|   |                           |   | w |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
|   |                           |   | T |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
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|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
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|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | z |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One Chief Nurse made      |   | C |     |   |   |    |             |
| * | reference to the          |   | o |     |   |   |    |             |
| 1 | relationship of the       |   | n |     |   |   |    |             |
| . | clinical disciplines with |   | c |     |   |   |    |             |
| 1 | professional              |   | e |     |   |   |    |             |
| 8 | organizations. The        |   | r |     |   |   |    |             |
| . | commentary notes that     |   | n |     |   |   |    |             |
| 1 | \'it is unclear if this   |   | a |     |   |   |    |             |
| * | is the only value of      |   | d |     |   |   |    |             |
| * | disciplines in HQ, why    |   | d |     |   |   |    |             |
|   | this function could not   |   | r |     |   |   |    |             |
|   | be aligned with the VISN  |   | e |     |   |   |    |             |
|   | office. It is of value    |   | s |     |   |   |    |             |
|   | that the report does see  |   | s |     |   |   |    |             |
|   | the importance of         |   | e |     |   |   |    |             |
|   | credentialing and         |   | d |     |   |   |    |             |
|   | standards guided by the   |   | i |     |   |   |    |             |
|   | discipline.\' The writer  |   | n |     |   |   |    |             |
|   | adds that she also sees   |   | r |     |   |   |    |             |
|   | policy decisions that     |   | e |     |   |   |    |             |
|   | should be made for VHA    |   | c |     |   |   |    |             |
|   | that should be discipline |   | o |     |   |   |    |             |
|   | specific. She closes by   |   | m |     |   |   |    |             |
|   | emphasizing that          |   | m |     |   |   |    |             |
|   | \'National policy for all |   | e |     |   |   |    |             |
|   | disciplines should assist |   | n |     |   |   |    |             |
|   | in standardizing specific |   | d |     |   |   |    |             |
|   | patient and personnel     |   | a |     |   |   |    |             |
|   | issues that will cut      |   | t |     |   |   |    |             |
|   | across VISN boundaries.   |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | 8 |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | In the development of     |   |   |     |   |   |    |             |
| * | this plan, options are    |   |   |     |   |   |    |             |
| 1 | presented regarding       |   |   |     |   |   |    |             |
| . | placement of              |   |   |     |   |   |    |             |
| 1 | discipline-specific       |   |   |     |   |   |    |             |
| 8 | offices. The benefits of  |   |   |     |   |   |    |             |
| * | discipline-specific       |   |   |     |   |   |    |             |
| * | leaders at Headquarters   |   |   |     |   |   |    |             |
|   | were not as strong as the |   |   |     |   |   |    |             |
| * | need to break down the    |   |   |     |   |   |    |             |
| * | discipline-specific       |   |   |     |   |   |    |             |
| R | \"stovepipes\" that had   |   |   |     |   |   |    |             |
| e | developed over the years. |   |   |     |   |   |    |             |
| - | While the workgroup       |   |   |     |   |   |    |             |
| v | believes that there are   |   |   |     |   |   |    |             |
| i | definitive advantages to  |   |   |     |   |   |    |             |
| s | locating the discipline   |   |   |     |   |   |    |             |
| e | specific leaders in the   |   |   |     |   |   |    |             |
| d | field, it also recognizes |   |   |     |   |   |    |             |
| * | that this approach should |   |   |     |   |   |    |             |
| * | be flexible, and reflect  |   |   |     |   |   |    |             |
|   | organizational            |   |   |     |   |   |    |             |
|   | circumstances and         |   |   |     |   |   |    |             |
|   | changing needs. The       |   |   |     |   |   |    |             |
|   | placement of the          |   |   |     |   |   |    |             |
|   | discipline specific       |   |   |     |   |   |    |             |
|   | leader is recommended in  |   |   |     |   |   |    |             |
|   | the following descending  |   |   |     |   |   |    |             |
|   | order: (1) Discipline     |   |   |     |   |   |    |             |
|   | specific leaders should   |   |   |     |   |   |    |             |
|   | be located in the field.  |   |   |     |   |   |    |             |
|   | (2) Senior staff          |   |   |     |   |   |    |             |
|   | currently serving in HQ   |   |   |     |   |   |    |             |
|   | as discipline specific    |   |   |     |   |   |    |             |
|   | leaders may request to    |   |   |     |   |   |    |             |
|   | remain in HQ until their  |   |   |     |   |   |    |             |
|   | current appointments      |   |   |     |   |   |    |             |
|   | expire. (3) It is         |   |   |     |   |   |    |             |
|   | understood that the USH   |   |   |     |   |   |    |             |
|   | always reserves the       |   |   |     |   |   |    |             |
|   | flexibility to appoint    |   |   |     |   |   |    |             |
|   | the discipline specific   |   |   |     |   |   |    |             |
|   | leader in HQ depending on |   |   |     |   |   |    |             |
|   | the needs of the          |   |   |     |   |   |    |             |
|   | discipline, the           |   |   |     |   |   |    |             |
|   | availability of a         |   |   |     |   |   |    |             |
|   | superior candidate, or    |   |   |     |   |   |    |             |
|   | other factors. In order   |   |   |     |   |   |    |             |
|   | to determine who remains  |   |   |     |   |   |    |             |
|   | in Headquarters and who   |   |   |     |   |   |    |             |
|   | is to be returned to the  |   |   |     |   |   |    |             |
|   | field, there would be a   |   |   |     |   |   |    |             |
|   | requirement that a        |   |   |     |   |   |    |             |
|   | workplan be developed     |   |   |     |   |   |    |             |
|   | that specifies projects,  |   |   |     |   |   |    |             |
|   | products and desired      |   |   |     |   |   |    |             |
|   | outcomes. The decision    |   |   |     |   |   |    |             |
|   | regarding placement would |   |   |     |   |   |    |             |
|   | be based upon which       |   |   |     |   |   |    |             |
|   | location best serves the  |   |   |     |   |   |    |             |
|   | interest of VHA.          |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Identify changes in field | D |   | To  |   |   |    |             |
| * | based placement of        | U |   | be  |   |   |    |             |
| 1 | discipline specific       | S |   | d   |   |   |    |             |
| . | leaders, if indicated,    | H |   | ete |   |   |    |             |
| 1 | upon review of the        |   |   | rmi |   |   |    |             |
| 8 | workplan developed by the |   |   | ned |   |   |    |             |
| . | discipline specific       |   |   | as  |   |   |    |             |
| 2 | leader under              |   |   | nee |   |   |    |             |
| * | consideration for         |   |   | ded |   |   |    |             |
| * | placement in HQ.          |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| R |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| - |                           |   |   |     |   |   |    |             |
| v |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| s |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Special Programs, as      |   |   |     |   |   | D/ |             |
| e | defined in the *Vision    |   |   |     |   |   | O] |             |
| f | for Change* , have        |   |   |     |   |   | {. |             |
| N | remained intact but are   |   |   |     |   |   | un |             |
| o | organizationally placed   |   |   |     |   |   | de |             |
| . | under appropriate         |   |   |     |   |   | rl |             |
| ] | Strategic Healthcare      |   |   |     |   |   | in |             |
| { | Groups. Special Programs  |   |   |     |   |   | e} |             |
| . | are distinguished from    |   |   |     |   |   | ** |             |
| u | other Product Lines       |   |   |     |   |   |    |             |
| n | because *every* VISN will |   |   |     |   |   |    |             |
| d | be required to provide    |   |   |     |   |   |    |             |
| e | access to *all* Products  |   |   |     |   |   |    |             |
| r | in that Product Line. For |   |   |     |   |   |    |             |
| l | instance, all VISNs will  |   |   |     |   |   |    |             |
| i | be required to be able to |   |   |     |   |   |    |             |
| n | provide access to an      |   |   |     |   |   |    |             |
| e | inpatient Blind           |   |   |     |   |   |    |             |
| } | Rehabilitation Program,   |   |   |     |   |   |    |             |
| * | regardless of whether     |   |   |     |   |   |    |             |
| * | they have one of the      |   |   |     |   |   |    |             |
|   | programs in their VISN.   |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| 9 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Realign the Women         | P |   | N   |   |   |    |             |
| * | Veterans Program to       | a |   | ov. |   |   |    |             |
| 1 | Patient Care Services in  | t |   | 1,  |   |   |    |             |
| . | their Primary Care        | i |   | 1   |   |   |    |             |
| 1 | Strategic Healthcare      | e |   | 995 |   |   |    |             |
| 9 | Group.                    | n |   |     |   |   |    |             |
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|   | **Comments**              | * | * |     |   |   |    |             |
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| * | A recommendation was made | * | N |     |   |   |    |             |
| * | that Traumatic Brain      | * | o |     |   |   |    |             |
| 1 | Injury should be afforded | D | t |     |   |   |    |             |
| . | Special Program status    | * | a |     |   |   |    |             |
| 1 | within the Rehabilitation | * | S |     |   |   |    |             |
| 9 | product line, considering |   | p |     |   |   |    |             |
| * | the complex needs of the  |   | e |     |   |   |    |             |
| * | veteran population and    |   | c |     |   |   |    |             |
|   | the mandate to provide    |   | i |     |   |   |    |             |
|   | access to such services   |   | a |     |   |   |    |             |
|   | within all the VISNs.     |   | l |     |   |   |    |             |
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+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer expressed      | * | S |     |   |   |    |             |
| * | concern that little       | * | e |     |   |   |    |             |
| 1 | attention was given to    | A | e |     |   |   |    |             |
| . | Special Programs, and the | * | c |     |   |   |    |             |
| 1 | development of policies   | * | l |     |   |   |    |             |
| 9 | for supporting these      |   | a |     |   |   |    |             |
| * | programs was not          |   | r |     |   |   |    |             |
| * | addressed by the          |   | i |     |   |   |    |             |
|   | workgroup. While the      |   | f |     |   |   |    |             |
|   | writer recognizes the     |   | i |     |   |   |    |             |
|   | reorganization as an      |   | c |     |   |   |    |             |
|   | evolutionary process that |   | a |     |   |   |    |             |
|   | is not taking place       |   | t |     |   |   |    |             |
|   | overnight, the            |   | i |     |   |   |    |             |
|   | environment being created |   | o |     |   |   |    |             |
|   | presents cause for        |   | n |     |   |   |    |             |
|   | concern. The              |   | o |     |   |   |    |             |
|   | recommenation stated by   |   | f |     |   |   |    |             |
|   | the workgroup may nullify |   | d |     |   |   |    |             |
|   | Objective 1 of the        |   | e |     |   |   |    |             |
|   | Prosthetics Improvement   |   | f |     |   |   |    |             |
|   | Implementation Plan       |   | i |     |   |   |    |             |
|   | concerning expanded CO    |   | n |     |   |   |    |             |
|   | management and jeopardize |   | i |     |   |   |    |             |
|   | Objectives 4 and 5        |   | t |     |   |   |    |             |
|   | concerning program        |   | i |     |   |   |    |             |
|   | oversight.                |   | o |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | G.V. (Sonny) Montgomery   | * | T |     |   |   |    |             |
| * | (Ranking Member of the    | * | h |     |   |   |    |             |
| 1 | CVA) expressed concerns   | D | e |     |   |   |    |             |
| . | regarding the future of   | * | c |     |   |   |    |             |
| 1 | VA\'s specialized medical | * | o |     |   |   |    |             |
| 9 | programs, which have      |   | n |     |   |   |    |             |
| * | historically been         |   | c |     |   |   |    |             |
| * | vulnerable, particularly  |   | e |     |   |   |    |             |
|   | during periods of budget  |   | r |     |   |   |    |             |
|   | constraint. He emphasizes |   | n |     |   |   |    |             |
|   | that unprecedented        |   | s |     |   |   |    |             |
|   | outyear budget pressures  |   | a |     |   |   |    |             |
|   | coupled with the proposed |   | b |     |   |   |    |             |
|   | decentralization heighten |   | o |     |   |   |    |             |
|   | the risk that these often |   | u |     |   |   |    |             |
|   | costly programs will be   |   | t |     |   |   |    |             |
|   | at risk and in need of    |   | t |     |   |   |    |             |
|   | fiscal, structural, and   |   | h |     |   |   |    |             |
|   | other protective          |   | e |     |   |   |    |             |
|   | mechanisms. He notes that |   | S |     |   |   |    |             |
|   | the reports appear to     |   | p |     |   |   |    |             |
|   | subordinate and blur the  |   | e |     |   |   |    |             |
|   | specialized services      |   | c |     |   |   |    |             |
|   | mission, rather than      |   | i |     |   |   |    |             |
|   | reflecting a policy aimed |   | a |     |   |   |    |             |
|   | at ensuring the vitality  |   | l |     |   |   |    |             |
|   | of the programs. He adds  |   | P |     |   |   |    |             |
|   | that it is ironic that an |   | r |     |   |   |    |             |
|   | agency which does not now |   | o |     |   |   |    |             |
|   | even have a primary care  |   | g |     |   |   |    |             |
|   | mission in law is         |   | r |     |   |   |    |             |
|   | proposing to make the     |   | a |     |   |   |    |             |
|   | expansion of \'primary    |   | m |     |   |   |    |             |
|   | care\' a systemwide       |   | s |     |   |   |    |             |
|   | performance goal while    |   | a |     |   |   |    |             |
|   | remaining silent on any   |   | r |     |   |   |    |             |
|   | such goal regarding       |   | e |     |   |   |    |             |
|   | critical specialized      |   | a |     |   |   |    |             |
|   | programs.                 |   | d |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
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|   |                           |   | r |     |   |   |    |             |
|   |                           |   | P |     |   |   |    |             |
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|   |                           |   | C |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
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|   |                           |   | I |     |   |   |    |             |
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|   |                           |   | s |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Two commentaries received |   | T |     |   |   |    |             |
| * | requested clarification   |   | h |     |   |   |    |             |
| 1 | of the way special        |   | e |     |   |   |    |             |
| . | programs were defined.    |   | d |     |   |   |    |             |
| 1 | One writer did not        |   | i |     |   |   |    |             |
| 9 | understand how VISNs can  |   | s |     |   |   |    |             |
| * | be expected to guarantee  |   | t |     |   |   |    |             |
| * | access which is implied   |   | r |     |   |   |    |             |
|   | in the current            |   | i |     |   |   |    |             |
|   | formulation of the        |   | b |     |   |   |    |             |
|   | statement. Rather their   |   | u |     |   |   |    |             |
|   | understanding was that    |   | t |     |   |   |    |             |
|   | VISNs will have to have   |   | i |     |   |   |    |             |
|   | policies for referrals to |   | o |     |   |   |    |             |
|   | special programs.         |   | n |     |   |   |    |             |
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|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | s |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Writers (5) expressed     | * | A |     |   |   |    |             |
| * | concern regarding the     | * | s |     |   |   |    |             |
| 1 | movement of the Women     | A | n |     |   |   |    |             |
| . | Veterans Program. One     | * | o |     |   |   |    |             |
| 1 | writer acknowledges that  | * | t |     |   |   |    |             |
| 9 | the rationale for         |   | t |     |   |   |    |             |
| . | placement of the program  |   | o |     |   |   |    |             |
| 1 | under Environmental       |   | i |     |   |   |    |             |
| * | Medicine and Public       |   | m |     |   |   |    |             |
| * | Health is somewhat vague. |   | p |     |   |   |    |             |
|   | However, as emphasized by |   | e |     |   |   |    |             |
|   | the workgroup, the        |   | d |     |   |   |    |             |
|   | program is working well.  |   | e |     |   |   |    |             |
|   | Coordination of these     |   | c |     |   |   |    |             |
|   | activities by the current |   | o |     |   |   |    |             |
|   | program official has      |   | n |     |   |   |    |             |
|   | helped prevent            |   | t |     |   |   |    |             |
|   | fragmentation of women\'s |   | i |     |   |   |    |             |
|   | services that existed in  |   | n |     |   |   |    |             |
|   | the past and contributed  |   | u |     |   |   |    |             |
|   | markedly to progress. At  |   | e |     |   |   |    |             |
|   | this juncture,            |   | d |     |   |   |    |             |
|   | organizational            |   | p |     |   |   |    |             |
|   | realignment is viewed as  |   | r |     |   |   |    |             |
|   | disadvantageous to        |   | o |     |   |   |    |             |
|   | continued program growth. |   | g |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
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+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One Chief Nurse comments  |   | S |     |   |   |    |             |
| * | that the realignment of   |   | e |     |   |   |    |             |
| 1 | Women Health Care with    |   | e |     |   |   |    |             |
| . | Primary Care Services is  |   | r |     |   |   |    |             |
| 1 | a positive. However, she  |   | e |     |   |   |    |             |
| 9 | highly recommends that    |   | v |     |   |   |    |             |
| * | performance measures be   |   | i |     |   |   |    |             |
| * | directed at complying     |   | s |     |   |   |    |             |
|   | with standards that       |   | e |     |   |   |    |             |
|   | ensure that practitioners |   | d |     |   |   |    |             |
|   | are knowledgeable and     |   | r |     |   |   |    |             |
|   | skilled in this area. She |   | e |     |   |   |    |             |
|   | further recommends that   |   | c |     |   |   |    |             |
|   | priority be given to      |   | o |     |   |   |    |             |
|   | developing performance    |   | m |     |   |   |    |             |
|   | measures that will        |   | m |     |   |   |    |             |
|   | increase market-share of  |   | e |     |   |   |    |             |
|   | women veterans, and       |   | n |     |   |   |    |             |
|   | accountability for        |   | d |     |   |   |    |             |
|   | improving services        |   | a |     |   |   |    |             |
|   | through preventive health |   | t |     |   |   |    |             |
|   | programs.                 |   | i |     |   |   |    |             |
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|   |                           |   | o |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer expresses      |   | S |     |   |   |    |             |
| * | concern that the          |   | e |     |   |   |    |             |
| 1 | definition of VHA Special |   | e |     |   |   |    |             |
| . | Programs is not accurate  |   | r |     |   |   |    |             |
| 1 | for all Special Programs. |   | e |     |   |   |    |             |
| 9 | Not all \'address         |   | v |     |   |   |    |             |
| . | service-connected         |   | i |     |   |   |    |             |
| 1 | illnesses highly specific |   | s |     |   |   |    |             |
| * | to the veteran            |   | e |     |   |   |    |             |
| * | population\' (e.g.,       |   | d |     |   |   |    |             |
|   | Homeless, GRECCs). She    |   | r |     |   |   |    |             |
|   | recommends listing the    |   | e |     |   |   |    |             |
|   | other criteria used in    |   | c |     |   |   |    |             |
|   | the *Vision for Change*   |   | o |     |   |   |    |             |
|   | to define Special         |   | m |     |   |   |    |             |
|   | Programs (i.e., services  |   | m |     |   |   |    |             |
|   | that are unlikely to be   |   | e |     |   |   |    |             |
|   | adequately served by a    |   | n |     |   |   |    |             |
|   | market-driven system and  |   | d |     |   |   |    |             |
|   | ones for which VHA has    |   | a |     |   |   |    |             |
|   | developed unique          |   | t |     |   |   |    |             |
|   | expertise and resources). |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | 4 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Concern was expressed     | * | I |     |   |   |    |             |
| * | regarding the role the    | * | t |     |   |   |    |             |
| 1 | Blind Rehabilitation      | D | w |     |   |   |    |             |
| . | Service Regional          | * | o |     |   |   |    |             |
| 1 | Consultant will perform   | * | u |     |   |   |    |             |
| 9 | in the new organization.  |   | l |     |   |   |    |             |
| * | Their current role is     |   | d |     |   |   |    |             |
| * | essentially one of        |   | b |     |   |   |    |             |
|   | oversight and review of   |   | e |     |   |   |    |             |
|   | the Visual Impairment     |   | t |     |   |   |    |             |
|   | Services Team Coordinator |   | h |     |   |   |    |             |
|   | positions, both full and  |   | e |     |   |   |    |             |
|   | part time at VAMCs. He    |   | r |     |   |   |    |             |
|   | questioned \'where and    |   | o |     |   |   |    |             |
|   | how do the Regional       |   | l |     |   |   |    |             |
|   | Consultants fit in?\'     |   | e |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | D |     |   |   |    |             |
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|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | r |     |   |   |    |             |
|   |                           |   | , |     |   |   |    |             |
|   |                           |   | B |     |   |   |    |             |
|   |                           |   | R |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | V |     |   |   |    |             |
|   |                           |   | I |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
|   |                           |   | N |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Consideration should be   | D |   | 9   |   |   |    |             |
| * | given to realignment of   | U |   | /30 |   |   |    |             |
| 1 | the Women Veterans        | S |   | /96 |   |   |    |             |
| . | Program to Patient Care   | H |   |     |   |   |    |             |
| 1 | Services in the Primary   |   |   |     |   |   |    |             |
| 9 | Care Strategic Healthcare |   |   |     |   |   |    |             |
| . | Group (SHG) at some time  |   |   |     |   |   |    |             |
| 1 | in the future. A          |   |   |     |   |   |    |             |
| * | determination and         |   |   |     |   |   |    |             |
| * | timetable for such        |   |   |     |   |   |    |             |
|   | realignment should be     |   |   |     |   |   |    |             |
| * | made by the Chief Public  |   |   |     |   |   |    |             |
| * | Health and Environmental  |   |   |     |   |   |    |             |
| R | Hazards Officer in        |   |   |     |   |   |    |             |
| e | conjunction with the      |   |   |     |   |   |    |             |
| - | Chief Patient Care        |   |   |     |   |   |    |             |
| v | Services Officer and the  |   |   |     |   |   |    |             |
| i | leader of the Primary     |   |   |     |   |   |    |             |
| s | Care SHG.                 |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | The existing Academic     |   |   |     |   |   | D/ |             |
| e | Programs, as outlined in  |   |   |     |   |   | O] |             |
| f | the June 1995, Office of  |   |   |     |   |   | {. |             |
| N | Academic Affairs          |   |   |     |   |   | un |             |
| o | *Position Paper on        |   |   |     |   |   | de |             |
| . | Programs: Background,     |   |   |     |   |   | rl |             |
| ] | Recommendations, and      |   |   |     |   |   | in |             |
| { | Rationale*, should remain |   |   |     |   |   | e} |             |
| . | in the Office of Academic |   |   |     |   |   | ** |             |
| u | Affairs.                  |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| r |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 2 |                           |   |   |     |   |   |    |             |
| 0 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Prior to VISN activation, | D |   | N   |   |   |    |             |
| * | convene an Academic       | U |   | ov. |   |   |    |             |
| 1 | Affiliation Task Force to | S |   | 15, |   |   |    |             |
| . | make recommendations to   | H |   | 1   |   |   |    |             |
| 2 | the USH regarding         |   |   | 995 |   |   |    |             |
| 0 | reorganization principles |   |   |     |   |   |    |             |
| . | for affiliation           |   |   |     |   |   |    |             |
| 1 | partnerships, both at     |   |   |     |   |   |    |             |
| * | Headquarters and at       |   |   |     |   |   |    |             |
| * | VISNs. Staffing levels    |   |   |     |   |   |    |             |
|   | for this office should be |   |   |     |   |   |    |             |
|   | a part of this review.    |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The AsCMD for Academic    | * | W |     |   |   |    |             |
| * | Affairs emphasized that   | * | h |     |   |   |    |             |
| 1 | there has already been    | D | i |     |   |   |    |             |
| . | substantive comment from  | * | l |     |   |   |    |             |
| 2 | a number of sources about | * | e |     |   |   |    |             |
| 0 | the role of affiliations  |   | w |     |   |   |    |             |
| . | in the new organization.  |   | e |     |   |   |    |             |
| 1 | Issues related to this    |   | a |     |   |   |    |             |
| * | matters are also being    |   | g |     |   |   |    |             |
| * | reviewed by the Special   |   | r |     |   |   |    |             |
|   | Medical Advisory Group    |   | e |     |   |   |    |             |
|   | (SMAG) at its August      |   | e |     |   |   |    |             |
|   | meeting. For this reason, |   | t |     |   |   |    |             |
|   | she disagrees with the    |   | h |     |   |   |    |             |
|   | action. A recommendation  |   | a |     |   |   |    |             |
|   | is made to let the VISNs  |   | t |     |   |   |    |             |
|   | implement their work in   |   | A |     |   |   |    |             |
|   | patient care delivery,    |   | f |     |   |   |    |             |
|   | and a determination can   |   | f |     |   |   |    |             |
|   | be made at some later     |   | i |     |   |   |    |             |
|   | date regarding the        |   | l |     |   |   |    |             |
|   | usefulness of further     |   | i |     |   |   |    |             |
|   | Task Force deliberations. |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | M |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | G.V. (Sonny) Montgomery   | * | T |     |   |   |    |             |
| * | (Ranking Member of the    | * | h |     |   |   |    |             |
| 1 | CVA) commented regarding  | D | i |     |   |   |    |             |
| . | the consideration being   | * | s |     |   |   |    |             |
| 2 | given to decentralizing   | * | W |     |   |   |    |             |
| 0 | the physician residency   |   | o |     |   |   |    |             |
| * | and other education       |   | r |     |   |   |    |             |
| * | programs. He notes        |   | k |     |   |   |    |             |
|   | concern for the apparent  |   | g |     |   |   |    |             |
|   | rationale given for the   |   | r |     |   |   |    |             |
|   | proposal, that the        |   | o |     |   |   |    |             |
|   | current system of         |   | u |     |   |   |    |             |
|   | allocating residency      |   | p |     |   |   |    |             |
|   | positions \'often has     |   | h |     |   |   |    |             |
|   | little relationship to (a |   | a |     |   |   |    |             |
|   | facility\'s) manpower     |   | s |     |   |   |    |             |
|   | needs\'. He emphasizes    |   | m |     |   |   |    |             |
|   | that VA\'s residency and  |   | a |     |   |   |    |             |
|   | training programs should  |   | d |     |   |   |    |             |
|   | not, however, be simply   |   | e |     |   |   |    |             |
|   | local manpower            |   | n |     |   |   |    |             |
|   | supplements. The programs |   | o |     |   |   |    |             |
|   | serve a larger purpose.   |   | r |     |   |   |    |             |
|   | He reminds us that VA is  |   | e |     |   |   |    |             |
|   | responsible under law for |   | c |     |   |   |    |             |
|   | operating a national      |   | o |     |   |   |    |             |
|   | education program. The    |   | m |     |   |   |    |             |
|   | proposed change would     |   | m |     |   |   |    |             |
|   | fragment that program     |   | e |     |   |   |    |             |
|   | into 22 different         |   | n |     |   |   |    |             |
|   | operations, and would     |   | d |     |   |   |    |             |
|   | have VA effectively       |   | a |     |   |   |    |             |
|   | abandon key national      |   | t |     |   |   |    |             |
|   | responsibilities, and     |   | i |     |   |   |    |             |
|   | such a step would be      |   | o |     |   |   |    |             |
|   | inconsistent with VA\'s   |   | n |     |   |   |    |             |
|   | statutory                 |   | w |     |   |   |    |             |
|   | responsibilities. While   |   | h |     |   |   |    |             |
|   | this change might serve   |   | i |     |   |   |    |             |
|   | operational goals, the    |   | c |     |   |   |    |             |
|   | reorganization cannot be  |   | h |     |   |   |    |             |
|   | permitted to undermine a  |   | c |     |   |   |    |             |
|   | national mission.         |   | h |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | H |     |   |   |    |             |
|   |                           |   | Q |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | I |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | V |     |   |   |    |             |
|   |                           |   | I |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
|   |                           |   | N |     |   |   |    |             |
|   |                           |   | A |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | W |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | k |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | A VAMC Director noted his | * | C |     |   |   |    |             |
| * | support for this          | * | o |     |   |   |    |             |
| 1 | organizational change     | A | m |     |   |   |    |             |
| . | commenting that it was    | * | m |     |   |   |    |             |
| 2 | good to focus this office | * | e |     |   |   |    |             |
| 0 | on affiliations only. The |   | n |     |   |   |    |             |
| * | extensive work by this    |   | t |     |   |   |    |             |
| * | office in conjunction     |   | a |     |   |   |    |             |
|   | with VISNs and VAMCs will |   | r |     |   |   |    |             |
|   | be needed to address the  |   | y |     |   |   |    |             |
|   | effect of the new VHA     |   | c |     |   |   |    |             |
|   | organization on existing  |   | o |     |   |   |    |             |
|   | agreements.               |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One individual expressed  | * | T |     |   |   |    |             |
| * | concern with the premise  | * | h |     |   |   |    |             |
| 1 | and rationale provided in | D | e |     |   |   |    |             |
| . | the HQ Restructuring      | * | p |     |   |   |    |             |
| 2 | Workgroup report for      | * | r |     |   |   |    |             |
| 0 | realigning employee       |   | e |     |   |   |    |             |
| * | education in HQ from the  |   | m |     |   |   |    |             |
| * | Office of Academic        |   | i |     |   |   |    |             |
|   | Affairs. In this          |   | s |     |   |   |    |             |
|   | extensive commentary, it  |   | e |     |   |   |    |             |
|   | was emphasizes that in    |   | o |     |   |   |    |             |
|   | the past VHA has not      |   | f |     |   |   |    |             |
|   | devoted sufficient        |   | t |     |   |   |    |             |
|   | resources to the          |   | h |     |   |   |    |             |
|   | education and career      |   | e |     |   |   |    |             |
|   | development of its        |   | r |     |   |   |    |             |
|   | employees and noted that  |   | e |     |   |   |    |             |
|   | increasing the priority   |   | a |     |   |   |    |             |
|   | placed and the resources  |   | l |     |   |   |    |             |
|   | expended is the real      |   | i |     |   |   |    |             |
|   | goal. The writer cautions |   | g |     |   |   |    |             |
|   | that splitting Academic   |   | n |     |   |   |    |             |
|   | Affairs and creating a    |   | m |     |   |   |    |             |
|   | separate Office of        |   | e |     |   |   |    |             |
|   | Employee Education is not |   | n |     |   |   |    |             |
|   | necessarily going to      |   | t |     |   |   |    |             |
|   | accomplish this goal. The |   | i |     |   |   |    |             |
|   | writer cites reasons to   |   | s |     |   |   |    |             |
|   | keep VHA\'s education     |   | t |     |   |   |    |             |
|   | elements together, and    |   | o |     |   |   |    |             |
|   | emphasizes that the issue |   | b |     |   |   |    |             |
|   | at the local level is     |   | r |     |   |   |    |             |
|   | also resources available  |   | i |     |   |   |    |             |
|   | to support employee       |   | n |     |   |   |    |             |
|   | education. It was also    |   | g |     |   |   |    |             |
|   | emphasizes that there is  |   | a |     |   |   |    |             |
|   | no discussion in any of   |   | l |     |   |   |    |             |
|   | the Reports of the impact |   | l |     |   |   |    |             |
|   | the proposed separation   |   | e |     |   |   |    |             |
|   | of education activities   |   | m |     |   |   |    |             |
|   | at the HQ level will have |   | p |     |   |   |    |             |
|   | for field facilities that |   | l |     |   |   |    |             |
|   | have coordinated          |   | o |     |   |   |    |             |
|   | education administrations |   | y |     |   |   |    |             |
|   | and physical and          |   | e |     |   |   |    |             |
|   | technological             |   | e |     |   |   |    |             |
|   | infrastructures. The      |   | e |     |   |   |    |             |
|   | writer closes by noting   |   | d |     |   |   |    |             |
|   | that if VHA HQ separates  |   | u |     |   |   |    |             |
|   | trainee education from    |   | c |     |   |   |    |             |
|   | employee education, the   |   | a |     |   |   |    |             |
|   | local levels will most    |   | t |     |   |   |    |             |
|   | likely follow suit which  |   | i |     |   |   |    |             |
|   | may lead to increased     |   | o |     |   |   |    |             |
|   | fragmentation and         |   | n |     |   |   |    |             |
|   | duplication of resources. |   | u |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Prior to VISN activation, | D |   | N   |   |   |    |             |
| * | convene an Academic       | U |   | ov. |   |   |    |             |
| 1 | Affiliation Task Force to | S |   | 15, |   |   |    |             |
| . | make recommendations to   | H |   | 1   |   |   |    |             |
| 2 | the USH regarding         |   |   | 995 |   |   |    |             |
| 0 | reorganization principles |   |   |     |   |   |    |             |
| . | for affiliation           |   |   |     |   |   |    |             |
| 1 | partnerships, both at     |   |   |     |   |   |    |             |
| * | Headquarters and at       |   |   |     |   |   |    |             |
| * | VISNs. Functions and      |   |   |     |   |   |    |             |
|   | staffing levels for the   |   |   |     |   |   |    |             |
| * | HQ office should be a     |   |   |     |   |   |    |             |
| * | part of this review. As   |   |   |     |   |   |    |             |
| R | representatives of the    |   |   |     |   |   |    |             |
| e | end user, the task force  |   |   |     |   |   |    |             |
| - | should be chaired by a    |   |   |     |   |   |    |             |
| v | VISN or VAMC director and |   |   |     |   |   |    |             |
| i | include both field and HQ |   |   |     |   |   |    |             |
| s | representatives. The      |   |   |     |   |   |    |             |
| e | report regarding revised  |   |   |     |   |   |    |             |
| d | functions and HQ staffing |   |   |     |   |   |    |             |
| * | levels should be          |   |   |     |   |   |    |             |
| * | submitted to the DUSH.    |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Library Services and      |   |   |     |   |   | D/ |             |
| e | satellite TV should be    |   |   |     |   |   | O] |             |
| f | organizationally moved to |   |   |     |   |   | {. |             |
| N | the Chief Information     |   |   |     |   |   | un |             |
| o | Officer (3 FTEE).         |   |   |     |   |   | de |             |
| . |                           |   |   |     |   |   | rl |             |
| ] |                           |   |   |     |   |   | in |             |
| { |                           |   |   |     |   |   | e} |             |
| . |                           |   |   |     |   |   | ** |             |
| u |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| r |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 2 |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Realign Library Services  | P |   | O   |   |   |    |             |
| * | and satellite TV to the   | a |   | ct. |   |   |    |             |
| 1 | CIO                       | t |   | 1,  |   |   |    |             |
| . |                           | i |   | 1   |   |   |    |             |
| 2 |                           | e |   | 995 |   |   |    |             |
| 1 |                           | n |   |     |   |   |    |             |
| . |                           | t |   |     |   |   |    |             |
| 1 |                           | C |   |     |   |   |    |             |
| * |                           | a |   |     |   |   |    |             |
| * |                           | r |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | S |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | v |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | c |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | , |   |     |   |   |    |             |
|   |                           | A |   |     |   |   |    |             |
|   |                           | c |   |     |   |   |    |             |
|   |                           | a |   |     |   |   |    |             |
|   |                           | d |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | m |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | c |   |     |   |   |    |             |
|   |                           | A |   |     |   |   |    |             |
|   |                           | f |   |     |   |   |    |             |
|   |                           | f |   |     |   |   |    |             |
|   |                           | a |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | s |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One individual affirmed   | * | W |     |   |   |    |             |
| * | understanding of the      | * | e |     |   |   |    |             |
| 1 | concept that all          | A | a |     |   |   |    |             |
| . | information should be     | * | g |     |   |   |    |             |
| 2 | under the CIO, but        | * | r |     |   |   |    |             |
| 1 | expressed concern that    |   | e |     |   |   |    |             |
| * | this small group of       |   | e |     |   |   |    |             |
| * | professional librarians   |   | t |     |   |   |    |             |
|   | will not receive the      |   | h |     |   |   |    |             |
|   | support and attention     |   | e |     |   |   |    |             |
|   | merited in a CIO          |   | s |     |   |   |    |             |
|   | organization which must   |   | e |     |   |   |    |             |
|   | preface focus on numerous |   | f |     |   |   |    |             |
|   | other more pressing       |   | u |     |   |   |    |             |
|   | issues. It is recommended |   | n |     |   |   |    |             |
|   | to leave this group under |   | c |     |   |   |    |             |
|   | Academic Affairs for the  |   | t |     |   |   |    |             |
|   | present, realizing that   |   | i |     |   |   |    |             |
|   | the CIO Office is pending |   | o |     |   |   |    |             |
|   | organization.             |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | ; |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | , |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
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|   |                           |   | d |     |   |   |    |             |
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|   |                           |   | c |     |   |   |    |             |
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|   |                           |   | u |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
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|   |                           |   | d |     |   |   |    |             |
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|   |                           |   | a |     |   |   |    |             |
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|   |                           |   | y |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | T |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
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|   |                           |   | d |     |   |   |    |             |
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|   |                           |   | p |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | f |     |   |   |    |             |
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|   |                           |   | h |     |   |   |    |             |
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|   |                           |   | w |     |   |   |    |             |
|   |                           |   | C |     |   |   |    |             |
|   |                           |   | I |     |   |   |    |             |
|   |                           |   | O |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer noted that the |   | T |     |   |   |    |             |
| * | staff numbers given to    |   | h |     |   |   |    |             |
| 1 | the Library and satellite |   | i |     |   |   |    |             |
| . | TV Network Programs       |   | s |     |   |   |    |             |
| 2 | don\'t reflect actual     |   | i |     |   |   |    |             |
| 1 | FTEE assigned to these    |   | n |     |   |   |    |             |
| * | program in HQ or in the   |   | f |     |   |   |    |             |
| * | field.                    |   | o |     |   |   |    |             |
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|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
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|   |                           |   | f |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | s |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Director of the       | * | C |     |   |   |    |             |
| * | National Media            | * | o |     |   |   |    |             |
| 1 | Development Center stated | D | n |     |   |   |    |             |
| . | that virtually all        | * | t |     |   |   |    |             |
| 2 | activities described for  | * | e |     |   |   |    |             |
| 1 | Library Services and      |   | m |     |   |   |    |             |
| * | satellite TV are          |   | p |     |   |   |    |             |
| * | educational support in    |   | o |     |   |   |    |             |
|   | nature. He expressed      |   | r |     |   |   |    |             |
|   | concern that placing this |   | a |     |   |   |    |             |
|   | program under the CIO     |   | r |     |   |   |    |             |
|   | will create a need for    |   | y |     |   |   |    |             |
|   | unnecessary               |   | t |     |   |   |    |             |
|   | organizational reliance,  |   | h |     |   |   |    |             |
|   | coordination, and         |   | i |     |   |   |    |             |
|   | communication.            |   | n |     |   |   |    |             |
|   |                           |   | k |     |   |   |    |             |
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|   |                           |   | y |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
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|   |                           |   | v |     |   |   |    |             |
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|   |                           |   | s |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | The Employee Education    |   |   |     |   |   | D/ |             |
| e | field units (Cooperative  |   |   |     |   |   | O] |             |
| f | Health-Manpower Education |   |   |     |   |   | {. |             |
| N | Programs, Regional        |   |   |     |   |   | un |             |
| o | Medical Education         |   |   |     |   |   | de |             |
| . | Centers, etc.) should     |   |   |     |   |   | rl |             |
| ] | remain within VHA under a |   |   |     |   |   | in |             |
| { | Chief Employee Education  |   |   |     |   |   | e} |             |
| . | Officer who is aligned    |   |   |     |   |   | ** |             |
| u | under the Deputy Under    |   |   |     |   |   |    |             |
| n | Secretary for Health      |   |   |     |   |   |    |             |
| d | (DUSH). Media Production  |   |   |     |   |   |    |             |
| e | and Development, along    |   |   |     |   |   |    |             |
| r | with its associated       |   |   |     |   |   |    |             |
| l | National Media            |   |   |     |   |   |    |             |
| i | Development Centers,      |   |   |     |   |   |    |             |
| n | should also be            |   |   |     |   |   |    |             |
| e | organizationally moved    |   |   |     |   |   |    |             |
| } | and aligned with the      |   |   |     |   |   |    |             |
| * | Employee Education field  |   |   |     |   |   |    |             |
| * | units under a Chief       |   |   |     |   |   |    |             |
|   | Employee Education        |   |   |     |   |   |    |             |
| * | Officer.                  |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 2 |                           |   |   |     |   |   |    |             |
| 2 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Realign Employee Eduation | D |   | To  |   |   |    |             |
| * | field units and Media     | U |   | be  |   |   |    |             |
| 1 | Production and            | S |   | de  |   |   |    |             |
| . | Development together with | H |   | ter |   |   |    |             |
| 2 | the field units in St.    |   |   | min |   |   |    |             |
| 2 | Louis, Cleveland,         |   |   | ed. |   |   |    |             |
| . | Washington, and Salt Lake |   |   |     |   |   |    |             |
| 1 | City under the new Chief  |   |   |     |   |   |    |             |
| * | Employee Education        |   |   |     |   |   |    |             |
| * | Officer after that        |   |   |     |   |   |    |             |
|   | position is filled.       |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Undertake a critical      | D |   | To  |   |   |    |             |
| * | analysis of Media         | U |   | be  |   |   |    |             |
| 1 | Production and            | S |   | de  |   |   |    |             |
| . | Development to include    | H |   | ter |   |   |    |             |
| 2 | contracting and staffing  |   |   | min |   |   |    |             |
| 2 | recommendations which     |   |   | ed. |   |   |    |             |
| . | should begin within 45    |   |   |     |   |   |    |             |
| 2 | days of appointment of    |   |   |     |   |   |    |             |
| * | the Chief Employee        |   |   |     |   |   |    |             |
| * | Education Officer.        |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Position Paper (dated     | * | N |     |   |   |    |             |
| * | 7/18) received from the   | * | o |     |   |   |    |             |
| 1 | Director National Media   | D | c |     |   |   |    |             |
| . | Development Cts. The      | * | h |     |   |   |    |             |
| 2 | paper provides an         | * | a |     |   |   |    |             |
| 2 | overview of the NMDCs     |   | n |     |   |   |    |             |
| . | listing services, cost    |   | g |     |   |   |    |             |
| 2 | data, and staffing        |   | e |     |   |   |    |             |
| * | information. The paper    |   | i |     |   |   |    |             |
| * | asserts the need for and  |   | n |     |   |   |    |             |
|   | quality of NMDCs          |   | a |     |   |   |    |             |
|   | operations. The paper     |   | c |     |   |   |    |             |
|   | further recommends that   |   | t |     |   |   |    |             |
|   | NMDCs (1) be established  |   | i |     |   |   |    |             |
|   | as system-wide assets and |   | o |     |   |   |    |             |
|   | (2) available services be |   | n |     |   |   |    |             |
|   | prioritized.              |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | P |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
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|   |                           |   | v |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | C |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
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|   |                           |   | E |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
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|   |                           |   | d |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
|   |                           |   | O |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
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|   |                           |   | i |     |   |   |    |             |
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|   |                           |   | r |     |   |   |    |             |
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|   |                           |   | r |     |   |   |    |             |
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|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | y |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | k |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Director of the       | * | N |     |   |   |    |             |
| * | Washington National Media | * | o |     |   |   |    |             |
| 1 | Development Center        | D | t |     |   |   |    |             |
| . | emphasizes the evolution  | * | e |     |   |   |    |             |
| 2 | of functions as the       | * | d |     |   |   |    |             |
| 2 | primary provider of       |   | . |     |   |   |    |             |
| . | communication programs    |   |   |     |   |   |    |             |
| 1 | and products. Previous    |   |   |     |   |   |    |             |
| * | alignment to the Office   |   |   |     |   |   |    |             |
| * | of Academic Affairs has   |   |   |     |   |   |    |             |
|   | been inconsistent with    |   |   |     |   |   |    |             |
|   | the evolving mission, and |   |   |     |   |   |    |             |
|   | it is believed that       |   |   |     |   |   |    |             |
|   | alignment within the      |   |   |     |   |   |    |             |
|   | Office of Employee        |   |   |     |   |   |    |             |
|   | Education will not        |   |   |     |   |   |    |             |
|   | improve access to the     |   |   |     |   |   |    |             |
|   | Washington NMDC as a      |   |   |     |   |   |    |             |
|   | system asset. Alignment   |   |   |     |   |   |    |             |
|   | under the Chief           |   |   |     |   |   |    |             |
|   | Administrative Officer is |   |   |     |   |   |    |             |
|   | recommended as the most   |   |   |     |   |   |    |             |
|   | efficient organizational  |   |   |     |   |   |    |             |
|   | design.                   |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The CHEP Directors        |   | T |     |   |   |    |             |
| * | comment that the existing |   | h |     |   |   |    |             |
| 1 | system of education       |   | e |     |   |   |    |             |
| . | delivery could be         |   | r |     |   |   |    |             |
| 2 | realigned to better       |   | e |     |   |   |    |             |
| 2 | address the new needs of  |   | c |     |   |   |    |             |
| . | the VISNs as well as      |   | o |     |   |   |    |             |
| 2 | constituent staff. They   |   | m |     |   |   |    |             |
| * | recommend a defined       |   | m |     |   |   |    |             |
| * | period of resource review |   | e |     |   |   |    |             |
|   | and redistribution based  |   | n |     |   |   |    |             |
|   | on the findings of a      |   | d |     |   |   |    |             |
|   | \"balanced cadre\" of     |   | e |     |   |   |    |             |
|   | education specialists and |   | d |     |   |   |    |             |
|   | VHA customers currently   |   | a |     |   |   |    |             |
|   | working within VHA. The   |   | s |     |   |   |    |             |
|   | CHEP model for meeting    |   | s |     |   |   |    |             |
|   | educational needs         |   | e |     |   |   |    |             |
|   | deserves serious review   |   | s |     |   |   |    |             |
|   | regarding how it can be   |   | m |     |   |   |    |             |
|   | replicated within the     |   | e |     |   |   |    |             |
|   | VISN structure for the    |   | n |     |   |   |    |             |
|   | VAMCs who desire          |   | t |     |   |   |    |             |
|   | community-VHA             |   | w |     |   |   |    |             |
|   | partnerships for          |   | i |     |   |   |    |             |
|   | education.                |   | l |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
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|   |                           |   | f |     |   |   |    |             |
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|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | O |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | E |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The AsCMD for Academic    |   | T |     |   |   |    |             |
| * | Affairs does not support  |   | h |     |   |   |    |             |
| 1 | the alignment of media    |   | e |     |   |   |    |             |
| . | functions under the       |   | r |     |   |   |    |             |
| 2 | Employee Education        |   | e |     |   |   |    |             |
| 2 | Officer. Support for the  |   | c |     |   |   |    |             |
| * | concept of examining      |   | o |     |   |   |    |             |
| * | either contracting for    |   | m |     |   |   |    |             |
|   | media functions outside   |   | m |     |   |   |    |             |
|   | VA or setting up the NMDC |   | e |     |   |   |    |             |
|   | units for that VHA        |   | n |     |   |   |    |             |
|   | clients can contract with |   | d |     |   |   |    |             |
|   | them in a true service    |   | e |     |   |   |    |             |
|   | center concept was        |   | d |     |   |   |    |             |
|   | recommended.              |   | a |     |   |   |    |             |
|   | Additionally, work with   |   | s |     |   |   |    |             |
|   | the OAA to establish the  |   | s |     |   |   |    |             |
|   | Service Centers as        |   | e |     |   |   |    |             |
|   | resources available to    |   | s |     |   |   |    |             |
|   | all VHA and all three VA  |   | m |     |   |   |    |             |
|   | agencies was suggested.   |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
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|   |                           |   | d |     |   |   |    |             |
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|   |                           |   | a |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer inquirers      | * | T |     |   |   |    |             |
| * | \'will field units such   | * | h |     |   |   |    |             |
| 1 | as GRECCs that are        | D | e |     |   |   |    |             |
| . | mandated to provide       | * | G |     |   |   |    |             |
| 2 | employee education, and   | * | R |     |   |   |    |             |
| 2 | the funding to provide    |   | E |     |   |   |    |             |
| * | that education, be moved  |   | C |     |   |   |    |             |
| * | to the Chief Employee     |   | C |     |   |   |    |             |
|   | Education Office?\'       |   | s |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
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|   |                           |   | m |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
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|   |                           |   | i |     |   |   |    |             |
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|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | The movement of the       |   |   |     |   |   | D/ |             |
| e | Rehabilitation Research   |   |   |     |   |   | O] |             |
| f | and Development (R&D)     |   |   |     |   |   | {. |             |
| N | Programs to the Office of |   |   |     |   |   | un |             |
| o | R&D, as noted in the      |   |   |     |   |   | de |             |
| . | *Vision for Change,*      |   |   |     |   |   | rl |             |
| ] | should occur. The         |   |   |     |   |   | in |             |
| { | integrity of the          |   |   |     |   |   | e} |             |
| . | legislative mandates      |   |   |     |   |   | ** |             |
| u | which demand full         |   |   |     |   |   |    |             |
| n | Rehabilitation R&D, must  |   |   |     |   |   |    |             |
| d | be monitored and          |   |   |     |   |   |    |             |
| e | protected.                |   |   |     |   |   |    |             |
| r |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 2 |                           |   |   |     |   |   |    |             |
| 3 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Complete the movement of  | P |   | O   |   |   |    |             |
| * | the Rehabilitation R&D    | a |   | ct. |   |   |    |             |
| 1 | Program.                  | t |   | 1,  |   |   |    |             |
| . |                           | i |   | 1   |   |   |    |             |
| 2 |                           | e |   | 995 |   |   |    |             |
| 3 |                           | n |   |     |   |   |    |             |
| . |                           | t |   |     |   |   |    |             |
| 1 |                           | C |   |     |   |   |    |             |
| * |                           | a |   |     |   |   |    |             |
| * |                           | r |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | S |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | v |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | c |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer emphasizes     | * | C |     |   |   |    |             |
| * | that this recommendation  | * | o |     |   |   |    |             |
| 1 | is so important, and      | A | m |     |   |   |    |             |
| . | emphasizes that a         | * | m |     |   |   |    |             |
| 2 | specific mechanism is     | * | e |     |   |   |    |             |
| 3 | needed to insure that     |   | n |     |   |   |    |             |
| * | Rehab. R&D initiatives    |   | t |     |   |   |    |             |
| * | are monitored and         |   | a |     |   |   |    |             |
|   | protected.                |   | r |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | N |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | q |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One VAMC Director         | * | T |     |   |   |    |             |
| * | emphasized the need for a | * | h |     |   |   |    |             |
| 1 | strong national structure | D | i |     |   |   |    |             |
| . | to support R&D. He noted  | * | s |     |   |   |    |             |
| 2 | a steady erosion in       | * | i |     |   |   |    |             |
| 3 | financial and leaderhip   |   | s |     |   |   |    |             |
| * | support for this program. |   | s |     |   |   |    |             |
| * | He cautioned that R&D     |   | u |     |   |   |    |             |
|   | cannot remain viable if   |   | e |     |   |   |    |             |
|   | the VISNs are expected to |   | i |     |   |   |    |             |
|   | absorb its financial      |   | s |     |   |   |    |             |
|   | impact while competing in |   | a |     |   |   |    |             |
|   | the healthcare market. He |   | l |     |   |   |    |             |
|   | expressed concern that    |   | r |     |   |   |    |             |
|   | this report does not      |   | e |     |   |   |    |             |
|   | address this issue.       |   | a |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | D |     |   |   |    |             |
|   |                           |   | U |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
|   |                           |   | H |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | z |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer commented that |   |   |     |   |   |    |             |
| * | he concurred with         |   |   |     |   |   |    |             |
| 1 | Rehabilitation R&D        |   |   |     |   |   |    |             |
| . | fencing.                  |   |   |     |   |   |    |             |
| 2 |                           |   |   |     |   |   |    |             |
| 3 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | The VISN HQ Support Team  |   |   |     |   |   | D/ |             |
| e | should be a fully         |   |   |     |   |   | O] |             |
| f | matrixed group of         |   |   |     |   |   | {. |             |
| N | individuals. Establish    |   |   |     |   |   | un |             |
| o | five VISN Headquarters    |   |   |     |   |   | de |             |
| . | Support Teams, each team  |   |   |     |   |   | rl |             |
| ] | supporting approximately  |   |   |     |   |   | in |             |
| { | 4 or 5 VISNs representing |   |   |     |   |   | e} |             |
| . | a broad spectrum of       |   |   |     |   |   | ** |             |
| u | Headquarters product      |   |   |     |   |   |    |             |
| n | lines and staff offices.  |   |   |     |   |   |    |             |
| d | The responsibility of     |   |   |     |   |   |    |             |
| e | these teams is to provide |   |   |     |   |   |    |             |
| r | proactive, responsive     |   |   |     |   |   |    |             |
| l | support to the VISN       |   |   |     |   |   |    |             |
| i | Directors, field          |   |   |     |   |   |    |             |
| n | personnel, the Chief      |   |   |     |   |   |    |             |
| e | Operating Officer and the |   |   |     |   |   |    |             |
| } | Chief Network Officer on  |   |   |     |   |   |    |             |
| * | the full-range of support |   |   |     |   |   |    |             |
| * | activities that these     |   |   |     |   |   |    |             |
|   | individuals might         |   |   |     |   |   |    |             |
| * | require. The team is      |   |   |     |   |   |    |             |
| * | responsible for providing |   |   |     |   |   |    |             |
| 1 | the information or        |   |   |     |   |   |    |             |
| . | assistance directly; or   |   |   |     |   |   |    |             |
| 2 | for advising the          |   |   |     |   |   |    |             |
| 4 | requester how and where   |   |   |     |   |   |    |             |
| * | the support may be        |   |   |     |   |   |    |             |
| * | obtained; or for          |   |   |     |   |   |    |             |
|   | recommending the need for |   |   |     |   |   |    |             |
|   | a policy decision, task   |   |   |     |   |   |    |             |
|   | force, legislative        |   |   |     |   |   |    |             |
|   | relief; etc. to the Chief |   |   |     |   |   |    |             |
|   | Network Officer or to     |   |   |     |   |   |    |             |
|   | Headquarters program      |   |   |     |   |   |    |             |
|   | officials.                |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Establish a VISN          | O |   | **A |   |   |    |             |
| * | Headquarters Support Team | f |   | ug. |   |   |    |             |
| 1 | Workgroup which consists  | f |   | 15, |   |   |    |             |
| . | of representatives from   | i |   | 199 |   |   |    |             |
| 2 | the various HQ activities | c |   | 5** |   |   |    |             |
| 4 | that will be represented  | e |   |     |   |   |    |             |
| . | on the VISN HQ Support    | o |   |     |   |   |    |             |
| 1 | Teams.                    | f |   |     |   |   |    |             |
| \ |                           | U |   |     |   |   |    |             |
| * |                           | S |   |     |   |   |    |             |
| * |                           | H |   |     |   |   |    |             |
| * |                           | , |   |     |   |   |    |             |
|   |                           | C |   |     |   |   |    |             |
|   |                           | N |   |     |   |   |    |             |
|   |                           | O |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Develop a proposal by the | V |   | S   |   |   |    |             |
| * | VISN HQ Support Team      | I |   | ep. |   |   |    |             |
| 1 | Workgroup which expands   | S |   | 15, |   |   |    |             |
| . | the full VISN HQ Support  | N |   | 1   |   |   |    |             |
| 2 | Team proposal, identifies | H |   | 995 |   |   |    |             |
| 4 | the final number of       | Q |   |     |   |   |    |             |
| . | teams, assigns teams to   | S |   |     |   |   |    |             |
| 2 | VISNs, defines            | u |   |     |   |   |    |             |
| * | organizational            | p |   |     |   |   |    |             |
| * | representation required   | p |   |     |   |   |    |             |
|   | by the VISN grouping, and | o |   |     |   |   |    |             |
|   | defines VISN support      | r |   |     |   |   |    |             |
|   | requirements needed to be | t |   |     |   |   |    |             |
|   | provided by HQ            | T |   |     |   |   |    |             |
|   | organizations.            | e |   |     |   |   |    |             |
|   |                           | a |   |     |   |   |    |             |
|   |                           | m |   |     |   |   |    |             |
|   |                           | W |   |     |   |   |    |             |
|   |                           | o |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | k |   |     |   |   |    |             |
|   |                           | g |   |     |   |   |    |             |
|   |                           | o |   |     |   |   |    |             |
|   |                           | u |   |     |   |   |    |             |
|   |                           | p |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Headquarters activities   | O |   | Co  |   |   |    |             |
| * | will select the           | f |   | mpl |   |   |    |             |
| 1 | individuals to serve as   | f |   | ete |   |   |    |             |
| . | members of the VISN HQ    | i |   | by  |   |   |    |             |
| 2 | Support Teams.            | c |   | S   |   |   |    |             |
| 4 |                           | e |   | ep. |   |   |    |             |
| . |                           | o |   | 30, |   |   |    |             |
| 3 |                           | f |   | 1   |   |   |    |             |
| * |                           | U |   | 995 |   |   |    |             |
| * |                           | S |   |     |   |   |    |             |
|   |                           | H |   |     |   |   |    |             |
|   |                           | , |   |     |   |   |    |             |
|   |                           | C |   |     |   |   |    |             |
|   |                           | h |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | f |   |     |   |   |    |             |
|   |                           | N |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | t |   |     |   |   |    |             |
|   |                           | w |   |     |   |   |    |             |
|   |                           | o |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | k |   |     |   |   |    |             |
|   |                           | O |   |     |   |   |    |             |
|   |                           | f |   |     |   |   |    |             |
|   |                           | f |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | c |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The VISN HQ Team          | O |   | S   |   |   |    |             |
| * | Workgroup, in conjunction | f |   | ep. |   |   |    |             |
| 1 | with program officials    | f |   | 30, |   |   |    |             |
| . | and the Office of the     | i |   | 1   |   |   |    |             |
| 2 | USH, will define roles,   | c |   | 995 |   |   |    |             |
| 4 | responsibilities for      | e |   |     |   |   |    |             |
| . | participation, and on     | o |   |     |   |   |    |             |
| 4 | going assignments of      | f |   |     |   |   |    |             |
| * | individuals identified as | U |   |     |   |   |    |             |
| * | team members.             | S |   |     |   |   |    |             |
|   |                           | H |   |     |   |   |    |             |
|   |                           | , |   |     |   |   |    |             |
|   |                           | C |   |     |   |   |    |             |
|   |                           | N |   |     |   |   |    |             |
|   |                           | O |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The VISN HQ Team          | V |   | O   |   |   |    |             |
| * | Workgroup will establish  | I |   | ct. |   |   |    |             |
| 1 | team operating procedures | S |   | 15, |   |   |    |             |
| . | and insure that           | N |   | 1   |   |   |    |             |
| 2 | communication links and   | H |   | 995 |   |   |    |             |
| 4 | official assignments are  | Q |   |     |   |   |    |             |
| . | completed.                | T |   |     |   |   |    |             |
| 5 |                           | e |   |     |   |   |    |             |
| * |                           | a |   |     |   |   |    |             |
| * |                           | m |   |     |   |   |    |             |
|   |                           | W |   |     |   |   |    |             |
|   |                           | o |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | k |   |     |   |   |    |             |
|   |                           | g |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | o |   |     |   |   |    |             |
|   |                           | u |   |     |   |   |    |             |
|   |                           | p |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | VISN HQ Support Teams     | O |   | NTE |   |   |    |             |
| * | will begin activity.      | f |   | N   |   |   |    |             |
| 1 |                           | f |   | ov. |   |   |    |             |
| . |                           | i |   | 1,  |   |   |    |             |
| 2 |                           | c |   | 1   |   |   |    |             |
| 4 |                           | e |   | 995 |   |   |    |             |
| . |                           | o |   |     |   |   |    |             |
| 6 |                           | f |   |     |   |   |    |             |
| * |                           | U |   |     |   |   |    |             |
| * |                           | S |   |     |   |   |    |             |
|   |                           | H |   |     |   |   |    |             |
|   |                           | , |   |     |   |   |    |             |
|   |                           | C |   |     |   |   |    |             |
|   |                           | N |   |     |   |   |    |             |
|   |                           | O |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Several individuals (5)   | * | T |     |   |   |    |             |
| * | supported the             | * | h |     |   |   |    |             |
| 1 | philosophical intent of   | D | e |     |   |   |    |             |
| . | these teams. However,     | * | s |     |   |   |    |             |
| 2 | they expressed concern    | * | e |     |   |   |    |             |
| 4 | with both the size and    |   | t |     |   |   |    |             |
| * | specific tasks charged to |   | e |     |   |   |    |             |
| * | the team. Concerns were   |   | a |     |   |   |    |             |
|   | expressed that the roles  |   | m |     |   |   |    |             |
|   | and number of staff would |   | s |     |   |   |    |             |
|   | increase, placing an      |   | a |     |   |   |    |             |
|   | undue burden of reporting |   | r |     |   |   |    |             |
|   | and other requirements on |   | e |     |   |   |    |             |
|   | VISN offices and VAMCs.   |   | v |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | , |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | N |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | \ |     |   |   |    |             |
|   |                           |   | C |     |   |   |    |             |
|   |                           |   | N |     |   |   |    |             |
|   |                           |   | O |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Several writers (8)       | * | S |     |   |   |    |             |
| * | requested clarification   | * | e |     |   |   |    |             |
| 1 | regarding how these teams | A | e |     |   |   |    |             |
| . | relate to the eleven      | * | a |     |   |   |    |             |
| 2 | support staff recommended | * | t |     |   |   |    |             |
| 4 | by the VISN Activation    |   | t |     |   |   |    |             |
| * | Work Group.               |   | a |     |   |   |    |             |
| * |                           |   | c |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | C |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | F |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | c |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | O |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One individual            | * | C |     |   |   |    |             |
| * | articulated support for   | * | o |     |   |   |    |             |
| 1 | the HQ Support Teams      | A | m |     |   |   |    |             |
| . | citing that this format   | * | m |     |   |   |    |             |
| 2 | would make more effective | * | e |     |   |   |    |             |
| 4 | use of the knowledge and  |   | n |     |   |   |    |             |
| * | talent in HQ than the     |   | t |     |   |   |    |             |
| * | alternate organizational  |   | a |     |   |   |    |             |
|   | plan put forward under    |   | r |     |   |   |    |             |
|   | the VISN Activation       |   | y |     |   |   |    |             |
|   | Workgroup report.         |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | N |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | / |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | q |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One individual expressed  | * | W |     |   |   |    |             |
| * | concern for the           | * | e |     |   |   |    |             |
| 1 | feasibility of the        | D | s |     |   |   |    |             |
| . | suggested new             | * | t |     |   |   |    |             |
| 2 | organization in view of   | * | r |     |   |   |    |             |
| 4 | the MAMOE levels expected |   | o |     |   |   |    |             |
| * | for FY 1996. This writer  |   | n |     |   |   |    |             |
| * | recommended the           |   | g |     |   |   |    |             |
|   | elimination of the VISN   |   | l |     |   |   |    |             |
|   | teams and associated HSS  |   | y |     |   |   |    |             |
|   | staff in the CNO office.  |   | b |     |   |   |    |             |
|   | He defined a              |   | e |     |   |   |    |             |
|   | four-dimensional mission  |   | l |     |   |   |    |             |
|   | for HQ as external        |   | i |     |   |   |    |             |
|   | liaison and function      |   | e |     |   |   |    |             |
|   | outside VHA; support to   |   | v |     |   |   |    |             |
|   | the USH, DUSH, CNO, and   |   | e |     |   |   |    |             |
|   | other HQ offices;         |   | t |     |   |   |    |             |
|   | national program          |   | h |     |   |   |    |             |
|   | leadership; and           |   | a |     |   |   |    |             |
|   | VISN/field support. Given |   | t |     |   |   |    |             |
|   | the mission of HQ         |   | t |     |   |   |    |             |
|   | offices, he emphasized    |   | h |     |   |   |    |             |
|   | that there should be no   |   | e |     |   |   |    |             |
|   | need for a liaison        |   | r |     |   |   |    |             |
|   | function between VISN and |   | e |     |   |   |    |             |
|   | health care facility      |   | a |     |   |   |    |             |
|   | staff and the HQ/Service  |   | n |     |   |   |    |             |
|   | center offices that       |   | e |     |   |   |    |             |
|   | support them. (See also   |   | e |     |   |   |    |             |
|   | recommendation 1. 7).     |   | d |     |   |   |    |             |
|   | This writer recommended   |   | f |     |   |   |    |             |
|   | the vertical integration  |   | o |     |   |   |    |             |
|   | of the Service Center     |   | r |     |   |   |    |             |
|   | staff (and all            |   | a |     |   |   |    |             |
|   | field-based staff outside |   | l |     |   |   |    |             |
|   | the VISNs) with their     |   | i |     |   |   |    |             |
|   | associated program        |   | n |     |   |   |    |             |
|   | offices in HQ.            |   | k |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | / |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
|   |                           |   | T |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | i |     |   |   |    |             |
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|   |                           |   | a |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | l |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer noted that the | * | C |     |   |   |    |             |
| * | proposed reorganization   | * | o |     |   |   |    |             |
| 1 | of HQ, including current  | A | m |     |   |   |    |             |
| . | staff, perpetuates the    | * | m |     |   |   |    |             |
| 2 | separation of clinical    | * | e |     |   |   |    |             |
| 4 | managers and health       |   | n |     |   |   |    |             |
| * | systems/financial         |   | t |     |   |   |    |             |
| * | managers. The only        |   | a |     |   |   |    |             |
|   | exception is in the VISN  |   | r |     |   |   |    |             |
|   | Support Team component.   |   | y |     |   |   |    |             |
|   | This commentary cites a   |   | i |     |   |   |    |             |
|   | lesson learned from VA\'s |   | s |     |   |   |    |             |
|   | involvement with National |   | c |     |   |   |    |             |
|   | Health Care Reform and    |   | o |     |   |   |    |             |
|   | VA\'s implementation of   |   | n |     |   |   |    |             |
|   | the proposed reform was   |   | s |     |   |   |    |             |
|   | that the intermeshing of  |   | i |     |   |   |    |             |
|   | the clinical manager\'s   |   | s |     |   |   |    |             |
|   | perspective and the       |   | t |     |   |   |    |             |
|   | health system manager\'s  |   | e |     |   |   |    |             |
|   | perspective resulted in   |   | n |     |   |   |    |             |
|   | recommendations that were |   | t |     |   |   |    |             |
|   | both patient-centered and |   | w |     |   |   |    |             |
|   | cost effective.           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
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|   |                           |   | o |     |   |   |    |             |
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|   |                           |   | t |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | N |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
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|   |                           |   | h |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
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|   |                           |   | d |     |   |   |    |             |
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|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | / |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | q |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One VAMC Director         | * | T |     |   |   |    |             |
| * | expressed concern with    | * | h |     |   |   |    |             |
| 1 | the size and organization | D | e |     |   |   |    |             |
| . | of the HQ VISN Support    | * | H |     |   |   |    |             |
| 2 | Teams. She notes that     | * | Q |     |   |   |    |             |
| 4 | this recommendation       |   | V |     |   |   |    |             |
| * | establishes five          |   | I |     |   |   |    |             |
| * | interdisciplinary teams,  |   | S |     |   |   |    |             |
|   | totaling 70 FTE for VISN  |   | N |     |   |   |    |             |
|   | support. Concerns range   |   | S |     |   |   |    |             |
|   | from (1) the insertion of |   | u |     |   |   |    |             |
|   | a layer between program   |   | p |     |   |   |    |             |
|   | offices and the VISNs and |   | p |     |   |   |    |             |
|   | the field, (2) the        |   | o |     |   |   |    |             |
|   | structure appears a       |   | r |     |   |   |    |             |
|   | variation on current      |   | t |     |   |   |    |             |
|   | Regions field staff       |   | T |     |   |   |    |             |
|   | office structure, (3) the |   | e |     |   |   |    |             |
|   | accountability of staff   |   | a |     |   |   |    |             |
|   | to the VISN is unclear,   |   | m |     |   |   |    |             |
|   | to (4) redundancy of      |   | s |     |   |   |    |             |
|   | current HQ organization   |   | d |     |   |   |    |             |
|   | if HQ is functioning as   |   | o |     |   |   |    |             |
|   | it should. This writer    |   | n |     |   |   |    |             |
|   | also emphasized that this |   | o |     |   |   |    |             |
|   | proposal does not         |   | t |     |   |   |    |             |
|   | correlate with the VISN   |   | i |     |   |   |    |             |
|   | Activation Workgroup      |   | n |     |   |   |    |             |
|   | proposal.                 |   | v |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
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|   |                           |   | 7 |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
|   |                           |   | A |     |   |   |    |             |
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|   |                           |   | k |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | C |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | C |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | 0 |     |   |   |    |             |
|   |                           |   | 8 |     |   |   |    |             |
|   |                           |   | / |     |   |   |    |             |
|   |                           |   | 2 |     |   |   |    |             |
|   |                           |   | 9 |     |   |   |    |             |
|   |                           |   | / |     |   |   |    |             |
|   |                           |   | 9 |     |   |   |    |             |
|   |                           |   | 5 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One physician recommended | * | T |     |   |   |    |             |
| * | that \'the VISN support   | * | h |     |   |   |    |             |
| 1 | teams may well be best    | A | e |     |   |   |    |             |
| . | utilized as a             | * | c |     |   |   |    |             |
| 2 | transitional group which  | * | o |     |   |   |    |             |
| 4 | has a fixed time for      |   | n |     |   |   |    |             |
| * | operations with a defined |   | c |     |   |   |    |             |
| * | point of re-evaluation.   |   | e |     |   |   |    |             |
|   | The review should         |   | p |     |   |   |    |             |
|   | determine if the HQ       |   | t |     |   |   |    |             |
|   | functions for VISN        |   | o |     |   |   |    |             |
|   | support are operating to  |   | f |     |   |   |    |             |
|   | meet expectations.        |   | a |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | - |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | z |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | A |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 2 |     |   |   |    |             |
|   |                           |   | 4 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 4 |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | A |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 2 |     |   |   |    |             |
|   |                           |   | 4 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 7 |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | - |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One group of employees    | * | N |     |   |   |    |             |
| * | emphasized that the VISN  | * | e |     |   |   |    |             |
| 1 | HQ Support Teams were the | D | w |     |   |   |    |             |
| . | least clearly described   | * | t |     |   |   |    |             |
| 2 | component of this report. | * | e |     |   |   |    |             |
| 4 | They noted that this team |   | a |     |   |   |    |             |
| * | structure merely replaces |   | m |     |   |   |    |             |
| * | the Regional structures   |   | c |     |   |   |    |             |
|   | that were previously in   |   | o |     |   |   |    |             |
|   | Central Office, adding    |   | n |     |   |   |    |             |
|   | that these structures     |   | c |     |   |   |    |             |
|   | were difficult to work    |   | e |     |   |   |    |             |
|   | with and should not be    |   | p |     |   |   |    |             |
|   | duplicated. This group    |   | t |     |   |   |    |             |
|   | emphasized also that this |   | d |     |   |   |    |             |
|   | appeared another level of |   | e |     |   |   |    |             |
|   | the bureaucracy and       |   | v |     |   |   |    |             |
|   | without definitive        |   | e |     |   |   |    |             |
|   | clarification of its      |   | l |     |   |   |    |             |
|   | purpose, they saw no need |   | o |     |   |   |    |             |
|   | for them.                 |   | p |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | R |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | k |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | T |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | z |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
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|   |                           |   | t |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | V |     |   |   |    |             |
|   |                           |   | I |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
|   |                           |   | N |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | H |     |   |   |    |             |
|   |                           |   | Q |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | f |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Director, National    | * | N |     |   |   |    |             |
| * | Veterans Service of the   | * | e |     |   |   |    |             |
| 1 | VFW also emphasized that  | D | w |     |   |   |    |             |
| . | it was unclear as to the  | * | t |     |   |   |    |             |
| 2 | real function of the VISN | * | e |     |   |   |    |             |
| 4 | HQ support teams. He      |   | a |     |   |   |    |             |
| * | questioned whether \'this |   | m |     |   |   |    |             |
| * | was a return to the       |   | c |     |   |   |    |             |
|   | former area office        |   | o |     |   |   |    |             |
|   | concept, thereby creating |   | n |     |   |   |    |             |
|   | another administrative    |   | c |     |   |   |    |             |
|   | layer?\'                  |   | e |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
|   |                           |   | T |     |   |   |    |             |
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|   |                           |   | s |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | V |     |   |   |    |             |
|   |                           |   | I |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
|   |                           |   | N |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | H |     |   |   |    |             |
|   |                           |   | Q |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer made extensive | * | C |     |   |   |    |             |
| * | comments generally        | * | o |     |   |   |    |             |
| 1 | supportive, noting that   | A | m |     |   |   |    |             |
| . | the \'sole purpose of the | * | m |     |   |   |    |             |
| 2 | teams was to support line | * | e |     |   |   |    |             |
| 4 | management (i.e., the     |   | n |     |   |   |    |             |
| * | VISN Directors).\' This   |   | t |     |   |   |    |             |
| * | individual suggested that |   | a |     |   |   |    |             |
|   | this team approach with   |   | r |     |   |   |    |             |
|   | collaboration between     |   | y |     |   |   |    |             |
|   | clincal and operational   |   | i |     |   |   |    |             |
|   | mangers should be         |   | s |     |   |   |    |             |
|   | evaluated as a potential  |   | c |     |   |   |    |             |
|   | model for all of HQ. A    |   | o |     |   |   |    |             |
|   | concern was expressed     |   | n |     |   |   |    |             |
|   | that these teams could    |   | s |     |   |   |    |             |
|   | create another \'layer\'  |   | i |     |   |   |    |             |
|   | between the Healthcare    |   | s |     |   |   |    |             |
|   | Program, Support          |   | t |     |   |   |    |             |
|   | Programs, Office of PPP   |   | e |     |   |   |    |             |
|   | in HQ, and the field.     |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | I |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
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|   |                           |   | l |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
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|   |                           |   | s |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | O |     |   |   |    |             |
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|   |                           |   | - |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
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|   |                           |   | d |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Several writers (3)       |   | N |     |   |   |    |             |
| * | commented on the numbers  |   | e |     |   |   |    |             |
| 1 | of meetings (i.e., Team   |   | w |     |   |   |    |             |
| . | Meetings, CNO Meetings,   |   | v |     |   |   |    |             |
| 2 | and Program Office        |   | i |     |   |   |    |             |
| 4 | Meetings) referenced      |   | r |     |   |   |    |             |
| * | within the proposal.      |   | t |     |   |   |    |             |
| * | Although noting these     |   | u |     |   |   |    |             |
|   | meetings as good methods  |   | a |     |   |   |    |             |
|   | to enhance communication, |   | l |     |   |   |    |             |
|   | a concern was expressed   |   | o |     |   |   |    |             |
|   | that a significant number |   | r |     |   |   |    |             |
|   | of HQ staff could be      |   | g |     |   |   |    |             |
|   | spending remendous        |   | a |     |   |   |    |             |
|   | numbers of hours in       |   | n |     |   |   |    |             |
|   | meetings.                 |   | i |     |   |   |    |             |
|   |                           |   | z |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | w |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
|   |                           |   | T |     |   |   |    |             |
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|   |                           |   | U |     |   |   |    |             |
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|   |                           |   | N |     |   |   |    |             |
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|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | H |     |   |   |    |             |
|   |                           |   | Q |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Director, Emergency   | * | P |     |   |   |    |             |
| * | Medical Preparedness      | * | a |     |   |   |    |             |
| 1 | Office recommended that   | A | r |     |   |   |    |             |
| . | membership on the VISN    | * | t |     |   |   |    |             |
| 2 | Support Teams include a   | * | i |     |   |   |    |             |
| 4 | designated member of the  |   | c |     |   |   |    |             |
| . | EMPO staff. He adds that  |   | i |     |   |   |    |             |
| 4 | since EMPO is located in  |   | p |     |   |   |    |             |
| * | Martinsburg, WV,          |   | a |     |   |   |    |             |
| * | arrangements can be made  |   | t |     |   |   |    |             |
|   | for actual present in HQ  |   | i |     |   |   |    |             |
|   | as necessary to meet      |   | o |     |   |   |    |             |
|   | support requirements.     |   | n |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
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|   |                           |   | h |     |   |   |    |             |
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|   |                           |   | b |     |   |   |    |             |
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|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | V |     |   |   |    |             |
|   |                           |   | I |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
|   |                           |   | N |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | q |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer expressed      | * | C |     |   |   |    |             |
| * | concern regarding the     | * | o |     |   |   |    |             |
| 1 | requirement that VISN     | A | m |     |   |   |    |             |
| . | directors formally        | * | m |     |   |   |    |             |
| 2 | evaluate the teams        | * | e |     |   |   |    |             |
| 4 | periodically. This writer |   | n |     |   |   |    |             |
| * | emphasized that there     |   | t |     |   |   |    |             |
| * | should be clear           |   | a |     |   |   |    |             |
|   | responsibility for the    |   | r |     |   |   |    |             |
|   | development of these      |   | y |     |   |   |    |             |
|   | performance factors that  |   | i |     |   |   |    |             |
|   | are specific and          |   | s |     |   |   |    |             |
|   | measurable.               |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | W |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | k |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | F |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | , |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 2 |     |   |   |    |             |
|   |                           |   | 4 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 4 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The VISN HQ Support Team  | O |   | Se  |   |   |    |             |
| * | Workgroup, in conjunction | f |   | pt. |   |   |    |             |
| 1 | with program officials    | f |   | 30, |   |   |    |             |
| . | and the Office of the     | i |   | 1   |   |   |    |             |
| 2 | USH, will define roles,   | c |   | 995 |   |   |    |             |
| 4 | responsibilities for      | e |   |     |   |   |    |             |
| . | participation, methods    | o |   |     |   |   |    |             |
| 4 | for assuring team as well | f |   |     |   |   |    |             |
| * | as individual member      | U |   |     |   |   |    |             |
| * | evaluation, and on going  | S |   |     |   |   |    |             |
|   | assignments of            | H |   |     |   |   |    |             |
| * | individuals identified as | , |   |     |   |   |    |             |
| * | team members.             |   |   |     |   |   |    |             |
| R |                           | C |   |     |   |   |    |             |
| e |                           | N |   |     |   |   |    |             |
| - |                           | O |   |     |   |   |    |             |
| v |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| s |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The VISN HQ Support Teams | O |   | J   |   |   |    |             |
| * | will be re-evaluated for  | f |   | une |   |   |    |             |
| 1 | effectiveness in meeting  | f |   | 30, |   |   |    |             |
| . | the functional objectives | i |   | 1   |   |   |    |             |
| 2 | stated. The VISN          | c |   | 996 |   |   |    |             |
| 4 | Headquarters Support Team | e |   |     |   |   |    |             |
| . | Workgroup performing this | o |   |     |   |   |    |             |
| 7 | assessment will be        | f |   |     |   |   |    |             |
| * | chaired by a VISN         | U |   |     |   |   |    |             |
| * | director and include both | S |   |     |   |   |    |             |
|   | HQ program officials and  | H |   |     |   |   |    |             |
| * | field representation at   | , |   |     |   |   |    |             |
| * | the level of VISN and     |   |   |     |   |   |    |             |
| A | VAMC directors. The       | C |   |     |   |   |    |             |
| d | report will include       | N |   |     |   |   |    |             |
| d | recommendations regarding | O |   |     |   |   |    |             |
| - | continuation of this      |   |   |     |   |   |    |             |
| i | model and be submitted to |   |   |     |   |   |    |             |
| t | the DUSH, through the     |   |   |     |   |   |    |             |
| i | CNO.                      |   |   |     |   |   |    |             |
| o |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

  -------------------- ------------------------- --------- --------------- -- ------------------------- ----------------------------- -------
  **[Ref               **SUPPORT PROGRAMS**                                   **[A/D/O]{.underline}**   **[Remarks-K]{.underline}**   
  No.]{.underline}**                                                                                                                  

                       **General Comments**      **A/D**   **Rationale**                                                              

                       One writer expressed      **D**     Would fragment                                                             
                       concern for the                     program; would                                                             
                       feasibility of the                  not yield                                                                  
                       suggested new                       significant FTE                                                            
                       organization in view of             savings.                                                                   
                       the MAMOE levels expected                                                                                      
                       for FY 1996. The                                                                                               
                       commentary recommends                                                                                          
                       elimination of the Chief                                                                                       
                       Administrative Officer                                                                                         
                       (CAO) organization and                                                                                         
                       reassignment of CAO                                                                                            
                       functions as follows: (1)                                                                                      
                       Management & Admin.                                                                                            
                       Support to COS, (2)                                                                                            
                       Volunteer Programs to COS                                                                                      
                       to integrate with VSO                                                                                          
                       Liaison, (3) VA/DoD                                                                                            
                       Medical Sharing to Chief                                                                                       
                       Affiliations Officer, (4)                                                                                      
                       Environmental Management                                                                                       
                       Service to Construction                                                                                        
                       Management (changing name                                                                                      
                       to Facilities &                                                                                                
                       Construction Mgt.), (5)                                                                                        
                       Health Administation                                                                                           
                       Service to the CIO, and                                                                                        
                       (6) the A&MM Liaison to                                                                                        
                       the CFO.                                                                                                       

                       One writer recommended    **D**     VHA not given                                                              
                       that the Canteen Service            authority to                                                               
                       might be better aligned             determine                                                                  
                       under the Chief                     location of                                                                
                       Administration Officer in           this program.                                                              
                       the Office of                                                                                                  
                       Administration.                                                                                                

                       The General Counsel (GC)  **A**     As appropriate,                                                            
                       expressed concern                   General Counsel                                                            
                       regarding issues on which           will be                                                                    
                       she believed the HQ                 suggested for                                                              
                       report did not adequately           membership to                                                              
                       address. These include              workgroups                                                                 
                       both (1) contracting and            and/or task                                                                
                       construction law issues             forces                                                                     
                       and (2) information law             recommended                                                                
                       issues. She emphasizes              that address                                                               
                       the need to assure                  these issues of                                                            
                       involvement and                     concern.                                                                   
                       representation of Office                                                                                       
                       of General Counsel in                                                                                          
                       future working group0s to                                                                                      
                       help identify and address                                                                                      
                       both contracting and                                                                                           
                       information law issues at                                                                                      
                       the earliest possible                                                                                          
                       time. The presence of GC                                                                                       
                       staff will also                                                                                                
                       facilitate assistance                                                                                          
                       needed to develop                                                                                              
                       legislative initiatives                                                                                        
                       to accomplish objectives                                                                                       
                       identified for the new                                                                                         
                       VHA organization.                                                                                              
  -------------------- ------------------------- --------- --------------- -- ------------------------- ----------------------------- -------

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Emergency Medical         |   |   |     |   |   | D/ |             |
| e | Preparedness Office       |   |   |     |   |   | O] |             |
| f | (EMPO). VHA should        |   |   |     |   |   | {. |             |
| N | evaluate VA\'s role and   |   |   |     |   |   | un |             |
| o | responsibilities in       |   |   |     |   |   | de |             |
| . | fulfilling the mandated   |   |   |     |   |   | rl |             |
| ] | DoD backup mission and    |   |   |     |   |   | in |             |
| { | make a decision on the    |   |   |     |   |   | e} |             |
| . | appropriate level of VHA  |   |   |     |   |   | ** |             |
| u | involvement in            |   |   |     |   |   |    |             |
| n | non-mandated functions    |   |   |     |   |   |    |             |
| d | performed based on the    |   |   |     |   |   |    |             |
| e | level of limited          |   |   |     |   |   |    |             |
| r | resources presently       |   |   |     |   |   |    |             |
| l | available.                |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 2 |                           |   |   |     |   |   |    |             |
| 5 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The DUSH will convene a   | U |   | C   |   |   |    |             |
| * | Task Force to evaluate    | S |   | onv |   |   |    |             |
| 1 | the Emergency Medical     | H |   | ene |   |   |    |             |
| . | Preparedness Office       |   |   | NTE |   |   |    |             |
| 2 | (EMPO) roles and          |   |   | S   |   |   |    |             |
| 5 | responsibilities. Task    |   |   | ep. |   |   |    |             |
| . | the Chief Emergency       |   |   | 30, |   |   |    |             |
| 1 | Medical Preparedness      |   |   | 1   |   |   |    |             |
| * | Officer to recommend      |   |   | 995 |   |   |    |             |
| * | members of the multi      |   |   |     |   |   |    |             |
|   | organization and/or       |   |   |     |   |   |    |             |
|   | disciplinary team, and    |   |   |     |   |   |    |             |
|   | assign a field based      |   |   |     |   |   |    |             |
|   | chairperson.              |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Task Force will       | D |   | By  |   |   |    |             |
| * | prepare a final report    | e |   | N   |   |   |    |             |
| 1 | with recommendations for  | s |   | ov. |   |   |    |             |
| . | downsizing and/or         | i |   | 15, |   |   |    |             |
| 2 | streamlining operations   | g |   | 19  |   |   |    |             |
| 5 | to the DUSH.              | n |   | 95. |   |   |    |             |
| . |                           | a |   |     |   |   |    |             |
| 2 |                           | t |   |     |   |   |    |             |
| * |                           | e |   |     |   |   |    |             |
| * |                           | d |   |     |   |   |    |             |
|   |                           | T |   |     |   |   |    |             |
|   |                           | a |   |     |   |   |    |             |
|   |                           | s |   |     |   |   |    |             |
|   |                           | k |   |     |   |   |    |             |
|   |                           | F |   |     |   |   |    |             |
|   |                           | o |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | c |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | In the discussion of the  | * | T |     |   |   |    |             |
| * | future role of EMPO,      | * | h |     |   |   |    |             |
| 1 | several writers (3)       | A | i |     |   |   |    |             |
| . | commented that the long   | * | s |     |   |   |    |             |
| 2 | term strategy is not      | * | c |     |   |   |    |             |
| 5 | clear of either retaining |   | o |     |   |   |    |             |
| * | and downsizing EMPO or    |   | m |     |   |   |    |             |
| * | moving it to DoD or FEMA. |   | m |     |   |   |    |             |
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+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One commenter recommended | * | T |     |   |   |    |             |
| * | that DVAs role in         | * | h |     |   |   |    |             |
| 1 | providing disaster        | A | e |     |   |   |    |             |
| . | medical emergency         | * | c |     |   |   |    |             |
| 2 | services should be        | * | u |     |   |   |    |             |
| 5 | eliminated resulting in a |   | r |     |   |   |    |             |
| * | reduction of FTEE. This   |   | r |     |   |   |    |             |
| * | permits the DoD to        |   | e |     |   |   |    |             |
|   | reassume their former     |   | n |     |   |   |    |             |
|   | role for this function.   |   | t |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Director, EMPO        | * | T |     |   |   |    |             |
| * | provided comments in the  | * | h |     |   |   |    |             |
| 1 | form of a position paper  | A | e |     |   |   |    |             |
| . | to clarify functions      | * | c |     |   |   |    |             |
| 2 | associated with this      | * | h |     |   |   |    |             |
| 5 | office. In addition to a  |   | a |     |   |   |    |             |
| * | clarification of          |   | n |     |   |   |    |             |
| * | functions, the            |   | g |     |   |   |    |             |
|   | information emphasized    |   | e |     |   |   |    |             |
|   | that streamlining of      |   | s |     |   |   |    |             |
|   | operations has already    |   | n |     |   |   |    |             |
|   | been proposed and EMPO    |   | o |     |   |   |    |             |
|   | will utilize the review   |   | t |     |   |   |    |             |
|   | process to make further   |   | e |     |   |   |    |             |
|   | recommendation to the     |   | d |     |   |   |    |             |
|   | DUSH. Corrections were    |   | w |     |   |   |    |             |
|   | cited to the              |   | i |     |   |   |    |             |
|   | organizational chart      |   | l |     |   |   |    |             |
|   | included in the workgroup |   | l |     |   |   |    |             |
|   | report as \'National      |   | b |     |   |   |    |             |
|   | Programs\' and \'Response |   | e |     |   |   |    |             |
|   | Support\' being the       |   | r |     |   |   |    |             |
|   | correct titles for the    |   | e |     |   |   |    |             |
|   | blocks shown under the    |   | f |     |   |   |    |             |
|   | Chief EMPO.               |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
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|   |                           |   | f |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
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|   |                           |   | r |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
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|   |                           |   | r |     |   |   |    |             |
|   |                           |   | H |     |   |   |    |             |
|   |                           |   | Q |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Emergency Medical         |   |   |     |   |   |    |             |
| * | Preparedness Office       |   |   |     |   |   |    |             |
| 1 | (EMPO). VHA should        |   |   |     |   |   |    |             |
| . | evaluate VA\'s role and   |   |   |     |   |   |    |             |
| 2 | responsibilities in       |   |   |     |   |   |    |             |
| 5 | fulfilling the DoD backup |   |   |     |   |   |    |             |
| * | mission and make          |   |   |     |   |   |    |             |
| * | decisions on the          |   |   |     |   |   |    |             |
|   | appropriate level of VHA  |   |   |     |   |   |    |             |
| * | involvement in            |   |   |     |   |   |    |             |
| * | non-mandated functions    |   |   |     |   |   |    |             |
| R | performed based on the    |   |   |     |   |   |    |             |
| e | level of resources        |   |   |     |   |   |    |             |
| - | available for support of  |   |   |     |   |   |    |             |
| v | this mission.             |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| s |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The DUSH will convene a   | U |   | C   |   |   |    |             |
| * | Task Force to evaluate    | S |   | onv |   |   |    |             |
| 1 | the Emergency Medical     | H |   | ene |   |   |    |             |
| . | Preparedness Office       |   |   | NTE |   |   |    |             |
| 2 | (EMPO) roles and          |   |   | S   |   |   |    |             |
| 5 | responsibilities. Task    |   |   | ep. |   |   |    |             |
| . | the Chief Emergency       |   |   | 30, |   |   |    |             |
| 1 | Medical Preparedness      |   |   | 1   |   |   |    |             |
| * | Officer to recommend      |   |   | 995 |   |   |    |             |
| * | members of the multi      |   |   |     |   |   |    |             |
|   | organization and/or       |   |   |     |   |   |    |             |
| * | disciplinary team, and    |   |   |     |   |   |    |             |
| * | assign a field based      |   |   |     |   |   |    |             |
| R | chairperson at the level  |   |   |     |   |   |    |             |
| e | of a VISN or VAMC         |   |   |     |   |   |    |             |
| - | director.                 |   |   |     |   |   |    |             |
| v |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| s |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | VA/DoD and Medical        |   |   |     |   |   | D/ |             |
| e | Sharing Office. Continue  |   |   |     |   |   | O] |             |
| f | the decentralization of   |   |   |     |   |   | {. |             |
| N | authority for sharing of  |   |   |     |   |   | un |             |
| o | specialized medical       |   |   |     |   |   | de |             |
| . | resources and scarce      |   |   |     |   |   | rl |             |
| ] | medical specialists to    |   |   |     |   |   | in |             |
| { | the VISNs with medical    |   |   |     |   |   | e} |             |
| . | center accountability     |   |   |     |   |   | ** |             |
| u | delineated in performance |   |   |     |   |   |    |             |
| n | measures. This oversight  |   |   |     |   |   |    |             |
| d | function is established   |   |   |     |   |   |    |             |
| e | as a part of overall      |   |   |     |   |   |    |             |
| r | Department oversight of   |   |   |     |   |   |    |             |
| l | contracts, and as a       |   |   |     |   |   |    |             |
| i | result of VA medical      |   |   |     |   |   |    |             |
| n | centers identified in     |   |   |     |   |   |    |             |
| e | non-compliance with       |   |   |     |   |   |    |             |
| } | external review           |   |   |     |   |   |    |             |
| * | regulations.              |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 2 |                           |   |   |     |   |   |    |             |
| 6 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Prepare appropriate       | S |   | Co  |   |   |    |             |
| * | performance elements for  | u |   | mpl |   |   |    |             |
| 1 | VISN directors to ensure  | p |   | ete |   |   |    |             |
| . | VAMC level accountability | p |   | by  |   |   |    |             |
| 2 | regarding program         | o |   | O   |   |   |    |             |
| 6 | management of specialized | r |   | ct. |   |   |    |             |
| . | medical resources and     | t |   | 1,  |   |   |    |             |
| 1 | scarce medical            | S |   | 1   |   |   |    |             |
| * | specialists.              | e |   | 995 |   |   |    |             |
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+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Task the Director, VA/DoD | D |   | Co  |   |   |    |             |
| * | and Medical Sharing with  | U |   | mpl |   |   |    |             |
| 1 | recommending members of a | S |   | ete |   |   |    |             |
| . | multi-level (HQ, VISN,    | H |   | by  |   |   |    |             |
| 2 | VAMC) and                 |   |   | S   |   |   |    |             |
| 6 | multi-disciplinary team   |   |   | ep. |   |   |    |             |
| . | to evaluate the           |   |   | 30, |   |   |    |             |
| 2 | decentralization of       |   |   | 1   |   |   |    |             |
| * | oversight to the lowest   |   |   | 995 |   |   |    |             |
| * | organizational level      |   |   |     |   |   |    |             |
|   | possible.                 |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
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|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Office of Acquisition | * | W |     |   |   |    |             |
| * | & Materiel Mgt (OA&MM)    | * | e |     |   |   |    |             |
| 1 | comments that this        | D | d |     |   |   |    |             |
| . | recommendation is         | * | i |     |   |   |    |             |
| 2 | unnecessary as the        | * | s |     |   |   |    |             |
| 6 | Medical Sharing Office is |   | a |     |   |   |    |             |
| * | already transitioning     |   | g |     |   |   |    |             |
| * | from a largely review     |   | r |     |   |   |    |             |
|   | function to a             |   | e |     |   |   |    |             |
|   | consultative resource for |   | e |     |   |   |    |             |
|   | VHA. As VHA moves to new  |   | t |     |   |   |    |             |
|   | clinical service          |   | h |     |   |   |    |             |
|   | contracts, OA&MM believes |   | a |     |   |   |    |             |
|   | it would be a significant |   | t |     |   |   |    |             |
|   | mistake to lose the       |   | t |     |   |   |    |             |
|   | program and acquisition   |   | h |     |   |   |    |             |
|   | related expertise of the  |   | e |     |   |   |    |             |
|   | Medical Sharing Office.   |   | r |     |   |   |    |             |
|   | While this office         |   | e |     |   |   |    |             |
|   | supports accountability   |   | c |     |   |   |    |             |
|   | at all organizational     |   | o |     |   |   |    |             |
|   | levels, it believes VISN  |   | m |     |   |   |    |             |
|   | Directors should have the |   | m |     |   |   |    |             |
|   | role of ensuring this     |   | e |     |   |   |    |             |
|   | type of statutory/program |   | n |     |   |   |    |             |
|   | compliance. OA&MM         |   | d |     |   |   |    |             |
|   | disagees with the         |   | a |     |   |   |    |             |
|   | assumption that no        |   | t |     |   |   |    |             |
|   | oversight is necessary.   |   | i |     |   |   |    |             |
|   | OA&MM believes strongly   |   | o |     |   |   |    |             |
|   | that the USH should be    |   | n |     |   |   |    |             |
|   | fully briefed on the      |   | i |     |   |   |    |             |
|   | major issues, including   |   | s |     |   |   |    |             |
|   | Congressional concerns,   |   | u |     |   |   |    |             |
|   | before approving this     |   | n |     |   |   |    |             |
|   | recommendation.           |   | n |     |   |   |    |             |
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+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Director Medical      | * | C |     |   |   |    |             |
| * | Sharing Office expresses  | * | o |     |   |   |    |             |
| 1 | concerns regarding a      | A | m |     |   |   |    |             |
| . | premise of lessening      | * | m |     |   |   |    |             |
| 2 | oversight. He emphasizes  | * | e |     |   |   |    |             |
| 6 | that VHA has delegated    |   | n |     |   |   |    |             |
| * | approval of competitive   |   | t |     |   |   |    |             |
| * | specialized medical       |   | a |     |   |   |    |             |
|   | resource sharing and      |   | r |     |   |   |    |             |
|   | scarce medical specialist |   | y |     |   |   |    |             |
|   | services contrats of up   |   | i |     |   |   |    |             |
|   | to \$1.5 million to the   |   | s |     |   |   |    |             |
|   | VAMCs, and notes that two |   | c |     |   |   |    |             |
|   | further major delgations  |   | o |     |   |   |    |             |
|   | are planned. He           |   | n |     |   |   |    |             |
|   | emphasizes the ongoing    |   | s |     |   |   |    |             |
|   | need for policy           |   | i |     |   |   |    |             |
|   | formulation and technical |   | s |     |   |   |    |             |
|   | assistance at the         |   | t |     |   |   |    |             |
|   | National level to include |   | e |     |   |   |    |             |
|   | continued liaison with    |   | n |     |   |   |    |             |
|   | Offices of General        |   | t |     |   |   |    |             |
|   | Counsel, Acquisition &    |   | w |     |   |   |    |             |
|   | Materiel Management, and  |   | i |     |   |   |    |             |
|   | Clinical Programs. The    |   | t |     |   |   |    |             |
|   | writer did express        |   | h |     |   |   |    |             |
|   | concern that the VISN     |   | o |     |   |   |    |             |
|   | director may be far too   |   | v |     |   |   |    |             |
|   | high a level for          |   | e |     |   |   |    |             |
|   | performance measures      |   | r |     |   |   |    |             |
|   | dealing with adherence to |   | a |     |   |   |    |             |
|   | specialized medical       |   | l |     |   |   |    |             |
|   | resource and scarce       |   | l |     |   |   |    |             |
|   | medical specialist        |   | r |     |   |   |    |             |
|   | services program          |   | e |     |   |   |    |             |
|   | management.               |   | p |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| 1 | One writer expresses      |   | N |     |   |   |    |             |
| . | concern that the          |   | o |     |   |   |    |             |
| 2 | assumption that no        |   | t |     |   |   |    |             |
| 6 | oversight would be        |   | e |     |   |   |    |             |
|   | required of medical       |   | d |     |   |   |    |             |
|   | centers creating          |   | . |     |   |   |    |             |
|   | contracts for specialized |   | A |     |   |   |    |             |
|   | medical resources since   |   | l |     |   |   |    |             |
|   | medical centers are to be |   | t |     |   |   |    |             |
|   | held accountable for      |   | e |     |   |   |    |             |
|   | following the mandates of |   | r |     |   |   |    |             |
|   | the law is not completely |   | n |     |   |   |    |             |
|   | accurate. The writer      |   | a |     |   |   |    |             |
|   | emphasizes that the       |   | t |     |   |   |    |             |
|   | oversight function was    |   | i |     |   |   |    |             |
|   | established as a result   |   | v |     |   |   |    |             |
|   | of non compliance, and a  |   | e |     |   |   |    |             |
|   | more appropriate          |   | f |     |   |   |    |             |
|   | assumption might be that  |   | o |     |   |   |    |             |
|   | oversight of a different  |   | r |     |   |   |    |             |
|   | type may be appropriate.  |   | m |     |   |   |    |             |
|   | The writer suggests       |   | s |     |   |   |    |             |
|   | rather than continuing    |   | o |     |   |   |    |             |
|   | the current review and    |   | f |     |   |   |    |             |
|   | approval of every sharing |   | o |     |   |   |    |             |
|   | contract by the HQ        |   | v |     |   |   |    |             |
|   | sharing office, an        |   | e |     |   |   |    |             |
|   | alternative form of       |   | r |     |   |   |    |             |
|   | oversight may be employed |   | s |     |   |   |    |             |
|   | such as comparing the     |   | i |     |   |   |    |             |
|   | projected revenues and    |   | g |     |   |   |    |             |
|   | workload used to          |   | h |     |   |   |    |             |
|   | initially justify the     |   | t |     |   |   |    |             |
|   | purchase of specialized   |   | n |     |   |   |    |             |
|   | medical equipment or to   |   | e |     |   |   |    |             |
|   | justify the need for the  |   | e |     |   |   |    |             |
|   | contract with actual      |   | d |     |   |   |    |             |
|   | recoveries or workload    |   | t |     |   |   |    |             |
|   | reimbursements. The       |   | o |     |   |   |    |             |
|   | writer adds that          |   | b |     |   |   |    |             |
|   | performance against       |   | e |     |   |   |    |             |
|   | contract should provide   |   | d |     |   |   |    |             |
|   | the necessary information |   | e |     |   |   |    |             |
|   | to signal the need for    |   | c |     |   |   |    |             |
|   | more in-depth review and  |   | e |     |   |   |    |             |
|   | oversight by external     |   | n |     |   |   |    |             |
|   | organizations.            |   | t |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | z |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | V |     |   |   |    |             |
|   |                           |   | I |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
|   |                           |   | N |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Task the Director, VA/DoD | D |   | Co  |   |   |    |             |
| * | and Medical Sharing with  | U |   | mpl |   |   |    |             |
| 1 | recommending members of a | S |   | ete |   |   |    |             |
| . | multi-level (HQ, VISN,    | H |   | by  |   |   |    |             |
| 2 | VAMC) and                 |   |   | S   |   |   |    |             |
| 6 | multi-disciplinary team   |   |   | ep. |   |   |    |             |
| . | to evaluate the           |   |   | 30, |   |   |    |             |
| 2 | decentralization of       |   |   | 1   |   |   |    |             |
| * | oversight to the lowest   |   |   | 995 |   |   |    |             |
| * | organizational level      |   |   |     |   |   |    |             |
|   | possible.                 |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| R |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| - |                           |   |   |     |   |   |    |             |
| v |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| s |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Voluntary Services        |   |   |     |   |   | D/ |             |
| e | restructuring should      |   |   |     |   |   | O] |             |
| f | follow the well-defined   |   |   |     |   |   | {. |             |
| N | mission as stated in      |   |   |     |   |   | un |             |
| o | th*Vision for Change* .   |   |   |     |   |   | de |             |
| . |                           |   |   |     |   |   | rl |             |
| ] |                           |   |   |     |   |   | in |             |
| { |                           |   |   |     |   |   | e} |             |
| . |                           |   |   |     |   |   | ** |             |
| u |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| r |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 2 |                           |   |   |     |   |   |    |             |
| 7 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | None. No organizational   |   |   |     |   |   |    |             |
| * | changes recommended.      |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 2 |                           |   |   |     |   |   |    |             |
| 7 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 0 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer recommends     | * | C |     |   |   |    |             |
| * | moving this office under  | * | o |     |   |   |    |             |
| 1 | the Chief Patient Care    | A | n |     |   |   |    |             |
| . | Services Officer since    | * | s |     |   |   |    |             |
| 2 | Voluntary Service         | * | i |     |   |   |    |             |
| 7 | primarily supports VHA\'s |   | d |     |   |   |    |             |
| * | clinical Services.        |   | e |     |   |   |    |             |
| * |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
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|   |                           |   | S |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | No organizational changes | D |   | To  |   |   |    |             |
| * | recommended at this time. | U |   | be  |   |   |    |             |
| 1 | The DUSH should task the  | S |   | d   |   |   |    |             |
| . | CAO with review of the    | H |   | ete |   |   |    |             |
| 2 | organizational alignment  |   |   | rmi |   |   |    |             |
| 7 | of Voluntary Service      |   |   | ned |   |   |    |             |
| . | within the new HQ         |   |   |     |   |   |    |             |
| 1 | organization.             |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| A |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| - |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| t |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| o |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+-----+-----+---+---+----+-------------+
| * | **[Recom                  |     |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |     |     |   |   | *[ | marks-K]{.u |
| [ |                           |     |     |   |   | A/ | nderline}** |
| R | Management and            |     |     |   |   | D/ |             |
| e | Administration Support    |     |     |   |   | O] |             |
| f | Office (MASO). Create a   |     |     |   |   | {. |             |
| N | new HQ administration     |     |     |   |   | un |             |
| o | function, the Management  |     |     |   |   | de |             |
| . | and Administration        |     |     |   |   | rl |             |
| ] | Support Office (MASO),    |     |     |   |   | in |             |
| { | for overall               |     |     |   |   | e} |             |
| . | administrative support of |     |     |   |   | ** |             |
| u | the internal operation of |     |     |   |   |    |             |
| n | VHA headquarters.         |     |     |   |   |    |             |
| d |                           |     |     |   |   |    |             |
| e |                           |     |     |   |   |    |             |
| r |                           |     |     |   |   |    |             |
| l |                           |     |     |   |   |    |             |
| i |                           |     |     |   |   |    |             |
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| } |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
|   |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
| 1 |                           |     |     |   |   |    |             |
| . |                           |     |     |   |   |    |             |
| 2 |                           |     |     |   |   |    |             |
| 8 |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
+---+---------------------------+-----+-----+---+---+----+-------------+
|   | **Action Required**       | **  | **  | * |   |    |             |
|   |                           | Act | Tar | * |   |    |             |
|   |                           | ion | get | A |   |    |             |
|   |                           | Of  | Dat | c |   |    |             |
|   |                           | fic | e** | t |   |    |             |
|   |                           | e** |     | u |   |    |             |
|   |                           |     |     | a |   |    |             |
|   |                           |     |     | l |   |    |             |
|   |                           |     |     | D |   |    |             |
|   |                           |     |     | a |   |    |             |
|   |                           |     |     | t |   |    |             |
|   |                           |     |     | e |   |    |             |
|   |                           |     |     | * |   |    |             |
|   |                           |     |     | * |   |    |             |
+---+---------------------------+-----+-----+---+---+----+-------------+
| * | Realign the Health Care   | D   | O   |   |   |    |             |
| * | Staff Development and     | USH | ct. |   |   |    |             |
| 1 | Retention Office within   |     | 1,  |   |   |    |             |
| . | the current Management    |     | 1   |   |   |    |             |
| 2 | Support Office.           |     | 995 |   |   |    |             |
| 8 |                           |     |     |   |   |    |             |
| . |                           |     |     |   |   |    |             |
| 1 |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
+---+---------------------------+-----+-----+---+---+----+-------------+
| * | Task the Chief            | D   | O   |   |   |    |             |
| * | Administrative Officer to | USH | ct. |   |   |    |             |
| 1 | recommend members of a    |     | 1,  |   |   |    |             |
| . | multi                     |     | 1   |   |   |    |             |
| 2 | organization/disciplinary |     | 995 |   |   |    |             |
| 8 | team to evaluate VHA      |     |     |   |   |    |             |
| . | needs for healthcare      |     |     |   |   |    |             |
| 2 | retention and             |     |     |   |   |    |             |
| * | development, both program |     |     |   |   |    |             |
| * | staff and distributed     |     |     |   |   |    |             |
|   | FTEE for such programs.   |     |     |   |   |    |             |
+---+---------------------------+-----+-----+---+---+----+-------------+
| * | The Task Force will       | S   | N   |   |   |    |             |
| * | complete a final          | upp | ov. |   |   |    |             |
| 1 | report/recommendations    | ort | 15, |   |   |    |             |
| . | for the DUSH              | Se  | 1   |   |   |    |             |
| 2 |                           | rvi | 995 |   |   |    |             |
| 8 |                           | ce, |     |   |   |    |             |
| . |                           | Ch  |     |   |   |    |             |
| 3 |                           | ief |     |   |   |    |             |
| * |                           | Ad  |     |   |   |    |             |
| * |                           | min |     |   |   |    |             |
|   |                           | ist |     |   |   |    |             |
|   |                           | rat |     |   |   |    |             |
|   |                           | ive |     |   |   |    |             |
|   |                           | O   |     |   |   |    |             |
|   |                           | ffi |     |   |   |    |             |
|   |                           | cer |     |   |   |    |             |
+---+---------------------------+-----+-----+---+---+----+-------------+
| * | The DUSH will task the    | D   | Fi  |   |   |    |             |
| * | Chief Administrative      | USH | nal |   |   |    |             |
| 1 | Officer and the Chief     |     | Rep |   |   |    |             |
| . | Construction Management   |     | ort |   |   |    |             |
| 2 | Officer with recommending |     | NTE |   |   |    |             |
| 8 | members of a              |     | D   |   |   |    |             |
| . | multi                     |     | ec. |   |   |    |             |
| 4 | -orgnization/disciplinary |     | 1,  |   |   |    |             |
| * | team to evaluate VHA      |     | 1   |   |   |    |             |
| * | needs for a consolidated  |     | 995 |   |   |    |             |
|   | office support function.  |     |     |   |   |    |             |
|   | Realignment includes      |     |     |   |   |    |             |
|   | transfer of three staff   |     |     |   |   |    |             |
|   | from the Administrative   |     |     |   |   |    |             |
|   | Support Office located    |     |     |   |   |    |             |
|   | within the Office of the  |     |     |   |   |    |             |
|   | USH.                      |     |     |   |   |    |             |
+---+---------------------------+-----+-----+---+---+----+-------------+

  ------------ ---------------------------- ---------- --------------- ---------- ---------- ----- --------------
               **Comments**                 **A/D**    **Rationale**                               

  **1.28**     The Deputy Asst. Secretary   **D**      Functions                                   
               for Financial Management                proposed are                                
               requested clarification of              same as those                               
               the responsibility that MASO            performed in                                
               will have for VHA-wide Human            current                                     
               Resources Management (HRM)              organization.                               
               policy and procedures. It is            Additional FTE                              
               difficult to infer whether              not available                               
               the staff support to be                 to assume the                               
               provided by this office                 global range of                             
               includes policy development             functions                                   
               or other HRM functions. The             analogous to                                
               establishment of this type              the VBA                                     
               of function/liaison in VHA              approach which                              
               is consistent with VBA\'s               are suggested.                              
               approach and would                                                                  
               facilitate the internal                                                             
               coordination and                                                                    
               implementation. within VHA                                                          
               of VHA-wide personnel and                                                           
               personnel system issues.                                                            

  **1.28**     The AsCMD for Construction   **D**      As VHA                                      
               Management (CM) supports the            restructuring                               
               greater sharing of its                  evolves, the                                
               administrative support                  total number of                             
               capabilities to provide                 employees                                   
               broader support to VHA.                 needed is                                   
               However, he emphasizes that             assumed to be                               
               a consolidated HQ                       less than the                               
               administrative support                  current number                              
               function does not have merit            assigned.                                   
               when those being supported              Consolidation                               
               are located in different                of support                                  
               buildings. He adds that the             functions makes                             
               Office and Library Support              good sense in                               
               Division in CM is the single            this new                                    
               point of contact for a broad            environment and                             
               range of essential support              separate                                    
               functions that extend beyond            geographic                                  
               \'administrative support\'.             locations is                                
               This writer believes that CM            not viewed as a                             
               currently provides these                hindrance to                                
               support services to all VHA             this objective.                             
               employees in the Lafayette              The current                                 
               Building and can continue to            Management                                  
               do so in the new                        Support Office,                             
               organization.                           located in Tech                             
                                                       World, does                                 
                                                       provide support                             
                                                       to various HQ                               
                                                       offices in                                  
                                                       physically                                  
                                                       separate                                    
                                                       locations.                                  

  **1.28.1**   One writer expressed concern **D**      The report                                  
               that the location of the                clearly notes                               
               Health Care Staff                       that the focus                              
               Development & Rentention                of HSD&R was                                
               Office (HSD&R) in the                   recruitment and                             
               Management & Administration             retention, not                              
               Office (MASO) appears to be             employee                                    
               in conflict with the                    education.                                  
               location of Employee                    Thus, alignment                             
               Education to the Deputy                 with other                                  
               Under Secretary for Health.             human resources                             
               This writer notes that staff            functions and                               
               development often (usually)             expertise to                                
               means training and/or                   the MASO                                    
               education.                              appears                                     
                                                       appropriate.                                

               **Proposed Revision**        **Action                   **Target   **Actual         
                                            Office**                   Date**     Date**           

                                                                                                   
  ------------ ---------------------------- ---------- --------------- ---------- ---------- ----- --------------

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Realign the Chief of      |   |   |     |   |   | D/ |             |
| e | Staff selection process   |   |   |     |   |   | O] |             |
| f | and the credentialling of |   |   |     |   |   | {. |             |
| N | headquarters Title 38     |   |   |     |   |   | un |             |
| o | personnel from the Office |   |   |     |   |   | de |             |
| . | of the USH to the         |   |   |     |   |   | rl |             |
| ] | Management and            |   |   |     |   |   | in |             |
| { | Administrative Support    |   |   |     |   |   | e} |             |
| . | Office.                   |   |   |     |   |   | ** |             |
| u |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| r |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 2 |                           |   |   |     |   |   |    |             |
| 9 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Realign this function and | D |   | O   |   |   |    |             |
| * | reassign 2.0 FTEE         | U |   | ct. |   |   |    |             |
| 1 | formerly part of the      | S |   | 1,  |   |   |    |             |
| . | Professional Affairs      | H |   | 1   |   |   |    |             |
| 2 | Staff to MASO.            |   |   | 995 |   |   |    |             |
| 9 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One commentary strongly   | * | N |     |   |   |    |             |
| * | recommends staff with     | * | o |     |   |   |    |             |
| 1 | clinical expertise in     | D | t |     |   |   |    |             |
| . | Health Care Staff         | * | r |     |   |   |    |             |
| 2 | Development and           | * | e |     |   |   |    |             |
| 9 | Rentention Office,        |   | q |     |   |   |    |             |
| . | including at least one MD |   | u |     |   |   |    |             |
| 1 | to be responsible for COS |   | i |     |   |   |    |             |
| * | selection and             |   | r |     |   |   |    |             |
| * | credentialing and Title   |   | e |     |   |   |    |             |
|   | 38 issues.                |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | H |     |   |   |    |             |
|   |                           |   | Q |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | a |     |   |   |    |             |
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|   |                           |   | d |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Establish a A&MM Liaison  |   |   |     |   |   | D/ |             |
| e | position the SES level    |   |   |     |   |   | O] |             |
| f | and provide appropriate   |   |   |     |   |   | {. |             |
| N | staff support within the  |   |   |     |   |   | un |             |
| o | Office of the Chief       |   |   |     |   |   | de |             |
| . | Administrative Officer.   |   |   |     |   |   | rl |             |
| ] | The position needs to be  |   |   |     |   |   | in |             |
| { | at the SES level to       |   |   |     |   |   | e} |             |
| . | represent the VHA in the  |   |   |     |   |   | ** |             |
| u | most effective manner in  |   |   |     |   |   |    |             |
| n | communicating and         |   |   |     |   |   |    |             |
| d | addressing VHA issues     |   |   |     |   |   |    |             |
| e | with Department           |   |   |     |   |   |    |             |
| r | acquisition officials.    |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 3 |                           |   |   |     |   |   |    |             |
| 0 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Establish and staff the   | D |   | NTE |   |   |    |             |
| * | A&MMS liaison position as | U |   | N   |   |   |    |             |
| 1 | soon as possible.         | S |   | ov. |   |   |    |             |
| . |                           | H |   | 1,  |   |   |    |             |
| 3 |                           |   |   | 1   |   |   |    |             |
| 0 |                           |   |   | 995 |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer questioned the | * | T |     |   |   |    |             |
| * | need to establish an SES  | * | h |     |   |   |    |             |
| 1 | position in VHA for this  | D | e |     |   |   |    |             |
| . | function. Currently, the  | * | r |     |   |   |    |             |
| 3 | Office of A&MM, which     | * | e |     |   |   |    |             |
| 0 | includes the National     |   | h |     |   |   |    |             |
| * | Acquisition Ctr in Hines, |   | a |     |   |   |    |             |
| * | provides this service to  |   | s |     |   |   |    |             |
|   | VHA. Thus, the            |   | n |     |   |   |    |             |
|   | establishment of this     |   | o |     |   |   |    |             |
|   | liaison position in VHA   |   | t |     |   |   |    |             |
|   | is viewed as a            |   | b |     |   |   |    |             |
|   | duplication of functions  |   | e |     |   |   |    |             |
|   | that already exist within |   | e |     |   |   |    |             |
|   | VA.                       |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
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|   |                           |   | m |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | O&MM strongly supports    | * | C |     |   |   |    |             |
| * | establishment of this     | * | o |     |   |   |    |             |
| 1 | position under the CAO.   | A | m |     |   |   |    |             |
| . | The position will         | * | m |     |   |   |    |             |
| 3 | facilitate day-to-day     | * | e |     |   |   |    |             |
| 0 | issues, improve service   |   | n |     |   |   |    |             |
| * | delivery, and assist with |   | t |     |   |   |    |             |
| * | contemplated changes.     |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | , |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | q |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Dirctor of EMS in HQ  | * | T |     |   |   |    |             |
| * | comments that the A-76 HQ | * | h |     |   |   |    |             |
| 1 | responsibility/function   | A | e |     |   |   |    |             |
| . | (                         | * | w |     |   |   |    |             |
| 3 | policy/scheduling/appeals | * | o |     |   |   |    |             |
| 0 | process, liaison with OMB |   | r |     |   |   |    |             |
| * | and 008) was not          |   | k |     |   |   |    |             |
| * | specifically referenced   |   | g |     |   |   |    |             |
|   | within the workgroup      |   | r |     |   |   |    |             |
|   | report. He recommends     |   | o |     |   |   |    |             |
|   | that such an assignment   |   | u |     |   |   |    |             |
|   | would be appropriate for  |   | p |     |   |   |    |             |
|   | inclusion within the      |   | c |     |   |   |    |             |
|   | scope of the A&MM Liaison |   | o |     |   |   |    |             |
|   | Organization.             |   | n |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | , |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | C |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | A |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | O |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | A |     |   |   |    |             |
|   |                           |   | & |     |   |   |    |             |
|   |                           |   | M |     |   |   |    |             |
|   |                           |   | M |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
|   |                           |   | L |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Task the new A&MM Liaison |   |   |     |   |   | D/ |             |
| e | with development of a     |   |   |     |   |   | O] |             |
| f | position paper to move    |   |   |     |   |   | {. |             |
| N | the Supply, Processing    |   |   |     |   |   | un |             |
| o | and Distribution (SPD)    |   |   |     |   |   | de |             |
| . | function from the         |   |   |     |   |   | rl |             |
| ] | Department\'s Deputy      |   |   |     |   |   | in |             |
| { | Assistant Secretary for   |   |   |     |   |   | e} |             |
| . | Acquisition to VHA,       |   |   |     |   |   | ** |             |
| u | Patient Care Services,    |   |   |     |   |   |    |             |
| n | defining the HQ role, if  |   |   |     |   |   |    |             |
| d | any, and functions of     |   |   |     |   |   |    |             |
| e | such a group.             |   |   |     |   |   |    |             |
| r |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 3 |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Submit the SPD position   | A |   | D   |   |   |    |             |
| * | paper to the DUSH through | & |   | ec. |   |   |    |             |
| 1 | the Chief Administrative  | M |   | 1,  |   |   |    |             |
| . | Officer.                  | M |   | 1   |   |   |    |             |
| 3 |                           | L |   | 995 |   |   |    |             |
| 1 |                           | i |   |     |   |   |    |             |
| . |                           | a |   |     |   |   |    |             |
| 1 |                           | i |   |     |   |   |    |             |
| * |                           | s |   |     |   |   |    |             |
| * |                           | o |   |     |   |   |    |             |
|   |                           | n |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | OA&MM recommends that the | * | S |     |   |   |    |             |
| * | A&MM Liaison be tasked    | * | e |     |   |   |    |             |
| 1 | with the responsibility   | A | e |     |   |   |    |             |
| . | to write a position paper | * | r |     |   |   |    |             |
| 3 | on the appropriate        | * | e |     |   |   |    |             |
| 1 | organizational placement  |   | v |     |   |   |    |             |
| * | of the SPD Program rather |   | i |     |   |   |    |             |
| * | than in support of a      |   | s |     |   |   |    |             |
|   | predetermined outcome.    |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 3 |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Director EMS in HQ    | * | T |     |   |   |    |             |
| * | recommends the alignment  | * | h |     |   |   |    |             |
| 1 | of the SPD function       | D | e |     |   |   |    |             |
| . | within the Facilities     | * | w |     |   |   |    |             |
| 3 | Management Program (FMP)  | * | o |     |   |   |    |             |
| 1 | Office. He notes in his   |   | r |     |   |   |    |             |
| * | extensive commentary      |   | k |     |   |   |    |             |
| * | functions and an          |   | g |     |   |   |    |             |
|   | historically prospective  |   | r |     |   |   |    |             |
|   | of this program, its      |   | o |     |   |   |    |             |
|   | initial alignment with    |   | u |     |   |   |    |             |
|   | Surgical Service and its  |   | p |     |   |   |    |             |
|   | current incorporation     |   | b |     |   |   |    |             |
|   | into EMS. He emphasizes   |   | e |     |   |   |    |             |
|   | that alignment with FMP   |   | l |     |   |   |    |             |
|   | will facilitate the       |   | i |     |   |   |    |             |
|   | review of program         |   | e |     |   |   |    |             |
|   | functions to determine    |   | v |     |   |   |    |             |
|   | deletion of redundancies  |   | e |     |   |   |    |             |
|   | and appropriate           |   | s |     |   |   |    |             |
|   | centra                    |   | t |     |   |   |    |             |
|   | lization/decentralization |   | h |     |   |   |    |             |
|   | issues.                   |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
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|   |                           |   | d |     |   |   |    |             |
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|   |                           |   | r |     |   |   |    |             |
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|   |                           |   | a |     |   |   |    |             |
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|   |                           |   | i |     |   |   |    |             |
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|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | f |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The new A&MM Liaison will | A |   | D   |   |   |    |             |
| * | develop a position paper  | & |   | ec. |   |   |    |             |
| 1 | that considers the most   | M |   | 1,  |   |   |    |             |
| . | efficient and effective   | M |   | 1   |   |   |    |             |
| 3 | organiztional placement   | L |   | 995 |   |   |    |             |
| 1 | of the SPD function in    | i |   |     |   |   |    |             |
| . | the VHA organization. The | a |   |     |   |   |    |             |
| 1 | paper will be submitted   | i |   |     |   |   |    |             |
| * | through the Chief         | s |   |     |   |   |    |             |
| * | Administrative Officer to | o |   |     |   |   |    |             |
|   | the DUSH.                 | n |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| R |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| - |                           |   |   |     |   |   |    |             |
| v |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| s |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+-----+-----+---+---+----+-------------+
| * | **[Recom                  |     |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |     |     |   |   | *[ | marks-K]{.u |
| [ |                           |     |     |   |   | A/ | nderline}** |
| R | Realign Engineering       |     |     |   |   | D/ |             |
| e | Management and Field      |     |     |   |   | O] |             |
| f | Support Office (EMFSO),   |     |     |   |   | {. |             |
| N | except for Non-Recurring  |     |     |   |   | un |             |
| o | Maintenance (NRM) and     |     |     |   |   | de |             |
| . | Environmental             |     |     |   |   | rl |             |
| ] | Engineering, within the   |     |     |   |   | in |             |
| { | Office of Construction    |     |     |   |   | e} |             |
| . | Management rather than    |     |     |   |   | ** |             |
| u | with Environment          |     |     |   |   |    |             |
| n | Management Service (EMS). |     |     |   |   |    |             |
| d |                           |     |     |   |   |    |             |
| e |                           |     |     |   |   |    |             |
| r |                           |     |     |   |   |    |             |
| l |                           |     |     |   |   |    |             |
| i |                           |     |     |   |   |    |             |
| n |                           |     |     |   |   |    |             |
| e |                           |     |     |   |   |    |             |
| } |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
|   |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
| 1 |                           |     |     |   |   |    |             |
| . |                           |     |     |   |   |    |             |
| 3 |                           |     |     |   |   |    |             |
| 2 |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
+---+---------------------------+-----+-----+---+---+----+-------------+
|   | **Action Required**       | **  | **  | * |   |    |             |
|   |                           | Act | Tar | * |   |    |             |
|   |                           | ion | get | A |   |    |             |
|   |                           | Of  | Dat | c |   |    |             |
|   |                           | fic | e** | t |   |    |             |
|   |                           | e** |     | u |   |    |             |
|   |                           |     |     | a |   |    |             |
|   |                           |     |     | l |   |    |             |
|   |                           |     |     | D |   |    |             |
|   |                           |     |     | a |   |    |             |
|   |                           |     |     | t |   |    |             |
|   |                           |     |     | e |   |    |             |
|   |                           |     |     | * |   |    |             |
|   |                           |     |     | * |   |    |             |
+---+---------------------------+-----+-----+---+---+----+-------------+
| * | Move EMFSO to the Chief   | C   | O   |   |   |    |             |
| * | Construction Management   | CMO | ct. |   |   |    |             |
| 1 | Officer (CCMO)            |     | 1,  |   |   |    |             |
| . |                           |     | 1   |   |   |    |             |
| 3 |                           |     | 995 |   |   |    |             |
| 2 |                           |     |     |   |   |    |             |
| . |                           |     |     |   |   |    |             |
| 1 |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
+---+---------------------------+-----+-----+---+---+----+-------------+
| * | The CCMO will recommend   | CMO | J   |   |   |    |             |
| * | members of a task force,  |     | an. |   |   |    |             |
| 1 | including a field         |     | 12, |   |   |    |             |
| . | chairperson. This task    |     | 1   |   |   |    |             |
| 3 | force will analyze these  |     | 996 |   |   |    |             |
| 2 | EMFSO functions to        |     |     |   |   |    |             |
| . | include (a) those that    |     |     |   |   |    |             |
| 2 | should remain in          |     |     |   |   |    |             |
| * | Headquarters, (b) those   |     |     |   |   |    |             |
| * | which could be performed  |     |     |   |   |    |             |
|   | at the Support Service    |     |     |   |   |    |             |
|   | level, and (c) those that |     |     |   |   |    |             |
|   | should be eliminated.     |     |     |   |   |    |             |
|   | This report with          |     |     |   |   |    |             |
|   | recommendations,          |     |     |   |   |    |             |
|   | including FTEE deployment |     |     |   |   |    |             |
|   | should be provided to the |     |     |   |   |    |             |
|   | DUSH. The analysis should |     |     |   |   |    |             |
|   | be in the context of the  |     |     |   |   |    |             |
|   | current and future CMO    |     |     |   |   |    |             |
|   | structure. For example,   |     |     |   |   |    |             |
|   | the remaining sections of |     |     |   |   |    |             |
|   | EMFSO, to include Plant   |     |     |   |   |    |             |
|   | Technology and Safety     |     |     |   |   |    |             |
|   | Management Services, and  |     |     |   |   |    |             |
|   | Fire Protection could be  |     |     |   |   |    |             |
|   | abolished at HQ level and |     |     |   |   |    |             |
|   | functions transferred to  |     |     |   |   |    |             |
|   | the VISN Service Support  |     |     |   |   |    |             |
|   | Centers (VSSO). See also  |     |     |   |   |    |             |
|   | recommendation 1.41.2.    |     |     |   |   |    |             |
+---+---------------------------+-----+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+-----+----+-------------+
|   | **Comments**              | * | * |     |     |    |             |
|   |                           | * | * |     |     |    |             |
|   |                           | A | R |     |     |    |             |
|   |                           | / | a |     |     |    |             |
|   |                           | D | t |     |     |    |             |
|   |                           | * | i |     |     |    |             |
|   |                           | * | o |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | a |     |     |    |             |
|   |                           |   | l |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | * |     |     |    |             |
|   |                           |   | * |     |     |    |             |
+---+---------------------------+---+---+-----+-----+----+-------------+
| * | The Regional Safety       |   | T |     |     |    |             |
| * | Advisory Council (RSAC)   |   | h |     |     |    |             |
| 1 | notes that the creation   |   | e |     |     |    |             |
| . | of the Plant, Technology  |   | r |     |     |    |             |
| 3 | and Safety Management     |   | e |     |     |    |             |
| 2 | (PTSM) Service and Fire   |   | c |     |     |    |             |
| . | Protection resulted from  |   | o |     |     |    |             |
| 2 | the reorganization of the |   | m |     |     |    |             |
| * | Office of Facilities. The |   | m |     |     |    |             |
| * | RSAC expresses concern    |   | e |     |     |    |             |
|   | regarding the visibility  |   | n |     |     |    |             |
|   | of PTSM within HQ. This   |   | d |     |     |    |             |
|   | group believes that the   |   | a |     |     |    |             |
|   | suggestion to abolish     |   | t |     |     |    |             |
|   | PTSM and Fire Protection  |   | i |     |     |    |             |
|   | sections at the HQ level  |   | o |     |     |    |             |
|   | and transfer these        |   | n |     |     |    |             |
|   | functions to the VISN     |   | a |     |     |    |             |
|   | level is regressive and   |   | n |     |     |    |             |
|   | does not build upon past  |   | d |     |     |    |             |
|   | program successes. They   |   | r |     |     |    |             |
|   | also express concern that |   | e |     |     |    |             |
|   | decentralizing the Fire   |   | p |     |     |    |             |
|   | Protection Program will   |   | o |     |     |    |             |
|   | result in significant     |   | r |     |     |    |             |
|   | loss of program status    |   | t |     |     |    |             |
|   | with JCAHO. The RSAC adds |   | s |     |     |    |             |
|   | that the VA was found     |   | u |     |     |    |             |
|   | deficient in the last     |   | p |     |     |    |             |
|   | three OSHA evaluations,   |   | p |     |     |    |             |
|   | and proposed changes are  |   | o |     |     |    |             |
|   | not in compliance with EO |   | r |     |     |    |             |
|   | 12196 as well as OSHA     |   | t |     |     |    |             |
|   | Regulations.              |   | r |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | v |     |     |    |             |
|   |                           |   | i |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | w |     |     |    |             |
|   |                           |   | o |     |     |    |             |
|   |                           |   | f |     |     |    |             |
|   |                           |   | t |     |     |    |             |
|   |                           |   | h |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | s |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | f |     |     |    |             |
|   |                           |   | u |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | c |     |     |    |             |
|   |                           |   | t |     |     |    |             |
|   |                           |   | i |     |     |    |             |
|   |                           |   | o |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | s |     |     |    |             |
|   |                           |   | f |     |     |    |             |
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|   |                           |   | r |     |     |    |             |
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|   |                           |   | l |     |     |    |             |
|   |                           |   | i |     |     |    |             |
|   |                           |   | g |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | m |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | t |     |     |    |             |
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|   |                           |   | H |     |     |    |             |
|   |                           |   | A |     |     |    |             |
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|   |                           |   | . |     |     |    |             |
+---+---------------------------+---+---+-----+-----+----+-------------+
| * | One writer comments that  | * | C |     |     |    |             |
| * | Construction, Operation,  | * | o |     |     |    |             |
| 1 | Safety, and Environmental | A | m |     |     |    |             |
| . | Engineering (EPA) should  | * | m |     |     |    |             |
| 3 | be maintained as a unit   | * | e |     |     |    |             |
| 2 | to effectively support    |   | n |     |     |    |             |
| * | VAMCs and provide a       |   | t |     |     |    |             |
| * | technical resource to     |   | a |     |     |    |             |
|   | respond to Congress and   |   | r |     |     |    |             |
|   | the various regulatory    |   | y |     |     |    |             |
|   | agencies. He believes a   |   | i |     |     |    |             |
|   | national office is needed |   | s |     |     |    |             |
|   | to interpret regulations  |   | c |     |     |    |             |
|   | for the VAMCs and to      |   | o |     |     |    |             |
|   | provide consistency       |   | n |     |     |    |             |
|   | across VHA. This writer   |   | s |     |     |    |             |
|   | emphasizes that the       |   | i |     |     |    |             |
|   | division of EMFSO will    |   | s |     |     |    |             |
|   | make it difficult to      |   | t |     |     |    |             |
|   | provide field support and |   | e |     |     |    |             |
|   | not have duplicate policy |   | n |     |     |    |             |
|   | and solutions.            |   | t |     |     |    |             |
|   |                           |   | w |     |     |    |             |
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|   |                           |   | . |     |     |    |             |
+---+---------------------------+---+---+-----+-----+----+-------------+
| * | The Assistant Secretary   | * | O |     |     |    |             |
| * | for Human Resources and   | * | c |     |     |    |             |
| 1 | Administration comments   | A | c |     |     |    |             |
| . | that there is one issue   | * | u |     |     |    |             |
| 3 | which does not fit neatly | * | p |     |     |    |             |
| 2 | into any single report,   |   | a |     |     |    |             |
| * | but which merits serious  |   | t |     |     |    |             |
| * | consideration. Staff in   |   | i |     |     |    |             |
|   | the Occupational Safety   |   | o |     |     |    |             |
|   | and Health Office         |   | n |     |     |    |             |
|   | emphasize that the        |   | a |     |     |    |             |
|   | reports did not address   |   | l |     |     |    |             |
|   | ongoing safety and health |   | S |     |     |    |             |
|   | responsibililities, and   |   | a |     |     |    |             |
|   | expressed concern about   |   | f |     |     |    |             |
|   | how this program will be  |   | e |     |     |    |             |
|   | managed in the new VHA.   |   | t |     |     |    |             |
|   | He notes it is important  |   | y |     |     |    |             |
|   | to include safety and     |   | a |     |     |    |             |
|   | health roles as VHA       |   | n |     |     |    |             |
|   | continues to develop      |   | d |     |     |    |             |
|   | organizational plans.     |   | H |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | a |     |     |    |             |
|   |                           |   | l |     |     |    |             |
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|   |                           |   | a |     |     |    |             |
|   |                           |   | s |     |     |    |             |
|   |                           |   | b |     |     |    |             |
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|   |                           |   | e |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | a |     |     |    |             |
|   |                           |   | d |     |     |    |             |
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|   |                           |   | e |     |     |    |             |
|   |                           |   | s |     |     |    |             |
|   |                           |   | s |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | d |     |     |    |             |
|   |                           |   | w |     |     |    |             |
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|   |                           |   | i |     |     |    |             |
|   |                           |   | n |     |     |    |             |
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|   |                           |   | i |     |     |    |             |
|   |                           |   | s |     |     |    |             |
|   |                           |   | r |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | p |     |     |    |             |
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|   |                           |   | r |     |     |    |             |
|   |                           |   | t |     |     |    |             |
|   |                           |   | . |     |     |    |             |
+---+---------------------------+---+---+-----+-----+----+-------------+
| * | One VAMC Engineering      | * | C |     |     |    |             |
| * | Officer comments that the | * | o |     |     |    |             |
| 1 | trend at VAMCs is to      | A | m |     |     |    |             |
| . | combine services with EMS | * | m |     |     |    |             |
| 3 | and Engineering being a   | * | e |     |     |    |             |
| 2 | logical grouping. In this |   | n |     |     |    |             |
| * | respect the HQ alignment  |   | t |     |     |    |             |
| * | should reflect the field  |   | i |     |     |    |             |
|   | reality. He emphasizes    |   | s |     |     |    |             |
|   | the relocation of         |   | c |     |     |    |             |
|   | functions now provided by |   | o |     |     |    |             |
|   | the EMFSO should be made  |   | n |     |     |    |             |
|   | with input from the       |   | s |     |     |    |             |
|   | engineers (customers) at  |   | i |     |     |    |             |
|   | VHA facilities. Currently |   | s |     |     |    |             |
|   | EMFSO provides a single   |   | t |     |     |    |             |
|   | point of contact for      |   | e |     |     |    |             |
|   | resolution of issues      |   | n |     |     |    |             |
|   | which involve multiple    |   | t |     |     |    |             |
|   | disciplines, and having   |   | w |     |     |    |             |
|   | them in one location and  |   | i |     |     |    |             |
|   | talking to each other     |   | t |     |     |    |             |
|   | works well. Whether they  |   | h |     |     |    |             |
|   | are a single entity or    |   | r |     |     |    |             |
|   | part of a larger group    |   | e |     |     |    |             |
|   | does not matter. They     |   | p |     |     |    |             |
|   | should be placed such     |   | o |     |     |    |             |
|   | that their allegiance is  |   | r |     |     |    |             |
|   | to VHA, the same as the   |   | t |     |     |    |             |
|   | field staff they support. |   | . |     |     |    |             |
|   |                           |   | S |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | r |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | v |     |     |    |             |
|   |                           |   | i |     |     |    |             |
|   |                           |   | s |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | d |     |     |    |             |
|   |                           |   | r |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | c |     |     |    |             |
|   |                           |   | o |     |     |    |             |
|   |                           |   | m |     |     |    |             |
|   |                           |   | m |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | d |     |     |    |             |
|   |                           |   | a |     |     |    |             |
|   |                           |   | t |     |     |    |             |
|   |                           |   | i |     |     |    |             |
|   |                           |   | o |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | 1 |     |     |    |             |
|   |                           |   | . |     |     |    |             |
|   |                           |   | 3 |     |     |    |             |
|   |                           |   | 2 |     |     |    |             |
|   |                           |   | b |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | l |     |     |    |             |
|   |                           |   | o |     |     |    |             |
|   |                           |   | w |     |     |    |             |
|   |                           |   | r |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | g |     |     |    |             |
|   |                           |   | a |     |     |    |             |
|   |                           |   | r |     |     |    |             |
|   |                           |   | d |     |     |    |             |
|   |                           |   | i |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | g |     |     |    |             |
|   |                           |   | d |     |     |    |             |
|   |                           |   | i |     |     |    |             |
|   |                           |   | v |     |     |    |             |
|   |                           |   | i |     |     |    |             |
|   |                           |   | s |     |     |    |             |
|   |                           |   | i |     |     |    |             |
|   |                           |   | o |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | o |     |     |    |             |
|   |                           |   | f |     |     |    |             |
|   |                           |   | E |     |     |    |             |
|   |                           |   | M |     |     |    |             |
|   |                           |   | F |     |     |    |             |
|   |                           |   | S |     |     |    |             |
|   |                           |   | O |     |     |    |             |
|   |                           |   | . |     |     |    |             |
+---+---------------------------+---+---+-----+-----+----+-------------+
| * | Commentaries (3)          | * | C |     |     |    |             |
| * | recommended a critical    | * | o |     |     |    |             |
| 1 | analysis prior to any     | A | m |     |     |    |             |
| . | decisions being made      | * | m |     |     |    |             |
| 3 | regarding this            | * | e |     |     |    |             |
| 2 | realignment. One writer   |   | n |     |     |    |             |
| * | emphasized that it is     |   | t |     |     |    |             |
| * | important to validate     |   | i |     |     |    |             |
|   | whether any or all of the |   | s |     |     |    |             |
|   | function currently        |   | c |     |     |    |             |
|   | performed by EMFSO are    |   | o |     |     |    |             |
|   | needed, and if so where   |   | n |     |     |    |             |
|   | they can be best be       |   | s |     |     |    |             |
|   | aligned.                  |   | i |     |     |    |             |
|   |                           |   | s |     |     |    |             |
|   |                           |   | t |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | t |     |     |    |             |
|   |                           |   | w |     |     |    |             |
|   |                           |   | i |     |     |    |             |
|   |                           |   | t |     |     |    |             |
|   |                           |   | h |     |     |    |             |
|   |                           |   | a |     |     |    |             |
|   |                           |   | c |     |     |    |             |
|   |                           |   | t |     |     |    |             |
|   |                           |   | i |     |     |    |             |
|   |                           |   | o |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | r |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | c |     |     |    |             |
|   |                           |   | o |     |     |    |             |
|   |                           |   | m |     |     |    |             |
|   |                           |   | m |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | d |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | d |     |     |    |             |
|   |                           |   | . |     |     |    |             |
+---+---------------------------+---+---+-----+-----+----+-------------+
| * | One Engineer wrote a      | * | C |     |     |    |             |
| * | detailed commentary       | * | o |     |     |    |             |
| 1 | noting his full agreement | A | m |     |     |    |             |
| . | with the *Vision for      | * | m |     |     |    |             |
| 3 | Change* and the           | * | e |     |     |    |             |
| 2 | delegation of the         |   | n |     |     |    |             |
| * | decision making to the    |   | t |     |     |    |             |
| * | lowest possible levels to |   | i |     |     |    |             |
|   | empower talented managers |   | s |     |     |    |             |
|   | to manage the complete    |   | c |     |     |    |             |
|   | process. This writer      |   | o |     |     |    |             |
|   | provides a proposal to    |   | n |     |     |    |             |
|   | join the resources of all |   | s |     |     |    |             |
|   | facility management into  |   | i |     |     |    |             |
|   | one organization          |   | s |     |     |    |             |
|   | structure. He emphasizes  |   | t |     |     |    |             |
|   | the need to stop the turf |   | e |     |     |    |             |
|   | conscious management      |   | n |     |     |    |             |
|   | practices currently       |   | t |     |     |    |             |
|   | evident, and encourages   |   | w |     |     |    |             |
|   | that we not centralize    |   | i |     |     |    |             |
|   | the delegated             |   | t |     |     |    |             |
|   | construction or the       |   | h |     |     |    |             |
|   | environmental and         |   | r |     |     |    |             |
|   | engineering technical     |   | e |     |     |    |             |
|   | support services. He      |   | p |     |     |    |             |
|   | cautions that the         |   | o |     |     |    |             |
|   | proposed joining of OCM,  |   | r |     |     |    |             |
|   | EMFSO, and EM would only  |   | t |     |     |    |             |
|   | become operational if it  |   | o |     |     |    |             |
|   | is structured             |   | b |     |     |    |             |
|   | effectively. He closes by |   | j |     |     |    |             |
|   | encouraging that a        |   | e |     |     |    |             |
|   | structure be formed that  |   | c |     |     |    |             |
|   | fully supports the VISN   |   | t |     |     |    |             |
|   | and VAMC operational      |   | i |     |     |    |             |
|   | needs.                    |   | v |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | s |     |     |    |             |
|   |                           |   | . |     |     |    |             |
+---+---------------------------+---+---+-----+-----+----+-------------+
| * | Construction Management   |   | T |     |     |    |             |
| * | (CM) recommends that the  |   | h |     |     |    |             |
| 1 | Fire Protection portions  |   | i |     |     |    |             |
| . | (functions and staff) of  |   | s |     |     |    |             |
| 3 | the EMFSO be retained in  |   | w |     |     |    |             |
| 2 | HQ and assigned to the    |   | i |     |     |    |             |
| . | Consulting Support Office |   | l |     |     |    |             |
| 2 | within CM. CM notes that  |   | l |     |     |    |             |
| * | over 200 requests (a 15%  |   | b |     |     |    |             |
| * | increase from 1994) from  |   | e |     |     |    |             |
|   | VAMCs for assistance has  |   | a |     |     |    |             |
|   | been received since       |   | d |     |     |    |             |
|   | October 1995.             |   | d |     |     |    |             |
|   |                           |   | r |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | s |     |     |    |             |
|   |                           |   | s |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | d |     |     |    |             |
|   |                           |   | b |     |     |    |             |
|   |                           |   | y |     |     |    |             |
|   |                           |   | t |     |     |    |             |
|   |                           |   | h |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | T |     |     |    |             |
|   |                           |   | a |     |     |    |             |
|   |                           |   | s |     |     |    |             |
|   |                           |   | k |     |     |    |             |
|   |                           |   | F |     |     |    |             |
|   |                           |   | o |     |     |    |             |
|   |                           |   | r |     |     |    |             |
|   |                           |   | c |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | r |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | v |     |     |    |             |
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|   |                           |   | e |     |     |    |             |
|   |                           |   | w |     |     |    |             |
|   |                           |   | r |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | c |     |     |    |             |
|   |                           |   | o |     |     |    |             |
|   |                           |   | m |     |     |    |             |
|   |                           |   | m |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | d |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | d |     |     |    |             |
|   |                           |   | i |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | a |     |     |    |             |
|   |                           |   | c |     |     |    |             |
|   |                           |   | t |     |     |    |             |
|   |                           |   | i |     |     |    |             |
|   |                           |   | o |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | 1 |     |     |    |             |
|   |                           |   | . |     |     |    |             |
|   |                           |   | 3 |     |     |    |             |
|   |                           |   | 2 |     |     |    |             |
|   |                           |   | . |     |     |    |             |
|   |                           |   | 2 |     |     |    |             |
|   |                           |   | . |     |     |    |             |
+---+---------------------------+---+---+-----+-----+----+-------------+
| * | One writer strongly       |   | S |     |     |    |             |
| * | recommends that the VA    |   | e |     |     |    |             |
| 1 | safety and industrial     |   | e |     |     |    |             |
| . | hygiene programs          |   | r |     |     |    |             |
| 3 | functionality remain      |   | e |     |     |    |             |
| 2 | intact. Administrative    |   | v |     |     |    |             |
| . | alignment of this program |   | i |     |     |    |             |
| 2 | should be developed with  |   | s |     |     |    |             |
| * | active participation of   |   | e |     |     |    |             |
| * | the safety and industrial |   | d |     |     |    |             |
|   | hygiene staff from the    |   | r |     |     |    |             |
|   | VAMCs, Regions, and VHA   |   | e |     |     |    |             |
|   | headquarters.             |   | c |     |     |    |             |
|   |                           |   | o |     |     |    |             |
|   |                           |   | m |     |     |    |             |
|   |                           |   | m |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | d |     |     |    |             |
|   |                           |   | a |     |     |    |             |
|   |                           |   | t |     |     |    |             |
|   |                           |   | i |     |     |    |             |
|   |                           |   | o |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | 1 |     |     |    |             |
|   |                           |   | . |     |     |    |             |
|   |                           |   | 3 |     |     |    |             |
|   |                           |   | 2 |     |     |    |             |
|   |                           |   | . |     |     |    |             |
+---+---------------------------+---+---+-----+-----+----+-------------+
| * | One writer recommends     | * | S |     |     |    |             |
| * | that all safety functions | * | e |     |     |    |             |
| 1 | currently assigned to     | A | e |     |     |    |             |
| . | EMFSO remain together at  | * | r |     |     |    |             |
| 3 | VHA HQ, including the     | * | e |     |     |    |             |
| 2 | Environmental Engineering |   | v |     |     |    |             |
| . | Division. Since the       |   | i |     |     |    |             |
| 2 | overwhelming majority of  |   | s |     |     |    |             |
| * | environmental             |   | e |     |     |    |             |
| * | requirements must be      |   | d |     |     |    |             |
|   | accomplished by VAMC      |   | r |     |     |    |             |
|   | Engineering and Safety    |   | e |     |     |    |             |
|   | staff, the Environmental  |   | c |     |     |    |             |
|   | Engineering Division      |   | o |     |     |    |             |
|   | should remain with EMFSO. |   | m |     |     |    |             |
|   |                           |   | m |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | d |     |     |    |             |
|   |                           |   | a |     |     |    |             |
|   |                           |   | t |     |     |    |             |
|   |                           |   | i |     |     |    |             |
|   |                           |   | o |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | 1 |     |     |    |             |
|   |                           |   | . |     |     |    |             |
|   |                           |   | 3 |     |     |    |             |
|   |                           |   | 2 |     |     |    |             |
|   |                           |   | . |     |     |    |             |
+---+---------------------------+---+---+-----+-----+----+-------------+
| * | The Director              | * | S |     |     |    |             |
| * | Environmental Management  | * | e |     |     |    |             |
| 1 | Service (EMS) recommends  | A | e |     |     |    |             |
| . | the realignment of the    | * | r |     |     |    |             |
| 3 | remaining EMFSO function  | * | e |     |     |    |             |
| 2 | to CM to provide          |   | v |     |     |    |             |
| * | appropriate assignment of |   | i |     |     |    |             |
| * | the majority of like      |   | s |     |     |    |             |
|   | functions. The CM         |   | e |     |     |    |             |
|   | organization provides the |   | d |     |     |    |             |
|   | proper expertise to       |   | r |     |     |    |             |
|   | further develop these     |   | e |     |     |    |             |
|   | functions, with the       |   | c |     |     |    |             |
|   | exception of Plant        |   | o |     |     |    |             |
|   | Technology, Safety        |   | m |     |     |    |             |
|   | Management Operations,    |   | m |     |     |    |             |
|   | and Biomedical support    |   | e |     |     |    |             |
|   | programs. Some of these   |   | n |     |     |    |             |
|   | programs, not closely     |   | d |     |     |    |             |
|   | related to the            |   | a |     |     |    |             |
|   | construction process, are |   | t |     |     |    |             |
|   | recommended for joint     |   | i |     |     |    |             |
|   | review by the Chief       |   | o |     |     |    |             |
|   | Administration Officer    |   | n |     |     |    |             |
|   | (CAO) and Facilities      |   | 1 |     |     |    |             |
|   | Management Officer (FMO)  |   | . |     |     |    |             |
|   | to determine their proper |   | 3 |     |     |    |             |
|   | role and future           |   | 2 |     |     |    |             |
|   | assignment for completion |   | . |     |     |    |             |
|   | NTE 1/12/96. The Director |   |   |     |     |    |             |
|   | EMS notes that some of    |   |   |     |     |    |             |
|   | these programs might      |   |   |     |     |    |             |
|   | appropriately be          |   |   |     |     |    |             |
|   | reassigned to the         |   |   |     |     |    |             |
|   | Facilities Management     |   |   |     |     |    |             |
|   | Program, and remaining    |   |   |     |     |    |             |
|   | functions to either the   |   |   |     |     |    |             |
|   | FMO HQ, the field or VISN |   |   |     |     |    |             |
|   | Service Centers.          |   |   |     |     |    |             |
+---+---------------------------+---+---+-----+-----+----+-------------+
| * | One Chief Engineer noted  |   | C |     |     |    |             |
| * | that the reorganization   |   | o |     |     |    |             |
| 1 | of EMS and Engineering    |   | m |     |     |    |             |
| . | into a Facilities         |   | m |     |     |    |             |
| 3 | Management Group has      |   | e |     |     |    |             |
| 2 | merit. He emphasized that |   | n |     |     |    |             |
| * | this reorganization was   |   | t |     |     |    |             |
| * | consistent with what he   |   | a |     |     |    |             |
|   | has seen in the private   |   | r |     |     |    |             |
|   | sector. He expressed a    |   | y |     |     |    |             |
|   | concern that Engineering  |   | h |     |     |    |             |
|   | and EMS not loose their   |   | a |     |     |    |             |
|   | identities in their       |   | s |     |     |    |             |
|   | specialty areas, as each  |   | m |     |     |    |             |
|   | needed to remain experts  |   | e |     |     |    |             |
|   | for the VAMC directors.   |   | r |     |     |    |             |
|   | He also suggested that    |   | i |     |     |    |             |
|   | Police and Dietietics may |   | t |     |     |    |             |
|   | be other probable         |   | , |     |     |    |             |
|   | candidates to bring into  |   | a |     |     |    |             |
|   | this group as well, and   |   | n |     |     |    |             |
|   | noted that in the private |   | d |     |     |    |             |
|   | sector this merged        |   | o |     |     |    |             |
|   | alignment was working     |   | v |     |     |    |             |
|   | well.                     |   | e |     |     |    |             |
|   |                           |   | r |     |     |    |             |
|   |                           |   | a |     |     |    |             |
|   |                           |   | l |     |     |    |             |
|   |                           |   | l |     |     |    |             |
|   |                           |   | o |     |     |    |             |
|   |                           |   | b |     |     |    |             |
|   |                           |   | j |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | c |     |     |    |             |
|   |                           |   | t |     |     |    |             |
|   |                           |   | i |     |     |    |             |
|   |                           |   | v |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | s |     |     |    |             |
|   |                           |   | a |     |     |    |             |
|   |                           |   | r |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | c |     |     |    |             |
|   |                           |   | o |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | s |     |     |    |             |
|   |                           |   | i |     |     |    |             |
|   |                           |   | s |     |     |    |             |
|   |                           |   | t |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | t |     |     |    |             |
|   |                           |   | w |     |     |    |             |
|   |                           |   | i |     |     |    |             |
|   |                           |   | t |     |     |    |             |
|   |                           |   | h |     |     |    |             |
|   |                           |   | r |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | o |     |     |    |             |
|   |                           |   | r |     |     |    |             |
|   |                           |   | g |     |     |    |             |
|   |                           |   | a |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | i |     |     |    |             |
|   |                           |   | z |     |     |    |             |
|   |                           |   | a |     |     |    |             |
|   |                           |   | t |     |     |    |             |
|   |                           |   | i |     |     |    |             |
|   |                           |   | o |     |     |    |             |
|   |                           |   | n |     |     |    |             |
|   |                           |   | e |     |     |    |             |
|   |                           |   | f |     |     |    |             |
|   |                           |   | f |     |     |    |             |
|   |                           |   | o |     |     |    |             |
|   |                           |   | r |     |     |    |             |
|   |                           |   | t |     |     |    |             |
|   |                           |   | s |     |     |    |             |
|   |                           |   | . |     |     |    |             |
+---+---------------------------+---+---+-----+-----+----+-------------+
| * | One Chief Engineer        |   | S |     |     |    |             |
| * | emphasizes that he does   |   | e |     |     |    |             |
| 1 | not agree with the        |   | e |     |     |    |             |
| . | recommendation not to     |   | r |     |     |    |             |
| 3 | combine EMFSO and EMS. He |   | e |     |     |    |             |
| 2 | recommends strongly that  |   | v |     |     |    |             |
| * | they should be combined   |   | i |     |     |    |             |
| * | in their entirely at the  |   | s |     |     |    |             |
|   | HQ level. Breaking EMFSO  |   | e |     |     |    |             |
|   | up and moving             |   | d |     |     |    |             |
|   | responsibilities to       |   | r |     |     |    |             |
|   | different locations can   |   | e |     |     |    |             |
|   | only provide fragmented   |   | c |     |     |    |             |
|   | support for Engineering   |   | o |     |     |    |             |
|   | Services at VAMCs. Not    |   | m |     |     |    |             |
|   | consolidating will only   |   | m |     |     |    |             |
|   | make the already present  |   | e |     |     |    |             |
|   | conflict worse and create |   | n |     |     |    |             |
|   | friction between sections |   | d |     |     |    |             |
|   | for those VAMCs where EMS |   | a |     |     |    |             |
|   | and Engineering have      |   | t |     |     |    |             |
|   | consolidated. He          |   | i |     |     |    |             |
|   | emphasizes that a single  |   | o |     |     |    |             |
|   | point in HQ that can      |   | n |     |     |    |             |
|   | provide consistant        |   | 1 |     |     |    |             |
|   | guidance on shared issues |   | . |     |     |    |             |
|   | is the best way to go.    |   | 3 |     |     |    |             |
|   |                           |   | 2 |     |     |    |             |
|   |                           |   | . |     |     |    |             |
+---+---------------------------+---+---+-----+-----+----+-------------+
|   | **Proposed Revision**     | * |   | **  | **  |    |             |
|   |                           | * |   | Tar | Act |    |             |
|   |                           | A |   | get | ual |    |             |
|   |                           | c |   | Dat | Dat |    |             |
|   |                           | t |   | e** | e** |    |             |
|   |                           | i |   |     |     |    |             |
|   |                           | o |   |     |     |    |             |
|   |                           | n |   |     |     |    |             |
|   |                           | O |   |     |     |    |             |
|   |                           | f |   |     |     |    |             |
|   |                           | f |   |     |     |    |             |
|   |                           | i |   |     |     |    |             |
|   |                           | c |   |     |     |    |             |
|   |                           | e |   |     |     |    |             |
|   |                           | * |   |     |     |    |             |
|   |                           | * |   |     |     |    |             |
+---+---------------------------+---+---+-----+-----+----+-------------+
| * | Realign Engineering       |   |   |     |     |    |             |
| * | Management and Field      |   |   |     |     |    |             |
| 1 | Support Office (EMFSO),   |   |   |     |     |    |             |
| . | except for Non-Recurring  |   |   |     |     |    |             |
| 3 | Maintenance (NRM), within |   |   |     |     |    |             |
| 2 | the Office of             |   |   |     |     |    |             |
| * | Construction Management.  |   |   |     |     |    |             |
| * |                           |   |   |     |     |    |             |
|   |                           |   |   |     |     |    |             |
| * |                           |   |   |     |     |    |             |
| * |                           |   |   |     |     |    |             |
| R |                           |   |   |     |     |    |             |
| e |                           |   |   |     |     |    |             |
| - |                           |   |   |     |     |    |             |
| v |                           |   |   |     |     |    |             |
| i |                           |   |   |     |     |    |             |
| s |                           |   |   |     |     |    |             |
| e |                           |   |   |     |     |    |             |
| d |                           |   |   |     |     |    |             |
| * |                           |   |   |     |     |    |             |
| * |                           |   |   |     |     |    |             |
+---+---------------------------+---+---+-----+-----+----+-------------+
| * | The CCMO will recommend   | C |   | J   |     |    |             |
| * | members of a task force   | M |   | an. |     |    |             |
| 1 | representative of HQ and  | O |   | 12, |     |    |             |
| . | the field, including a    |   |   | 1   |     |    |             |
| 3 | field chairperson that is |   |   | 996 |     |    |             |
| 2 | a VISN or VAMC director.  |   |   |     |     |    |             |
| . | This task force will      |   |   |     |     |    |             |
| 2 | analyze these EMFSO       |   |   |     |     |    |             |
| * | functions to include (a)  |   |   |     |     |    |             |
| * | those that should remain  |   |   |     |     |    |             |
|   | in Headquarters, (b)      |   |   |     |     |    |             |
| * | those which could be      |   |   |     |     |    |             |
| * | performed at the Support  |   |   |     |     |    |             |
| R | Service level, and (c)    |   |   |     |     |    |             |
| e | those that should be      |   |   |     |     |    |             |
| - | eliminated. This report   |   |   |     |     |    |             |
| v | with recommendations,     |   |   |     |     |    |             |
| i | including FTEE deployment |   |   |     |     |    |             |
| s | should be provided to the |   |   |     |     |    |             |
| e | DUSH. The analysis should |   |   |     |     |    |             |
| d | be in the context of the  |   |   |     |     |    |             |
| * | current and future CMO    |   |   |     |     |    |             |
| * | structure. For example,   |   |   |     |     |    |             |
|   | the remaining sections of |   |   |     |     |    |             |
|   | EMFSO, to include         |   |   |     |     |    |             |
|   | Environmental Management, |   |   |     |     |    |             |
|   | Plant Technology and      |   |   |     |     |    |             |
|   | Safety Management         |   |   |     |     |    |             |
|   | Services, and Fire        |   |   |     |     |    |             |
|   | Protection could be       |   |   |     |     |    |             |
|   | reduced at HQ level and   |   |   |     |     |    |             |
|   | significant functions     |   |   |     |     |    |             |
|   | transferred to the VISN   |   |   |     |     |    |             |
|   | Service Support Centers   |   |   |     |     |    |             |
|   | (VSSO) or to VAMCs. See   |   |   |     |     |    |             |
|   | also recommendation       |   |   |     |     |    |             |
|   | 1.41.2.                   |   |   |     |     |    |             |
+---+---------------------------+---+---+-----+-----+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Relocate the NRM program  |   |   |     |   |   | D/ |             |
| e | and functions to the      |   |   |     |   |   | O] |             |
| f | VISNs to allow for less   |   |   |     |   |   | {. |             |
| N | interruption in project   |   |   |     |   |   | un |             |
| o | design, improved          |   |   |     |   |   | de |             |
| . | planning, and increased   |   |   |     |   |   | rl |             |
| ] | local accountability.     |   |   |     |   |   | in |             |
| { |                           |   |   |     |   |   | e} |             |
| . |                           |   |   |     |   |   | ** |             |
| u |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| r |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 3 |                           |   |   |     |   |   |    |             |
| 3 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Delegate the NRM program  | C |   | A   |   |   |    |             |
| * | to the VISNs.             | C |   | pr. |   |   |    |             |
| 1 |                           | M |   | 1,  |   |   |    |             |
| . |                           | O |   | 1   |   |   |    |             |
| 3 |                           |   |   | 996 |   |   |    |             |
| 3 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One Engineering Officer   | * | C |     |   |   |    |             |
| * | comments that moving the  | * | o |     |   |   |    |             |
| 1 | NRM program to the VISN   | A | m |     |   |   |    |             |
| . | level should prove        | * | m |     |   |   |    |             |
| 3 | beneficial to the VAMCs.  | * | e |     |   |   |    |             |
| 3 | He also recommends        |   | n |     |   |   |    |             |
| * | consideration of movement |   | t |     |   |   |    |             |
| * | of the Minor Construction |   | a |     |   |   |    |             |
|   | program to the VISN level |   | r |     |   |   |    |             |
|   | and not to CM.            |   | y |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer comments that  | * | C |     |   |   |    |             |
| * | the NRM program should be | * | o |     |   |   |    |             |
| 1 | consolidated with CM      | A | m |     |   |   |    |             |
| . | rather than relocating it | * | m |     |   |   |    |             |
| 3 | to the VISNs. CM will     | * | e |     |   |   |    |             |
| 3 | delegate the management   |   | n |     |   |   |    |             |
| * | of the NRM and the minor  |   | t |     |   |   |    |             |
| * | programs to the VISNs.    |   | a |     |   |   |    |             |
|   | However, some HQ          |   | r |     |   |   |    |             |
|   | oversight/roll-up         |   | y |     |   |   |    |             |
|   | functions such as budget, |   | i |     |   |   |    |             |
|   | operating plan,           |   | s |     |   |   |    |             |
|   | prioritization of project |   | c |     |   |   |    |             |
|   | categories (i.e.,         |   | o |     |   |   |    |             |
|   | asbestos abatement), are  |   | n |     |   |   |    |             |
|   | necessary for required    |   | s |     |   |   |    |             |
|   | top management and        |   | i |     |   |   |    |             |
|   | Congressional reports.    |   | s |     |   |   |    |             |
|   | These functions would     |   | t |     |   |   |    |             |
|   | best be accomplished      |   | e |     |   |   |    |             |
|   | within CM and is          |   | n |     |   |   |    |             |
|   | consistent with           |   | t |     |   |   |    |             |
|   | consolidating all         |   | w |     |   |   |    |             |
|   | construction function in  |   | i |     |   |   |    |             |
|   | one office as a single    |   | t |     |   |   |    |             |
|   | point of contact within   |   | h |     |   |   |    |             |
|   | VA.                       |   | c |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Several comments (4)      |   | C |     |   |   |    |             |
| * | received in support of    |   | o |     |   |   |    |             |
| 1 | this recommendation. One  |   | m |     |   |   |    |             |
| . | writer suggests that the  |   | m |     |   |   |    |             |
| 3 | delegation be taken       |   | e |     |   |   |    |             |
| 3 | another step by           |   | n |     |   |   |    |             |
| * | delegating operational    |   | t |     |   |   |    |             |
| * | responsibility for all    |   | a |     |   |   |    |             |
|   | construction of 25        |   | r |     |   |   |    |             |
|   | million and less (major,  |   | y |     |   |   |    |             |
|   | minor misc, and NRM) to   |   | i |     |   |   |    |             |
|   | the VISN level.           |   | s |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Relocate Environmental    |   |   |     |   |   | D/ |             |
| e | Engineering in HQ to      |   |   |     |   |   | O] |             |
| f | Environmental Management  |   |   |     |   |   | {. |             |
| N | Service (EMS).            |   |   |     |   |   | un |             |
| o |                           |   |   |     |   |   | de |             |
| . |                           |   |   |     |   |   | rl |             |
| ] |                           |   |   |     |   |   | in |             |
| { |                           |   |   |     |   |   | e} |             |
| . |                           |   |   |     |   |   | ** |             |
| u |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| r |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 3 |                           |   |   |     |   |   |    |             |
| 4 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Transfer the              | M |   | O   |   |   |    |             |
| * | Environmental Engineering | A |   | ct. |   |   |    |             |
| 1 | Unit of 3.0 FTEE to EMS.  | S |   | 1,  |   |   |    |             |
| . |                           | O |   | 1   |   |   |    |             |
| 3 |                           |   |   | 995 |   |   |    |             |
| 4 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Task the Chief            | C |   | J   |   |   |    |             |
| * | Administrative Officer    | A |   | an. |   |   |    |             |
| 1 | (CAO) with reviewing the  | O |   | 12, |   |   |    |             |
| . | appropriate functions and |   |   | 1   |   |   |    |             |
| 3 | location of EMS staff.    |   |   | 996 |   |   |    |             |
| 4 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 2 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Chief Engineers       | * | C |     |   |   |    |             |
| * | Advisory Board (CEAB)     | * | o |     |   |   |    |             |
| 1 | believes that there is    | A | n |     |   |   |    |             |
| . | not firm rationale for    | * | c |     |   |   |    |             |
| 3 | this relocation of        | * | u |     |   |   |    |             |
| 4 | Environmental             |   | r |     |   |   |    |             |
| * | Engineering, emphasizing  |   | w |     |   |   |    |             |
| * | that the professionals    |   | i |     |   |   |    |             |
|   | that reside with EMFSO do |   | t |     |   |   |    |             |
|   | not have the ability to   |   | h |     |   |   |    |             |
|   | easily interface with     |   | p |     |   |   |    |             |
|   | their peers. The          |   | r |     |   |   |    |             |
|   | commentary emphasizes     |   | o |     |   |   |    |             |
|   | that Environmental        |   | p |     |   |   |    |             |
|   | Engineering encompasses a |   | o |     |   |   |    |             |
|   | wide range of complex     |   | s |     |   |   |    |             |
|   | regulatory issues, and    |   | a |     |   |   |    |             |
|   | note that the splitting   |   | l |     |   |   |    |             |
|   | off of this function      |   | t |     |   |   |    |             |
|   | could lead to             |   | h |     |   |   |    |             |
|   | communication and         |   | a |     |   |   |    |             |
|   | compliance problems.      |   | t |     |   |   |    |             |
|   | Several comments (5)      |   | E |     |   |   |    |             |
|   | received also were not in |   | n |     |   |   |    |             |
|   | agreement with the        |   | v |     |   |   |    |             |
|   | relocation of Environment |   | i |     |   |   |    |             |
|   | Engineering.              |   | r |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | E |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | E |     |   |   |    |             |
|   |                           |   | M |     |   |   |    |             |
|   |                           |   | F |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
|   |                           |   | O |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
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|   |                           |   | 4 |     |   |   |    |             |
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|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
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|   |                           |   | c |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Regional Safety       |   | S |     |   |   |    |             |
| * | Advisory Council (RSAC)   |   | e |     |   |   |    |             |
| 1 | expressed concerns        |   | e |     |   |   |    |             |
| . | regarding relocation of   |   | r |     |   |   |    |             |
| 3 | this program to EMS. With |   | a |     |   |   |    |             |
| 4 | the exception of the      |   | t |     |   |   |    |             |
| * | hazardous materials and   |   | i |     |   |   |    |             |
| * | waste management          |   | o |     |   |   |    |             |
|   | functions, the RSAC       |   | n |     |   |   |    |             |
|   | emphasizes that these     |   | a |     |   |   |    |             |
|   | programs have little in   |   | l |     |   |   |    |             |
|   | common and express        |   | e |     |   |   |    |             |
|   | concern that the          |   | f |     |   |   |    |             |
|   | integrity established     |   | o |     |   |   |    |             |
|   | with regulatory agencies  |   | r |     |   |   |    |             |
|   | may be jeopardized. As an |   | c |     |   |   |    |             |
|   | alternative, the RSAC     |   | o |     |   |   |    |             |
|   | suggests placement under  |   | m |     |   |   |    |             |
|   | Construction Management   |   | m |     |   |   |    |             |
|   | as CM handles more        |   | e |     |   |   |    |             |
|   | diverse and complex       |   | n |     |   |   |    |             |
|   | environmental issues than |   | t |     |   |   |    |             |
|   | EMS.                      |   | a |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Director EMS supports | * | S |     |   |   |    |             |
| * | this proposal, as an      | * | e |     |   |   |    |             |
| 1 | appropriate step in the   | D | e |     |   |   |    |             |
| . | direction of creating a   | * | r |     |   |   |    |             |
| 3 | customer focused, field   | * | e |     |   |   |    |             |
| 4 | supporting, and           |   | v |     |   |   |    |             |
| . | coordinated integrated    |   | i |     |   |   |    |             |
| 1 | waste management program. |   | s |     |   |   |    |             |
| * |                           |   | e |     |   |   |    |             |
| * |                           |   | d |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 3 |     |   |   |    |             |
|   |                           |   | 4 |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | E |     |   |   |    |             |
|   |                           |   | M |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Delete Recommendation:    |   |   |     |   |   |    |             |
| * | Relocate Environmental    |   |   |     |   |   |    |             |
| 1 | Engineering in HQ to      |   |   |     |   |   |    |             |
| . | Environmental Management  |   |   |     |   |   |    |             |
| 3 | Service (EMS).            |   |   |     |   |   |    |             |
| 4 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| D |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| t |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Delete Action: Transfer   |   |   |     |   |   |    |             |
| * | the Environmental         |   |   |     |   |   |    |             |
| 1 | Engineering Unit to EMS.  |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 3 |                           |   |   |     |   |   |    |             |
| 4 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| D |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| t |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Task the Chief            | C |   | J   |   |   |    |             |
| * | Administrative Officer    | A |   | an. |   |   |    |             |
| 1 | (CAO) with performing a   | O |   | 12, |   |   |    |             |
| . | critical analysis of the  |   |   | 1   |   |   |    |             |
| 3 | appropriate functions and |   |   | 996 |   |   |    |             |
| 4 | location of EMS staff.    |   |   |     |   |   |    |             |
| . | This analysis should      |   |   |     |   |   |    |             |
| 2 | include (a) those         |   |   |     |   |   |    |             |
| * | functions that should     |   |   |     |   |   |    |             |
| * | remain in Headquarters,   |   |   |     |   |   |    |             |
|   | (b) those which could be  |   |   |     |   |   |    |             |
| * | performed at the Support  |   |   |     |   |   |    |             |
| * | Service level, and (c)    |   |   |     |   |   |    |             |
| R | those that should be      |   |   |     |   |   |    |             |
| e | eliminated.               |   |   |     |   |   |    |             |
| - |                           |   |   |     |   |   |    |             |
| v |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| s |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Review the Engineering    |   |   |     |   |   | D/ |             |
| e | Service Center (14 FTEE)  |   |   |     |   |   | O] |             |
| f | in St. Louis for          |   |   |     |   |   | {. |             |
| N | continued need whether in |   |   |     |   |   | un |             |
| o | total or in part.         |   |   |     |   |   | de |             |
| . |                           |   |   |     |   |   | rl |             |
| ] |                           |   |   |     |   |   | in |             |
| { |                           |   |   |     |   |   | e} |             |
| . |                           |   |   |     |   |   | ** |             |
| u |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| r |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 3 |                           |   |   |     |   |   |    |             |
| 5 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Chief Construction    | C |   | O   |   |   |    |             |
| * | Management Officer (CCMO) | C |   | ct. |   |   |    |             |
| 1 | will recommend members of | M |   | 1,  |   |   |    |             |
| . | a task group, including a | O |   | 1   |   |   |    |             |
| 3 | field chairperson, to     |   |   | 995 |   |   |    |             |
| 5 | perform a critical        |   |   |     |   |   |    |             |
| . | analysis of the           |   |   |     |   |   |    |             |
| 1 | Engineering Service       |   |   |     |   |   |    |             |
| * | Center in St. Louis. (See |   |   |     |   |   |    |             |
| * | also recommendation       |   |   |     |   |   |    |             |
|   | 1.40.2.c.)                |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The task group report     | C |   | J   |   |   |    |             |
| * | with recommendations will | C |   | an. |   |   |    |             |
| 1 | be provided through the   | M |   | 12, |   |   |    |             |
| . | CCMO to the DUSH.         | O |   | 1   |   |   |    |             |
| 3 |                           |   |   | 995 |   |   |    |             |
| 5 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 2 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Chiefs Engineering    | * | S |     |   |   |    |             |
| * | Advisory Board (CEAB)     | * | e |     |   |   |    |             |
| 1 | emphasizes the productive | A | e |     |   |   |    |             |
| . | and cost effective        | * | r |     |   |   |    |             |
| 3 | operation of the          | * | e |     |   |   |    |             |
| 5 | Engineering Service Ctr.  |   | v |     |   |   |    |             |
| * | The commentary            |   | i |     |   |   |    |             |
| * | acknowledges that a       |   | s |     |   |   |    |             |
|   | review may be required,   |   | i |     |   |   |    |             |
|   | and supports continued    |   | o |     |   |   |    |             |
|   | operation of the center   |   | n |     |   |   |    |             |
|   | citing many reasons. The  |   | o |     |   |   |    |             |
|   | CEAB and requests         |   | f |     |   |   |    |             |
|   | representation on the     |   | r |     |   |   |    |             |
|   | task group selected to do |   | e |     |   |   |    |             |
|   | this review. Other        |   | c |     |   |   |    |             |
|   | comments (4) received     |   | o |     |   |   |    |             |
|   | from Engineer Officers at |   | m |     |   |   |    |             |
|   | various VAMCs request     |   | m |     |   |   |    |             |
|   | representation in any     |   | e |     |   |   |    |             |
|   | deliberative process or   |   | n |     |   |   |    |             |
|   | task force reviewing this |   | d |     |   |   |    |             |
|   | issue.                    |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 3 |     |   |   |    |             |
|   |                           |   | 5 |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 3 |     |   |   |    |             |
|   |                           |   | 5 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 3 |     |   |   |    |             |
|   |                           |   | 5 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 2 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Director of the VA    | * | S |     |   |   |    |             |
| * | National Engineering      | * | e |     |   |   |    |             |
| 1 | Service Center (NESC) at  | A | e |     |   |   |    |             |
| . | St. Louis recommends      | * | r |     |   |   |    |             |
| 3 | deletion of this action   | * | e |     |   |   |    |             |
| 5 | item. He cites that the   |   | v |     |   |   |    |             |
| . | Deputy Under Secretary    |   | i |     |   |   |    |             |
| 1 | for Health for            |   | s |     |   |   |    |             |
| * | Administration and        |   | i |     |   |   |    |             |
| * | Operations ordered an     |   | o |     |   |   |    |             |
|   | onsite critical review in |   | n |     |   |   |    |             |
|   | 3/93. Reviews were        |   | o |     |   |   |    |             |
|   | completed in 4/93, 8/94,  |   | f |     |   |   |    |             |
|   | and again by the Board of |   | r |     |   |   |    |             |
|   | Directors in 4/95. It is  |   | e |     |   |   |    |             |
|   | recommended that HQ       |   | c |     |   |   |    |             |
|   | formalize the reporting   |   | o |     |   |   |    |             |
|   | process of this Board and |   | m |     |   |   |    |             |
|   | solicit the Board\'s      |   | m |     |   |   |    |             |
|   | advice and                |   | e |     |   |   |    |             |
|   | recommendations when      |   | n |     |   |   |    |             |
|   | making decision regarding |   | d |     |   |   |    |             |
|   | the Center. Comments      |   | a |     |   |   |    |             |
|   | provided by the Regional  |   | t |     |   |   |    |             |
|   | Safety Advisory Council   |   | i |     |   |   |    |             |
|   | also noted existence of   |   | o |     |   |   |    |             |
|   | the Board and completion  |   | n |     |   |   |    |             |
|   | of a critical review      |   | 1 |     |   |   |    |             |
|   | approximately two years   |   | . |     |   |   |    |             |
|   | ago.                      |   | 3 |     |   |   |    |             |
|   |                           |   | 5 |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 3 |     |   |   |    |             |
|   |                           |   | 5 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 3 |     |   |   |    |             |
|   |                           |   | 5 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 2 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Several Chief Engineers   | * | S |     |   |   |    |             |
| * | (3) comment on the cost   | * | e |     |   |   |    |             |
| 1 | effective service         | A | e |     |   |   |    |             |
| . | received in the past that | * | r |     |   |   |    |             |
| 3 | has made the Biomedical   | * | e |     |   |   |    |             |
| 5 | Programs so successful.   |   | v |     |   |   |    |             |
| * | They encourage the        |   | i |     |   |   |    |             |
| * | continuation of this      |   | s |     |   |   |    |             |
|   | function regardless of    |   | i |     |   |   |    |             |
|   | where the Engineering     |   | o |     |   |   |    |             |
|   | Service Center is         |   | n |     |   |   |    |             |
|   | positioned in the         |   | o |     |   |   |    |             |
|   | organization.             |   | f |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 3 |     |   |   |    |             |
|   |                           |   | 5 |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 3 |     |   |   |    |             |
|   |                           |   | 5 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | 1 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 3 |     |   |   |    |             |
|   |                           |   | 5 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | 2 |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Review the Engineering    | D |   | To  |   |   |    |             |
| * | Service Center (14 FTEE)  | U |   | be  |   |   |    |             |
| 1 | in St. Louis for          | S |   | d   |   |   |    |             |
| . | continued need whether in | H |   | ete |   |   |    |             |
| 3 | total or in part. This    |   |   | rmi |   |   |    |             |
| 5 | review should be made as  |   |   | ned |   |   |    |             |
| * | part of other reviews of  |   |   |     |   |   |    |             |
| * | out-placed Headquarters   |   |   |     |   |   |    |             |
|   | programs (i.e. Ôoff the   |   |   |     |   |   |    |             |
| * | topÕ programs).           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| R |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| - |                           |   |   |     |   |   |    |             |
| v |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| s |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Delete Action: The Chief  |   |   |     |   |   |    |             |
| * | Construction Management   |   |   |     |   |   |    |             |
| 1 | Officer will recommend    |   |   |     |   |   |    |             |
| . | members of a task group,  |   |   |     |   |   |    |             |
| 3 | including a field         |   |   |     |   |   |    |             |
| 5 | chairperson, to perform a |   |   |     |   |   |    |             |
| . | critical analysis of the  |   |   |     |   |   |    |             |
| 1 | Engineering Service       |   |   |     |   |   |    |             |
| * | Center in St. Louis.      |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| D |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| t |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Delete Action: The task   |   |   |     |   |   |    |             |
| * | group with recommendation |   |   |     |   |   |    |             |
| 1 | will be provided through  |   |   |     |   |   |    |             |
| . | the CCMO to the DUSH.     |   |   |     |   |   |    |             |
| 3 |                           |   |   |     |   |   |    |             |
| 5 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 2 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| D |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| t |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Organizationally realign  |   |   |     |   |   | D/ |             |
| e | the Engineering Training  |   |   |     |   |   | O] |             |
| f | Center (15.5 FTEE) in     |   |   |     |   |   | {. |             |
| N | Little Rock to the Office |   |   |     |   |   | un |             |
| o | of Employee Education and |   |   |     |   |   | de |             |
| . | Training in VHA.          |   |   |     |   |   | rl |             |
| ] |                           |   |   |     |   |   | in |             |
| { |                           |   |   |     |   |   | e} |             |
| . |                           |   |   |     |   |   | ** |             |
| u |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| r |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 3 |                           |   |   |     |   |   |    |             |
| 6 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **R**ealign the           | O |   | O   |   |   |    |             |
| * | Engineering Training      | f |   | ct. |   |   |    |             |
| 1 | Center (15.5 FTEE) to the | f |   | 1,  |   |   |    |             |
| . | newly created Office of   | i |   | 1   |   |   |    |             |
| 3 | Employee Education and    | c |   | 995 |   |   |    |             |
| 6 | Training aligned under    | e |   |     |   |   |    |             |
| . | the DUSH.                 | o |   |     |   |   |    |             |
| 1 |                           | f |   |     |   |   |    |             |
| * |                           | E |   |     |   |   |    |             |
| * |                           | m |   |     |   |   |    |             |
|   |                           | p |   |     |   |   |    |             |
|   |                           | l |   |     |   |   |    |             |
|   |                           | o |   |     |   |   |    |             |
|   |                           | y |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | E |   |     |   |   |    |             |
|   |                           | d |   |     |   |   |    |             |
|   |                           | u |   |     |   |   |    |             |
|   |                           | c |   |     |   |   |    |             |
|   |                           | a |   |     |   |   |    |             |
|   |                           | t |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | o |   |     |   |   |    |             |
|   |                           | n |   |     |   |   |    |             |
|   |                           | a |   |     |   |   |    |             |
|   |                           | n |   |     |   |   |    |             |
|   |                           | d |   |     |   |   |    |             |
|   |                           | T |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | a |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | n |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | n |   |     |   |   |    |             |
|   |                           | g |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Chief Engineers       | * | T |     |   |   |    |             |
| * | Advisory Board (CEAB )    | * | h |     |   |   |    |             |
| 1 | believes that this        | D | i |     |   |   |    |             |
| . | organizational            | * | s |     |   |   |    |             |
| 3 | realignment does not      | * | f |     |   |   |    |             |
| 6 | support the increasing    |   | u |     |   |   |    |             |
| * | needs to provide          |   | n |     |   |   |    |             |
| * | technical and targeted    |   | c |     |   |   |    |             |
|   | training to employees.    |   | t |     |   |   |    |             |
|   | The CEAB feels that this  |   | i |     |   |   |    |             |
|   | function should remain    |   | o |     |   |   |    |             |
|   | with EMFSO, even if it is |   | n |     |   |   |    |             |
|   | moved to CMO as this      |   | w |     |   |   |    |             |
|   | group also uses the ETC   |   | i |     |   |   |    |             |
|   | for training activities.  |   | l |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | z |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | O |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | E |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | E |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Director Education &  | * | C |     |   |   |    |             |
| * | Trng Ctr for Engineering  | * | o |     |   |   |    |             |
| 1 | & Construction Mgt        | A | n |     |   |   |    |             |
| . | comments that             | * | s |     |   |   |    |             |
| 3 | organizationally aligning | * | i |     |   |   |    |             |
| 6 | the Engineering Center to |   | s |     |   |   |    |             |
| * | the Office of Employee    |   | t |     |   |   |    |             |
| * | Education makes sense if  |   | e |     |   |   |    |             |
|   | all VHA training          |   | n |     |   |   |    |             |
|   | functions are assigned to |   | t |     |   |   |    |             |
|   | this office to facilitate |   | w |     |   |   |    |             |
|   | the efficient             |   | i |     |   |   |    |             |
|   | coordination of           |   | t |     |   |   |    |             |
|   | resources. He emphasizes  |   | h |     |   |   |    |             |
|   | that the function of the  |   | r |     |   |   |    |             |
|   | Engineering Center should |   | e |     |   |   |    |             |
|   | be maintained to use the  |   | p |     |   |   |    |             |
|   | existing staff and        |   | o |     |   |   |    |             |
|   | resources developed. Much |   | r |     |   |   |    |             |
|   | training delivered by the |   | t |     |   |   |    |             |
|   | Center is not available   |   | o |     |   |   |    |             |
|   | otherwise, especially in  |   | b |     |   |   |    |             |
|   | the cost effective modes  |   | j |     |   |   |    |             |
|   | utilized.                 |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Several comments from     | * | F |     |   |   |    |             |
| * | VAMC Engineers (5) noted  | * | u |     |   |   |    |             |
| 1 | the outstanding           | D | n |     |   |   |    |             |
| . | performance of this       | * | c |     |   |   |    |             |
| 3 | organization, and         | * | t |     |   |   |    |             |
| 6 | expressed concern about   |   | i |     |   |   |    |             |
| * | attention being lost to   |   | o |     |   |   |    |             |
| * | Engineers if this         |   | n |     |   |   |    |             |
|   | organization is aligned   |   | w |     |   |   |    |             |
|   | under the Chief Employee  |   | i |     |   |   |    |             |
|   | Education Officer.        |   | l |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Create a new organization |   |   |     |   |   | D/ |             |
| e | unit called Health        |   |   |     |   |   | O] |             |
| f | Administration Service    |   |   |     |   |   | {. |             |
| N | (HAS) comprised of:       |   |   |     |   |   | un |             |
| o |                           |   |   |     |   |   | de |             |
| . | \(1\) the former VACO     |   |   |     |   |   | rl |             |
| ] | Medical Administration    |   |   |     |   |   | in |             |
| { | Service, (2) the Health   |   |   |     |   |   | e} |             |
| . | Eligibility Center to     |   |   |     |   |   | ** |             |
| u | include the current       |   |   |     |   |   |    |             |
| n | Income Verification       |   |   |     |   |   |    |             |
| d | Matching (IVM) Center,    |   |   |     |   |   |    |             |
| e | Atlanta, GA, and the (3)  |   |   |     |   |   |    |             |
| r | The Health Administration |   |   |     |   |   |    |             |
| l | Center, Denver, CO.       |   |   |     |   |   |    |             |
| i | (CHAMPVA)                 |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 3 |                           |   |   |     |   |   |    |             |
| 7 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Establish the             | C |   | On  |   |   |    |             |
| * | sub-organizational unit,  | h |   | or  |   |   |    |             |
| 1 | Health Administration     | i |   | ab  |   |   |    |             |
| . | Service (HAS)             | e |   | out |   |   |    |             |
| 3 |                           | f |   | O   |   |   |    |             |
| 7 |                           | A |   | ct. |   |   |    |             |
| . |                           | d |   | 1,  |   |   |    |             |
| 1 |                           | m |   | 1   |   |   |    |             |
| * |                           | i |   | 995 |   |   |    |             |
| * |                           | n |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | - |   |     |   |   |    |             |
|   |                           | s |   |     |   |   |    |             |
|   |                           | t |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | a |   |     |   |   |    |             |
|   |                           | t |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | v |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | O |   |     |   |   |    |             |
|   |                           | f |   |     |   |   |    |             |
|   |                           | f |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | c |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | ( |   |     |   |   |    |             |
|   |                           | C |   |     |   |   |    |             |
|   |                           | A |   |     |   |   |    |             |
|   |                           | O |   |     |   |   |    |             |
|   |                           | ) |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Task the CAO with         |   |   |     |   |   | D/ |             |
| e | convening a task force to |   |   |     |   |   | O] |             |
| f | review current staffing   |   |   |     |   |   | {. |             |
| N | and function in each of   |   |   |     |   |   | un |             |
| o | the sub-organizational    |   |   |     |   |   | de |             |
| . | elements of the HAS for   |   |   |     |   |   | rl |             |
| ] | retention, shift to       |   |   |     |   |   | in |             |
| { | Service Support Center or |   |   |     |   |   | e} |             |
| . | deletion.                 |   |   |     |   |   | ** |             |
| u |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| r |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 3 |                           |   |   |     |   |   |    |             |
| 8 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The CAO will convene a    | C |   | J   |   |   |    |             |
| * | task force to conduct a   | A |   | an. |   |   |    |             |
| 1 | thorough analysis of      | O |   | 12, |   |   |    |             |
| . | current staffing and      |   |   | 1   |   |   |    |             |
| 3 | functions of MAS, Health  |   |   | 996 |   |   |    |             |
| 8 | Eligibility Center, and   |   |   |     |   |   |    |             |
| . | Health Administration     |   |   |     |   |   |    |             |
| 1 | Center. The report, for   |   |   |     |   |   |    |             |
| * | submission to the DUSH,   |   |   |     |   |   |    |             |
| * | should consider reduction |   |   |     |   |   |    |             |
|   | of supervisory levels,    |   |   |     |   |   |    |             |
|   | consolidation of          |   |   |     |   |   |    |             |
|   | functions where           |   |   |     |   |   |    |             |
|   | appropriate, elimination  |   |   |     |   |   |    |             |
|   | of functions no longer    |   |   |     |   |   |    |             |
|   | necessary and             |   |   |     |   |   |    |             |
|   | consideration of the role |   |   |     |   |   |    |             |
|   | of the Support Service    |   |   |     |   |   |    |             |
|   | Center. Task Force        |   |   |     |   |   |    |             |
|   | membership should include |   |   |     |   |   |    |             |
|   | \"unbiased third          |   |   |     |   |   |    |             |
|   | parties\".                |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Implement recommendations | C |   | D   |   |   |    |             |
| * | of the Task Force that    | A |   | ec. |   |   |    |             |
| 1 | have been approved by the | O |   | 31, |   |   |    |             |
| . | DUSH to streamline the    |   |   | 1   |   |   |    |             |
| 3 | new HAS organization.     |   |   | 996 |   |   |    |             |
| 8 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 2 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer notes that the |   | C |     |   |   |    |             |
| * | creation of the Health    |   | o |     |   |   |    |             |
| 1 | Administration Service    |   | m |     |   |   |    |             |
| . | and its proposed          |   | m |     |   |   |    |             |
| 3 | consolidation implies a   |   | e |     |   |   |    |             |
| 8 | reduction in HQ of the    |   | n |     |   |   |    |             |
| * | present Medical           |   | t |     |   |   |    |             |
| * | Administration Service HQ |   | a |     |   |   |    |             |
|   | staff. The writer asks    |   | r |     |   |   |    |             |
|   | what are the proposed     |   | y |     |   |   |    |             |
|   | staff savings involved    |   | i |     |   |   |    |             |
|   | with this consolidation?  |   | s |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | b |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | C |     |   |   |    |             |
|   |                           |   | A |     |   |   |    |             |
|   |                           |   | O |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Centralize fee-basis      |   |   |     |   |   | D/ |             |
| e | claims processing to the  |   |   |     |   |   | O] |             |
| f | CHAMPVA Center in Denver, |   |   |     |   |   | {. |             |
| N | CO                        |   |   |     |   |   | un |             |
| o |                           |   |   |     |   |   | de |             |
| . |                           |   |   |     |   |   | rl |             |
| ] |                           |   |   |     |   |   | in |             |
| { |                           |   |   |     |   |   | e} |             |
| . |                           |   |   |     |   |   | ** |             |
| u |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| r |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 3 |                           |   |   |     |   |   |    |             |
| 9 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The CAO will convene a    | C |   | O   |   |   |    |             |
| * | task force to include     | A |   | ct. |   |   |    |             |
| 1 | CHAMPVA Officials and     | O |   | 1,  |   |   |    |             |
| . | staff from field          |   |   | 1   |   |   |    |             |
| 3 | facilities to determine   |   |   | 995 |   |   |    |             |
| 9 | the number of FTEE needed |   |   |     |   |   |    |             |
| . | in Denver to accomplish   |   |   |     |   |   |    |             |
| 1 | centralized claims        |   |   |     |   |   |    |             |
| * | processing and identify   |   |   |     |   |   |    |             |
| * | the number of FTEE        |   |   |     |   |   |    |             |
|   | currently performing this |   |   |     |   |   |    |             |
|   | function across the       |   |   |     |   |   |    |             |
|   | system.                   |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Task Force will       | C |   | D   |   |   |    |             |
| * | complete their report for | A |   | ec. |   |   |    |             |
| 1 | submission to the DUSH.   | O |   | 31, |   |   |    |             |
| . | The report will include   |   |   | 1   |   |   |    |             |
| 3 | staffing and FTEE         |   |   | 995 |   |   |    |             |
| 9 | available for             |   |   |     |   |   |    |             |
| . | redeployment.             |   |   |     |   |   |    |             |
| 2 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Deputy Asst Secretary | * | N |     |   |   |    |             |
| * | for Financial Mgt.        | * | o |     |   |   |    |             |
| 1 | questioned the            | D | t |     |   |   |    |             |
| . | feasibility or need to    | * | e |     |   |   |    |             |
| 3 | centralize Fee Basis      | * | d |     |   |   |    |             |
| 9 | payments with CHAMPVA     |   | , |     |   |   |    |             |
| * | since a large portion of  |   | a |     |   |   |    |             |
| * | these payment will, as of |   | n |     |   |   |    |             |
|   | January 1, 1996, be made  |   | d |     |   |   |    |             |
|   | out of PAID. This arises  |   | c |     |   |   |    |             |
|   | from an agreement VA made |   | a |     |   |   |    |             |
|   | with the IRS in order to  |   | n |     |   |   |    |             |
|   | comply with federal tax   |   | b |     |   |   |    |             |
|   | withholding and reporting |   | e |     |   |   |    |             |
|   | requirements. Further,    |   | c |     |   |   |    |             |
|   | Financial Management      |   | o |     |   |   |    |             |
|   | believes that the VAMCs   |   | n |     |   |   |    |             |
|   | should retain             |   | s |     |   |   |    |             |
|   | accountability for Fee    |   | i |     |   |   |    |             |
|   | Basis claims since they   |   | d |     |   |   |    |             |
|   | are responsible for       |   | e |     |   |   |    |             |
|   | appointments, assigning   |   | r |     |   |   |    |             |
|   | work, scheduling          |   | e |     |   |   |    |             |
|   | appointments, and         |   | d |     |   |   |    |             |
|   | ensuring proper payment.  |   | a |     |   |   |    |             |
|   | It is recommended that    |   | s |     |   |   |    |             |
|   | further review be         |   | p |     |   |   |    |             |
|   | accomplished before       |   | a |     |   |   |    |             |
|   | settling on this approach |   | r |     |   |   |    |             |
|   | to centralize.            |   | t |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One VAMC Director concurs | * | C |     |   |   |    |             |
| * | with centralized          | * | o |     |   |   |    |             |
| 1 | processing of fee basis   | A | m |     |   |   |    |             |
| . | payments, but recommends  | * | m |     |   |   |    |             |
| 3 | that the management of    | * | e |     |   |   |    |             |
| 9 | fee basis funds remain at |   | n |     |   |   |    |             |
| * | the VISN level to create  |   | t |     |   |   |    |             |
| * | incentives for cost       |   | a |     |   |   |    |             |
|   | efficiency. He emphasizes |   | r |     |   |   |    |             |
|   | that the avoidance of     |   | y |     |   |   |    |             |
|   | interest payments should  |   | c |     |   |   |    |             |
|   | be a priority for the new |   | o |     |   |   |    |             |
|   | Health Administration     |   | n |     |   |   |    |             |
|   | Center in Denver.         |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One VAMC Director         | * | C |     |   |   |    |             |
| * | recommends that steps be  | * | o |     |   |   |    |             |
| 1 | taken to assure that a    | A | m |     |   |   |    |             |
| . | centralized fee basis     | * | m |     |   |   |    |             |
| 3 | claim processing center   | * | e |     |   |   |    |             |
| 9 | can process claims in a   |   | n |     |   |   |    |             |
| * | timely manner.            |   | t |     |   |   |    |             |
| * |                           |   | a |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | p |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One commentary notes that | * | C |     |   |   |    |             |
| * | this recommendation to    | * | o |     |   |   |    |             |
| 1 | have fee basis payments   | A | m |     |   |   |    |             |
| . | performed by CHAMPVA is   | * | m |     |   |   |    |             |
| 3 | similar to the modified   | * | e |     |   |   |    |             |
| 9 | CALM proposal that was    |   | n |     |   |   |    |             |
| * | tried and failed. The     |   | t |     |   |   |    |             |
| * | writer emphasizes that    |   | a |     |   |   |    |             |
|   | the decision was not made |   | r |     |   |   |    |             |
|   | by contacting staff in    |   | y |     |   |   |    |             |
|   | the field or ISC          |   | c |     |   |   |    |             |
|   | representatives. The      |   | o |     |   |   |    |             |
|   | writer expresses concern  |   | n |     |   |   |    |             |
|   | that at face value this   |   | s |     |   |   |    |             |
|   | seems to cost VHA more,   |   | i |     |   |   |    |             |
|   | as modifications will     |   | s |     |   |   |    |             |
|   | need to be made in the    |   | t |     |   |   |    |             |
|   | Fee Basis DHCP package in |   | e |     |   |   |    |             |
|   | order to pass information |   | n |     |   |   |    |             |
|   | to CHAMPVA and to         |   | t |     |   |   |    |             |
|   | retrieve information to   |   | w |     |   |   |    |             |
|   | update the DHCP database. |   | i |     |   |   |    |             |
|   | The proposal may also     |   | t |     |   |   |    |             |
|   | appear to be cheaper to   |   | h |     |   |   |    |             |
|   | decentralize all of fee,  |   | r |     |   |   |    |             |
|   | make any one-time         |   | e |     |   |   |    |             |
|   | improvements in the       |   | p |     |   |   |    |             |
|   | payment process at the    |   | o |     |   |   |    |             |
|   | field level, and          |   | r |     |   |   |    |             |
|   | eliminate positions. The  |   | t |     |   |   |    |             |
|   | writer strongly           |   | r |     |   |   |    |             |
|   | recommends that an        |   | e |     |   |   |    |             |
|   | impartial cost-benefit    |   | c |     |   |   |    |             |
|   | analysis be performed.    |   | o |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One comment emphasizes    | * |   |     |   |   |    |             |
| * | that with the move to     | * |   |     |   |   |    |             |
| 1 | primary care and          | D |   |     |   |   |    |             |
| . | increased access points,  | * |   |     |   |   |    |             |
| 3 | reliance on fee basis     | * |   |     |   |   |    |             |
| 9 | programs should be        |   |   |     |   |   |    |             |
| * | reduced. The writer       |   |   |     |   |   |    |             |
| * | challenges the            |   |   |     |   |   |    |             |
|   | recommendation noting,    |   |   |     |   |   |    |             |
|   | \"If fee care is          |   |   |     |   |   |    |             |
|   | centralized to anything   |   |   |     |   |   |    |             |
|   | greater than the VISN     |   |   |     |   |   |    |             |
|   | level, then a facility    |   |   |     |   |   |    |             |
|   | director would be foolish |   |   |     |   |   |    |             |
|   | to do anything but        |   |   |     |   |   |    |             |
|   | authorize fee care for    |   |   |     |   |   |    |             |
|   | veterans who require the  |   |   |     |   |   |    |             |
|   | most cost intensive care  |   |   |     |   |   |    |             |
|   | as it would not affect    |   |   |     |   |   |    |             |
|   | that VAMCs dollars and    |   |   |     |   |   |    |             |
|   | would be paid from a      |   |   |     |   |   |    |             |
|   | centralized fund control  |   |   |     |   |   |    |             |
|   | point. With               |   |   |     |   |   |    |             |
|   | decentralization, there   |   |   |     |   |   |    |             |
|   | comes accountability      |   |   |     |   |   |    |             |
|   | including fiscal          |   |   |     |   |   |    |             |
|   | accountability. Each VAMC |   |   |     |   |   |    |             |
|   | and VISN director should  |   |   |     |   |   |    |             |
|   | determine the most cost   |   |   |     |   |   |    |             |
|   | effective avenue of       |   |   |     |   |   |    |             |
|   | ensuring care. The        |   |   |     |   |   |    |             |
|   | clause, geographically    |   |   |     |   |   |    |             |
|   | inaccessible, that is the |   |   |     |   |   |    |             |
|   | prime consideration for   |   |   |     |   |   |    |             |
|   | fee care will be          |   |   |     |   |   |    |             |
|   | significantly impacted by |   |   |     |   |   |    |             |
|   | future VHA changes.\" The |   |   |     |   |   |    |             |
|   | writer recommends not to  |   |   |     |   |   |    |             |
|   | centralize the fee basis  |   |   |     |   |   |    |             |
|   | program.                  |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One writer emphasizes a   |   | C |     |   |   |    |             |
| * | correction to the         |   | o |     |   |   |    |             |
| O | information stated in the |   | m |     |   |   |    |             |
| t | \'Assumptions\' for this  |   | m |     |   |   |    |             |
| h | section. The writer notes |   | e |     |   |   |    |             |
| e | that \'Hospital-based     |   | n |     |   |   |    |             |
| r | Home Care\' is misnamed   |   | t |     |   |   |    |             |
| * | Home-based Hospital Care  |   | a |     |   |   |    |             |
| * | in the workgroup          |   | r |     |   |   |    |             |
|   | document. Also, the       |   | y |     |   |   |    |             |
|   | writer emphasizes that    |   | u |     |   |   |    |             |
|   | Hospital-based Home Care  |   | n |     |   |   |    |             |
|   | is not a fee-basis        |   | c |     |   |   |    |             |
|   | program and should not be |   | l |     |   |   |    |             |
|   | referenced as such. The   |   | e |     |   |   |    |             |
|   | commentary clarifies that |   | a |     |   |   |    |             |
|   | \'Hospital-based Home     |   | r |     |   |   |    |             |
|   | Care is designated as a   |   | . |     |   |   |    |             |
|   | Special Program under PCS |   |   |     |   |   |    |             |
|   | and provides primary care |   |   |     |   |   |    |             |
|   | through an                |   |   |     |   |   |    |             |
|   | interdisciplinary team of |   |   |     |   |   |    |             |
|   | VA staff.\'               |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Transfer needed FTEE from |   |   |     |   |   | D/ |             |
| e | the VAMCs to the CHAMPVA  |   |   |     |   |   | O] |             |
| f | Center and return         |   |   |     |   |   | {. |             |
| N | remainder of the FTEE to  |   |   |     |   |   | un |             |
| o | the VISN directors for    |   |   |     |   |   | de |             |
| . | redeployment.             |   |   |     |   |   | rl |             |
| ] |                           |   |   |     |   |   | in |             |
| { |                           |   |   |     |   |   | e} |             |
| . |                           |   |   |     |   |   | ** |             |
| u |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| r |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 4 |                           |   |   |     |   |   |    |             |
| 0 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Redeploy staff in order   | C |   | J   |   |   |    |             |
| * | to accomplish centralized | A |   | un. |   |   |    |             |
| 1 | payment.                  | O |   | 1,  |   |   |    |             |
| . |                           |   |   | 1   |   |   |    |             |
| 4 |                           |   |   | 996 |   |   |    |             |
| 0 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Consolidate all           |   |   |     |   |   | D/ |             |
| e | construction related      |   |   |     |   |   | O] |             |
| f | programs in the Office of |   |   |     |   |   | {. |             |
| N | Construction Management.  |   |   |     |   |   | un |             |
| o |                           |   |   |     |   |   | de |             |
| . | Transfer the construction |   |   |     |   |   | rl |             |
| ] | related functions and     |   |   |     |   |   | in |             |
| { | staff located in the      |   |   |     |   |   | e} |             |
| . | Office of the Chief       |   |   |     |   |   | ** |             |
| u | Financial Officer to the  |   |   |     |   |   |    |             |
| n | Office of Construction    |   |   |     |   |   |    |             |
| d | Management. These include |   |   |     |   |   |    |             |
| e | 25 FTEE assigned to the   |   |   |     |   |   |    |             |
| r | Infrastructure Policy and |   |   |     |   |   |    |             |
| l | Development Office, and   |   |   |     |   |   |    |             |
| i | 10 FTEE assigned to       |   |   |     |   |   |    |             |
| n | Construction Budget       |   |   |     |   |   |    |             |
| e | Formulation.              |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 4 |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 4 |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Complete the transfer of  | C |   | O   |   |   |    |             |
| * | construction related      | h |   | ct. |   |   |    |             |
| 1 | functions and staff.      | i |   | 1,  |   |   |    |             |
| . |                           | e |   | 1   |   |   |    |             |
| 4 |                           | f |   | 995 |   |   |    |             |
| 1 |                           | C |   |     |   |   |    |             |
| . |                           | o |   |     |   |   |    |             |
| 1 |                           | n |   |     |   |   |    |             |
| . |                           | s |   |     |   |   |    |             |
| a |                           | t |   |     |   |   |    |             |
| * |                           | r |   |     |   |   |    |             |
| * |                           | u |   |     |   |   |    |             |
|   |                           | c |   |     |   |   |    |             |
|   |                           | t |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | o |   |     |   |   |    |             |
|   |                           | n |   |     |   |   |    |             |
|   |                           | M |   |     |   |   |    |             |
|   |                           | a |   |     |   |   |    |             |
|   |                           | n |   |     |   |   |    |             |
|   |                           | a |   |     |   |   |    |             |
|   |                           | g |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | m |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | n |   |     |   |   |    |             |
|   |                           | t |   |     |   |   |    |             |
|   |                           | O |   |     |   |   |    |             |
|   |                           | f |   |     |   |   |    |             |
|   |                           | f |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | c |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | ( |   |     |   |   |    |             |
|   |                           | C |   |     |   |   |    |             |
|   |                           | C |   |     |   |   |    |             |
|   |                           | M |   |     |   |   |    |             |
|   |                           | O |   |     |   |   |    |             |
|   |                           | ) |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The DUSH will task the    | C |   | O   |   |   |    |             |
| * | CCMO to analyze these     | h |   | ct. |   |   |    |             |
| 1 | functions to include (a)  | i |   | 1,  |   |   |    |             |
| . | those that should remain  | e |   | 1   |   |   |    |             |
| 4 | in HQ and (b) those which | f |   | 995 |   |   |    |             |
| 1 | could be performed at the | C |   |     |   |   |    |             |
| . | Support Service level and | o |   |     |   |   |    |             |
| 1 | (c) those that should be  | n |   |     |   |   |    |             |
| . | eliminated.               | s |   |     |   |   |    |             |
| b |                           | t |   |     |   |   |    |             |
| . |                           | r |   |     |   |   |    |             |
| * |                           | u |   |     |   |   |    |             |
| * |                           | c |   |     |   |   |    |             |
|   |                           | t |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | o |   |     |   |   |    |             |
|   |                           | n |   |     |   |   |    |             |
|   |                           | M |   |     |   |   |    |             |
|   |                           | a |   |     |   |   |    |             |
|   |                           | n |   |     |   |   |    |             |
|   |                           | a |   |     |   |   |    |             |
|   |                           | g |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | m |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | n |   |     |   |   |    |             |
|   |                           | t |   |     |   |   |    |             |
|   |                           | O |   |     |   |   |    |             |
|   |                           | f |   |     |   |   |    |             |
|   |                           | f |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | c |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | ( |   |     |   |   |    |             |
|   |                           | C |   |     |   |   |    |             |
|   |                           | C |   |     |   |   |    |             |
|   |                           | M |   |     |   |   |    |             |
|   |                           | O |   |     |   |   |    |             |
|   |                           | ) |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The completed task force  | C |   | J   |   |   |    |             |
| * | report with               | h |   | an. |   |   |    |             |
| 1 | recommendations,          | i |   | 12, |   |   |    |             |
| . | including FTEE            | e |   | 1   |   |   |    |             |
| 4 | recommendations will be   | f |   | 996 |   |   |    |             |
| 1 | submitted to the DUSH.    | C |   |     |   |   |    |             |
| . |                           | o |   |     |   |   |    |             |
| 1 |                           | n |   |     |   |   |    |             |
| . |                           | s |   |     |   |   |    |             |
| c |                           | t |   |     |   |   |    |             |
| * |                           | r |   |     |   |   |    |             |
| * |                           | u |   |     |   |   |    |             |
|   |                           | c |   |     |   |   |    |             |
|   |                           | t |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | o |   |     |   |   |    |             |
|   |                           | n |   |     |   |   |    |             |
|   |                           | M |   |     |   |   |    |             |
|   |                           | a |   |     |   |   |    |             |
|   |                           | n |   |     |   |   |    |             |
|   |                           | a |   |     |   |   |    |             |
|   |                           | g |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | m |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | n |   |     |   |   |    |             |
|   |                           | t |   |     |   |   |    |             |
|   |                           | O |   |     |   |   |    |             |
|   |                           | f |   |     |   |   |    |             |
|   |                           | f |   |     |   |   |    |             |
|   |                           | i |   |     |   |   |    |             |
|   |                           | c |   |     |   |   |    |             |
|   |                           | e |   |     |   |   |    |             |
|   |                           | r |   |     |   |   |    |             |
|   |                           | ( |   |     |   |   |    |             |
|   |                           | C |   |     |   |   |    |             |
|   |                           | C |   |     |   |   |    |             |
|   |                           | M |   |     |   |   |    |             |
|   |                           | O |   |     |   |   |    |             |
|   |                           | ) |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One VAMC Director         | * | T |     |   |   |    |             |
| * | emphasizes that the       | * | o |     |   |   |    |             |
| 1 | current downsizing of     | A | b |     |   |   |    |             |
| . | construction budgets      | * | e |     |   |   |    |             |
| 4 | should be reflected in a  | * | e |     |   |   |    |             |
| 1 | concomitant reduction in  |   | v |     |   |   |    |             |
| * | size of the Construction  |   | a |     |   |   |    |             |
| * | Management Office.        |   | l |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | z |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One commentary notes that | * | R |     |   |   |    |             |
| * | it is critical that all   | * | e |     |   |   |    |             |
| 1 | analyses of the           | A | f |     |   |   |    |             |
| . | Construction Management   | * | e |     |   |   |    |             |
| 4 | Office (CMO) and its      | * | r |     |   |   |    |             |
| 1 | components recognize the  |   | f |     |   |   |    |             |
| * | importance of their role  |   | o |     |   |   |    |             |
| * | in the State Home         |   | r |     |   |   |    |             |
|   | Construction Grant        |   | c |     |   |   |    |             |
|   | Progrm. The writer        |   | o |     |   |   |    |             |
|   | emphasizes that their     |   | n |     |   |   |    |             |
|   | functions in relation to  |   | s |     |   |   |    |             |
|   | this program must remain  |   | i |     |   |   |    |             |
|   | in HQ in order to         |   | d |     |   |   |    |             |
|   | maintain the efficient    |   | e |     |   |   |    |             |
|   | operation of this         |   | r |     |   |   |    |             |
|   | Federal/State sharing     |   | a |     |   |   |    |             |
|   | program.                  |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | z |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One commentary notes that | * | I |     |   |   |    |             |
| * | the moving of the         | * | t |     |   |   |    |             |
| 1 | Infrastructure Policy and | A | i |     |   |   |    |             |
| . | Development Office,       | * | s |     |   |   |    |             |
| 4 | Construction Budget       | * | b |     |   |   |    |             |
| 1 | Formulation, and          |   | e |     |   |   |    |             |
| * | Delegated Construction    |   | l |     |   |   |    |             |
| * | programs under CM has     |   | i |     |   |   |    |             |
|   | been tried several times  |   | e |     |   |   |    |             |
|   | over the past twenty      |   | v |     |   |   |    |             |
|   | years. It has never       |   | e |     |   |   |    |             |
|   | worked in the past. The   |   | d |     |   |   |    |             |
|   | writer expresses concern  |   | t |     |   |   |    |             |
|   | that to go back to a      |   | h |     |   |   |    |             |
|   | system that did not work  |   | a |     |   |   |    |             |
|   | appears to be less than   |   | t |     |   |   |    |             |
|   | progressive. He           |   | t |     |   |   |    |             |
|   | recommends a better       |   | h |     |   |   |    |             |
|   | approach would be for the |   | e |     |   |   |    |             |
|   | VISNs and the VISN        |   | C |     |   |   |    |             |
|   | Service Centers to        |   | h |     |   |   |    |             |
|   | develop a data driven     |   | i |     |   |   |    |             |
|   | process for providing     |   | e |     |   |   |    |             |
|   | these function in         |   | f |     |   |   |    |             |
|   | conjunction with the CNO. |   | C |     |   |   |    |             |
|   | He emphasizes that this   |   | o |     |   |   |    |             |
|   | approach would be more    |   | n |     |   |   |    |             |
|   | consistent with the       |   | s |     |   |   |    |             |
|   | stated goals of this      |   | t |     |   |   |    |             |
|   | reorganization.           |   | r |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | M |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | m |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | O |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | ( |     |   |   |    |             |
|   |                           |   | C |     |   |   |    |             |
|   |                           |   | C |     |   |   |    |             |
|   |                           |   | M |     |   |   |    |             |
|   |                           |   | O |     |   |   |    |             |
|   |                           |   | ) |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | v |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | y |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | z |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

<table style="width:100%;">
<colgroup>
<col style="width: 4%" />
<col style="width: 32%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 7%" />
<col style="width: 5%" />
<col style="width: 2%" />
<col style="width: 6%" />
<col style="width: 16%" />
<col style="width: 9%" />
<col style="width: 9%" />
</colgroup>
<tbody>
<tr class="odd">
<td><p><strong><u>Ref No.</u></strong></p>
<p><strong>1.41</strong></p>
<p><strong>1.41.2</strong></p></td>
<td colspan="5"><p><strong><u>Recommendation:</u></strong></p>
<p>Consolidate all construction related programs in the Office of
Construction Management.</p>
<p>Transfer the major portion of the Engineering Management and Field
Support Office. (EMFSO)</p></td>
<td></td>
<td><strong><u>A/D/O</u></strong></td>
<td><strong><u>Remarks-K</u></strong></td>
<td></td>
<td></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></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td><strong>1.41.2.a</strong></td>
<td>Transfer the minor/minor miscellaneous construction program and the
delegated construction program to the Office of Construction Management
- plus 14 FTEE. See also recommendations 1.32 and 1.33.</td>
<td colspan="2">CCMO</td>
<td>Oct. 1, 1995</td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td><strong>1.41.2.b</strong></td>
<td>Realign the Engineering Service Center in St. Louis to the Office of
Construction Management - plus 14 FTEE See also Recommendation
1.35.</td>
<td colspan="2">CCMO</td>
<td>Oct. 1, 1995</td>
<td colspan="2"></td>
<td></td>
<td></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></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td><p><strong>1.41.2</strong></p>
<p><strong>1.41.2.b</strong></p></td>
<td>The Chief Engineers Advisory Board (CEAB) expressed concerns
regarding the movement of EMFSO to the CMO citing past alignment of the
Office of Facilities under Construction Management with very limited
success. The CEAB further requests representation on any group that will
make final disposition of current functions of EMFSO.</td>
<td><strong>D</strong></td>
<td colspan="4">The functions of EMFSO as a whole will move to
Construction Management. The <em>Vision for Change</em> abolishes
Operations of which EMFSO was formally located.</td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td colspan="4"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td colspan="4"></td>
<td></td>
<td></td>
<td colspan="2"></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 colspan="2"><strong>Actual Date</strong></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td><p><strong>1.41.2</strong></p>
<p><strong>Re-vised</strong></p></td>
<td><p>Consolidate all construction related programs in the Office of
Construction Management.</p>
<p>1.42.2. Transfer the entire portion Engineering Management and Field
Support Office (EMFSO).</p></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
</tbody>
</table>

<table>
<colgroup>
<col style="width: 4%" />
<col style="width: 32%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 7%" />
<col style="width: 5%" />
<col style="width: 2%" />
<col style="width: 6%" />
<col style="width: 16%" />
<col style="width: 9%" />
<col style="width: 9%" />
</colgroup>
<tbody>
<tr class="odd">
<td><p><strong><u>Ref No.</u></strong></p>
<p><strong>1.42</strong></p></td>
<td colspan="5"><p><strong><u>Recommendation:</u></strong></p>
<p>Transfer construction management budget execution functions from the
Office of Construction Management to the Chief Financial
Officer.</p></td>
<td></td>
<td><strong><u>A/D/O</u></strong></td>
<td><strong><u>Remarks-K</u></strong></td>
<td></td>
<td></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></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td><strong>1.42.1</strong></td>
<td>Transfer construction management budget execution function from the
Office of Construction Management to the CFO.</td>
<td colspan="2">CCMO and CFO</td>
<td>Oct. 1, 1995</td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td><strong>1.42.2</strong></td>
<td>Determine associated FTEE to be transferred with this function by
conducting a joint review by the CFO and CCMO.</td>
<td colspan="2">CCMO and CFO</td>
<td>Oct. 1, 1995</td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td><strong>Comments</strong></td>
<td><strong>A/D</strong></td>
<td colspan="4"><strong>Rationale</strong></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td><strong>1.42</strong></td>
<td>The AsCMD for Construction Management (CM) supports transferring a
portion of the budget execution function to the CFO. The budget
execution staff also serves NCS and VBA customers. The removal of this
entire function from CM would result in reduced service to CM's many
customers. It is recommended that the AsCMD negotiate this issue with
the CFO and provide a written recommendation by January 12, 1996.</td>
<td><strong>A</strong></td>
<td colspan="4">Consistent with the action recommended in 1.42.2.</td>
<td></td>
<td></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></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
</tbody>
</table>

<table>
<colgroup>
<col style="width: 4%" />
<col style="width: 32%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 7%" />
<col style="width: 5%" />
<col style="width: 2%" />
<col style="width: 6%" />
<col style="width: 16%" />
<col style="width: 9%" />
<col style="width: 9%" />
</colgroup>
<tbody>
<tr class="odd">
<td><p><strong><u>Ref No.</u></strong></p>
<p><strong>1.43</strong></p></td>
<td colspan="5"><p><strong><u>Recommendation:</u></strong></p>
<p>Consolidate information resource management functions through
transferring a selected portion of the information management staff in
the Office of Construction Management to the Office of the Chief
Information Officer.</p></td>
<td></td>
<td><strong><u>A/D/O</u></strong></td>
<td><strong><u>Remarks-K</u></strong></td>
<td></td>
<td></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></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td><strong>1.43.1</strong></td>
<td>Determine the final number of Construction Management IRM personnel
to be transferred through a joint review completed by the CIO and
CCMO.</td>
<td colspan="2">CIO and CCMO</td>
<td>Oct. 1, 1995</td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td><strong>1.43.2</strong></td>
<td>Transfer appropriate FTEE determined as a result of the review.</td>
<td colspan="2">CCMO</td>
<td>NTE Dec. 1, 1995</td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td><strong>Comments</strong></td>
<td><strong>A/D</strong></td>
<td colspan="4"><strong>Rationale</strong></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td><strong>1.43.1</strong></td>
<td>The AsCMD for Construction Management (CM) comments that CM
recognizes the need stated by the workgroup for effective information
systems support for HQ staff, some of whom may be presently
under-served. The critical need for support is met through the
Information Management Office of CM which supports on-line access to a
variety of CM, HQ, field, and non VHA staff such as NCS and
Congressional Affairs. CM emphasizes that they are engaged in active
discussions with the Director of MIRMO and his staff to determine how to
expand effective desktop support to a greater number of HQ staff.</td>
<td><strong>A</strong></td>
<td colspan="4">This issue is addressed within recommendation, specifics
can be worked out between the Chief Information Officer and the AsCMD
for Construction Management (i.e., proposed title change to Chief
Construction Management Officer).</td>
<td></td>
<td></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></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
</tbody>
</table>

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Create a new headquarters |   |   |     |   |   | D/ |             |
| e | administration function,  |   |   |     |   |   | O] |             |
| f | composed of a portion of  |   |   |     |   |   | {. |             |
| N | the current Office of     |   |   |     |   |   | un |             |
| o | Construction Management   |   |   |     |   |   | de |             |
| . | administrative support,   |   |   |     |   |   | rl |             |
| ] | for overall               |   |   |     |   |   | in |             |
| { | administrative support of |   |   |     |   |   | e} |             |
| . | the internal operation of |   |   |     |   |   | ** |             |
| u | VHA headquarters to       |   |   |     |   |   |    |             |
| n | assure the basics of a    |   |   |     |   |   |    |             |
| d | functional office         |   |   |     |   |   |    |             |
| e | environment.              |   |   |     |   |   |    |             |
| r |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 4 |                           |   |   |     |   |   |    |             |
| 4 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The CAO and CCMO will     | C |   | O   |   |   |    |             |
| * | recommend members of a    | A |   | ct. |   |   |    |             |
| 1 | multi-                    | O |   | 1,  |   |   |    |             |
| . | organization/disciplinary | a |   | 1   |   |   |    |             |
| 4 | team to evaluate VHA      | n |   | 995 |   |   |    |             |
| 4 | needs for a consolidated  | d |   |     |   |   |    |             |
| . | office support function   | C |   |     |   |   |    |             |
| 1 | as part of the Management | C |   |     |   |   |    |             |
| * | and Administration        | M |   |     |   |   |    |             |
| * | Support Office (MASO).    | O |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The final report and      | C |   | D   |   |   |    |             |
| * | recommendations will be   | A |   | ec. |   |   |    |             |
| 1 | prepared for the DUSH,    | O |   | 1,  |   |   |    |             |
| . | and should consider the   | a |   | 1   |   |   |    |             |
| 4 | transfer of three staff   | n |   | 995 |   |   |    |             |
| 4 | from the Administrative   | d |   |     |   |   |    |             |
| . | Support Office located in | C |   |     |   |   |    |             |
| 2 | the Office of the USH.    | C |   |     |   |   |    |             |
| * |                           | M |   |     |   |   |    |             |
| * |                           | O |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

<table style="width:100%;">
<colgroup>
<col style="width: 4%" />
<col style="width: 36%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 8%" />
<col style="width: 5%" />
<col style="width: 2%" />
<col style="width: 6%" />
<col style="width: 18%" />
<col style="width: 10%" />
</colgroup>
<tbody>
<tr class="odd">
<td><p><strong><u>Ref No.</u></strong></p>
<p><strong>1.45</strong></p></td>
<td colspan="5"><p><strong><u>Recommendation:</u></strong></p>
<p>Transfer several functions from the Office of the CFO to other HQ
programs.</p></td>
<td></td>
<td><strong><u>A/D/O</u></strong></td>
<td><strong><u>Remarks-K</u></strong></td>
<td></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></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><strong>1.45.1</strong></td>
<td>Transfer strategic planning [including 9 FTEE], and policy analysis
functions [including 4 FTEE] to the Office of Policy, Planning and
Performance.</td>
<td colspan="2">Office of PPP</td>
<td>Oct. 1, 1995</td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><strong>1.45.2</strong></td>
<td>Transfer the OIG/GAO liaison function [including 5 FTEE] to the
Office of Policy, Planning and Performance.</td>
<td colspan="2">Office of PPP</td>
<td>Oct. 1, 1995</td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><strong>1.45.3</strong></td>
<td>Transfer the construction related functions located in the present
Infrastructure Policy and Development Office [including 25 FTEE} to the
Office of Construction Management.</td>
<td colspan="2">CCMO</td>
<td>Oct. 1, 1995</td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><strong>1.45.4</strong></td>
<td>Transfer the Construction Budget Formulation function [including 10
FTEE] to the Office of Construction Management.</td>
<td colspan="2">CCMO</td>
<td>Oct. 1, 1995</td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><strong>1.45.5</strong></td>
<td>Transfer the Decision Support System (DSS) to the Chief Information
Officer. - [70 FTEE includes Kansas City and multiple locations]
(Reference also recommendation 1.51).</td>
<td colspan="2">CIO</td>
<td>Oct. 1, 1995</td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td><strong>Comments</strong></td>
<td><strong>A/D</strong></td>
<td colspan="4"><strong>Rationale</strong></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><strong>1.45.2</strong></td>
<td>The Deputy Asst Secretary for Financial Mgt does not support the
realignment of this function from the CFO organization, emphasizing the
focus on performance measurement. The varied audit related activities
coordinated and/or conducted by the CFO are cited in support of the CFO
as the organization with the best knowledge to respond to IG and GAO
audits.</td>
<td><strong>D</strong></td>
<td colspan="4">The OIG/GAO liaison functions referenced include a
broader scope than financial audits. More important to have this
function aligned with performance monitoring and the Medical Inspector,
as scope of issues are both clinical and administrative to reflect our
healthcare system.</td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><strong>1.45.2</strong></td>
<td>The Assistant Secretary for Management expresses concern involving
the realignment of responsibilities from the CFO regarding the OIG/GAO
function. He remains convinced that the VHA CFO's office possesses the
expertise and inherent background to perform these decision
functions.</td>
<td><strong>D</strong></td>
<td colspan="4">The OIG/GAO liaison functions referenced include a
broader scope than financial audits. More important to have this
function aligned with performance monitoring and the Medical Inspector,
as scope of issues are both clinical and administrative to reflect our
healthcare system.</td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><strong>1.45.2</strong></td>
<td>The Director, National Media Development Center comments that one of
the stated objectives in this reorganization is the need to eliminate
the fragmented approach to VHA education. He questions that if this is
true, it appears inconsistent to move any educational resources or staff
to offices other than the new Education office. This comment assumes
that this action includes moving the DSS Education Support Office
located in Cleveland to the CIO. This educational activity is currently
dedicated to staff education and training related to DSS; however, the
need for this training may well change or be expanded to other automated
performance systems. Therefore, he closes that it seems consistent that
this function should become part of employee education and not the
CIO.</td>
<td><strong>A</strong></td>
<td colspan="4">It is appropriate that the DSS Education Support
referenced be retained with other employee education resources aligned
under the Office of the Employee Education Officer. The action is
revised to clarify the alignment of this function.</td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><strong>1.45.5</strong></td>
<td>The Assistant Secretary for Management notes that locating the DSS
function under the CIO is reasonable. However, he emphasizes that the
VHA CFO should retain primary authority over maintaining the system's
cost accounting standards.</td>
<td><strong>A</strong></td>
<td colspan="4">Recommendation is consistent with report.</td>
<td></td>
<td></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 colspan="2"><strong>Actual Date</strong></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><p><strong>1.45.5</strong></p>
<p><strong>Re-vised</strong></p></td>
<td>Transfer the Decision Support System (DSS) to the Chief Information
Officer. - [70 FTEE includes Kansas City and multiple locations]. This
excludes staff employees assigned to the DSS Education Support Office
located in Cleveland aligned under the Director, National Media
Development.</td>
<td colspan="2">CIO</td>
<td>Oct. 1, 1995</td>
<td colspan="2"></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Transfer to the Office of |   |   |     |   |   | D/ |             |
| e | the CFO the construction  |   |   |     |   |   | O] |             |
| f | management budget         |   |   |     |   |   | {. |             |
| N | execution from the Office |   |   |     |   |   | un |             |
| o | on Construction           |   |   |     |   |   | de |             |
| . | Management, \[exact       |   |   |     |   |   | rl |             |
| ] | number to be determined   |   |   |     |   |   | in |             |
| { | later\].                  |   |   |     |   |   | e} |             |
| . |                           |   |   |     |   |   | ** |             |
| u |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| r |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 4 |                           |   |   |     |   |   |    |             |
| 6 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Transfer construction     |   |   | O   |   |   |    |             |
| * | mangement budget          |   |   | ct. |   |   |    |             |
| 1 | execution and determine   |   |   | 1,  |   |   |    |             |
| . | associated FTEE to be     |   |   | 1   |   |   |    |             |
| 4 | transferred by a joint    |   |   | 995 |   |   |    |             |
| 6 | review by the CFO and     |   |   |     |   |   |    |             |
| . | CCMO.                     |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

<table>
<colgroup>
<col style="width: 4%" />
<col style="width: 32%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 7%" />
<col style="width: 5%" />
<col style="width: 2%" />
<col style="width: 6%" />
<col style="width: 16%" />
<col style="width: 9%" />
<col style="width: 9%" />
</colgroup>
<tbody>
<tr class="odd">
<td><p><strong><u>Ref No.</u></strong></p>
<p><strong>1.47</strong></p></td>
<td colspan="5"><p><strong><u>Recommendation:</u></strong></p>
<p>Dependent upon adequate justification, expand the current CFO
functions to provide the following functions: enhance evaluation
service, establish business planning function, establish financial
audits, enhance financial policy activity to include the revolving fund
policy function, and enhance the current rate development and price
staff. (The CFO has requested additional FTEE for each of the above
functions.)</p></td>
<td></td>
<td><strong><u>A/D/O</u></strong></td>
<td><strong><u>Remarks-K</u></strong></td>
<td></td>
<td></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></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td><strong>1.47.1</strong></td>
<td>Create the Office of Financial Evaluation.</td>
<td colspan="2">CFO</td>
<td>On or about Oct. 1, 1995</td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td><strong>1.47.2</strong></td>
<td>The CFO will thoroughly analyze staffing required for the sections
and functions described for the Office of Financial Evaluation. A report
and recommendations to include sub-elements and functions of Evaluation
Service and Post Occupancy Evaluations should be submitted to the
DUSH.</td>
<td colspan="2">CFO</td>
<td>Dec. 1, 1995</td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td><strong>1.47.3</strong></td>
<td>The CFO will review/study the establishment of a 'financial audit
capability' to include (a) out placement of these staff at field
locations and (b) the need to continue the financial integrity audits
out of Austin, TX. A report and recommendations will be provided to the
DUSH.</td>
<td colspan="2">CFO</td>
<td>Dec. 1, 1995</td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td><strong>1.47.4</strong></td>
<td>The CFO will submit a proposal for the desired additional and
enhanced funtions, including function description, justification and
staffing, to the DUSH.</td>
<td colspan="2">CFO</td>
<td>Nov. 1, 1995</td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td><strong>1.47. 5</strong></td>
<td>The CFO, in conjunction with the Chief of PPP, will perform a review
for submission to the DUSH to determine the future alignment of the
following organizational elements currently assigned to the CFO: (a)
Management Science Group at Bedford, includes 12 FTEE; (b) Planning
System Support Group at Gainesville, includes 6 FTEE; (c) Planning &amp;
Evaluation Front Office, includes 4 FTEE; (d) Statistical Analysis
Service, includes 4 FTEE; and (e) the Performance Measurement Service,
includes 3 FTEE.</td>
<td colspan="2">Office of PPP</td>
<td>Recommen-dations due by Dec. 1, 1995</td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td><strong>Comments</strong></td>
<td><strong>A/D</strong></td>
<td colspan="4"><strong>Rationale</strong></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td><strong>1.47.3</strong></td>
<td>The Deputy Asst. Secretary for Financial Mgt. believes that this
discussion of the Austin Financial Quality Assurance Service staff
exceeds the purpose of the VHA restructuring and recommends that this
action be deleted. It is critical that this independent review function
remain with the Department's CFO to ensure that internal controls are
not sacrificed as VA undergoes change. The Department CFO will continue
to perform these reviews to provide assurances that policy and systems
from a VA perspective are being followed.</td>
<td><strong>A</strong></td>
<td colspan="4">Concur. Action 1.47.3 is deleted from report.</td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td><strong>1.47.3</strong></td>
<td>The Assistant Secretary for Management questions the need of the
workgroup to consider any action relative to financial integrity
auditing out of Austin., Texas. He emphasizes that maintaining the
independence of this audit review function is critical to his oversight
role as the VA CFO/CIRO, and recommends that this action be
removed.</td>
<td><strong>A</strong></td>
<td colspan="4">Concur. Action 1.47.3 is deleted from report.</td>
<td></td>
<td></td>
<td colspan="2"></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 colspan="2"><strong>Actual Date</strong></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td><p><strong>1.47.3</strong></p>
<p><strong>Delete</strong></p></td>
<td>Delete Action: The CFO will review/study the establishment of a
'financial audit capability' to include (a) out placement of these staff
at field locations and (b) the need to continue the financial integrity
audits out of Austin, TX. A report and recommendations will be provided
to the DUSH.</td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
</tbody>
</table>

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Develop a plan for IRM    |   |   |     |   |   | D/ |             |
| e | acquisition oversight and |   |   |     |   |   | O] |             |
| f | independent review;       |   |   |     |   |   | {. |             |
| N | establish a management    |   |   |     |   |   | un |             |
| o | process for integrating   |   |   |     |   |   | de |             |
| . | strategic planning        |   |   |     |   |   | rl |             |
| ] | efforts in information    |   |   |     |   |   | in |             |
| { | management and technology |   |   |     |   |   | e} |             |
| . | investments; establish    |   |   |     |   |   | ** |             |
| u | information technology    |   |   |     |   |   |    |             |
| n | performance measurement;  |   |   |     |   |   |    |             |
| d | establish a formal        |   |   |     |   |   |    |             |
| e | concept approval and      |   |   |     |   |   |    |             |
| r | acquisition process; and  |   |   |     |   |   |    |             |
| l | establish an              |   |   |     |   |   |    |             |
| i | organizational structure  |   |   |     |   |   |    |             |
| n | to support a formal, life |   |   |     |   |   |    |             |
| e | cycle oriented, review    |   |   |     |   |   |    |             |
| } | process of IRM            |   |   |     |   |   |    |             |
| * | activities.               |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 4 |                           |   |   |     |   |   |    |             |
| 8 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Classify and recruit for  | O |   | O   |   |   |    |             |
| * | the CIO position.         | f |   | ct. |   |   |    |             |
| 1 |                           | f |   | 1,  |   |   |    |             |
| . |                           | i |   | 1   |   |   |    |             |
| 4 |                           | c |   | 995 |   |   |    |             |
| 8 |                           | e |   |     |   |   |    |             |
| . |                           | o |   |     |   |   |    |             |
| 1 |                           | f |   |     |   |   |    |             |
| * |                           | U |   |     |   |   |    |             |
| * |                           | S |   |     |   |   |    |             |
|   |                           | H |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The CIO will develop a    | C |   | D   |   |   |    |             |
| * | proposed organizational   | I |   | ec. |   |   |    |             |
| 1 | chart reflecting          | O |   | 1,  |   |   |    |             |
| . | additional FTEE           |   |   | 1   |   |   |    |             |
| 4 | requirements and          |   |   | 995 |   |   |    |             |
| 8 | justification for same.   |   |   |     |   |   |    |             |
| . | The proposal for          |   |   |     |   |   |    |             |
| 2 | additional FTEE will be   |   |   |     |   |   |    |             |
| * | submitted to the DUSH.    |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The CIO and appropriate   | C |   | D   |   |   |    |             |
| * | personnel will develop a  | I |   | ec. |   |   |    |             |
| 1 | plan for IRM acquisition  | O |   | 1,  |   |   |    |             |
| . | oversight, independent    |   |   | 1   |   |   |    |             |
| 4 | review, and               |   |   | 995 |   |   |    |             |
| 8 | identification of         |   |   |     |   |   |    |             |
| . | processes to address the  |   |   |     |   |   |    |             |
| 3 | other components of the   |   |   |     |   |   |    |             |
| * | review of IRM activities  |   |   |     |   |   |    |             |
| * | noted above. The report   |   |   |     |   |   |    |             |
|   | with recommendations will |   |   |     |   |   |    |             |
|   | be made to the DUSH.      |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | One VAMC Director notes   | * | R |     |   |   |    |             |
| * | that no mention is made   | * | e |     |   |   |    |             |
| 1 | in the report of ensuring | A | f |     |   |   |    |             |
| . | that enhancements are     | * | e |     |   |   |    |             |
| 4 | made to information       | * | r |     |   |   |    |             |
| 8 | systems to keep them      |   | t |     |   |   |    |             |
| . | consistent with new       |   | o |     |   |   |    |             |
| 3 | programs. An example is   |   | C |     |   |   |    |             |
| * | cited in the Prime Vendor |   | I |     |   |   |    |             |
| * | programs that require     |   | O |     |   |   |    |             |
|   | streamlined IFCAP         |   | f |     |   |   |    |             |
|   | processing menus; yet,    |   | o |     |   |   |    |             |
|   | over two years after      |   | r |     |   |   |    |             |
|   | intial implementation, no |   | c |     |   |   |    |             |
|   | effort has been made to   |   | o |     |   |   |    |             |
|   | modify IFCAP.             |   | n |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | z |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The Western Region        | * | R |     |   |   |    |             |
| * | Information Management    | * | e |     |   |   |    |             |
| 1 | Group recommends adding   | A | f |     |   |   |    |             |
| . | the establishment of a    | * | e |     |   |   |    |             |
| 4 | database administration   | * | r |     |   |   |    |             |
| 8 | (DBA) function within the |   | t |     |   |   |    |             |
| * | Office of the CIO. This   |   | o |     |   |   |    |             |
| * | would be a database       |   | C |     |   |   |    |             |
|   | administrator not only    |   | I |     |   |   |    |             |
|   | for traditional DHCP      |   | O |     |   |   |    |             |
|   | packages, but for all     |   | f |     |   |   |    |             |
|   | other VHA databases.      |   | o |     |   |   |    |             |
|   | Coordination is needed    |   | r |     |   |   |    |             |
|   | within VHA and between    |   | c |     |   |   |    |             |
|   | VHA, VBA, and NCS. This   |   | o |     |   |   |    |             |
|   | DBA could also function   |   | n |     |   |   |    |             |
|   | as liaison with outside   |   | s |     |   |   |    |             |
|   | agencies in data linkage  |   | i |     |   |   |    |             |
|   | and data sharing          |   | d |     |   |   |    |             |
|   | projects.                 |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | c |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | w |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | z |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| 1 | One writer emphasizes     |   | N |     |   |   |    |             |
| . | that the HQ Restructuring |   | o |     |   |   |    |             |
| 4 | and Information Systems   |   | t |     |   |   |    |             |
| 8 | Work Group Reports need   |   | e |     |   |   |    |             |
|   | to both address the exact |   | d |     |   |   |    |             |
| O | nature of the role of the |   | . |     |   |   |    |             |
| t | CIO. The writer           |   | T |     |   |   |    |             |
| h | emphasizes that a final   |   | h |     |   |   |    |             |
| e | agreement on the CIO      |   | e |     |   |   |    |             |
| r | function is critical to a |   | d |     |   |   |    |             |
|   | number of recommendtions  |   | e |     |   |   |    |             |
|   | that affect VHA and the   |   | v |     |   |   |    |             |
|   | proposed CIO              |   | e |     |   |   |    |             |
|   | organization. In a        |   | l |     |   |   |    |             |
|   | lengthy commentary this   |   | o |     |   |   |    |             |
|   | writer also adds that     |   | p |     |   |   |    |             |
|   | what is at issue is the   |   | m |     |   |   |    |             |
|   | nature of the role of the |   | e |     |   |   |    |             |
|   | CIO, and points out that  |   | n |     |   |   |    |             |
|   | the CIO function should   |   | t |     |   |   |    |             |
|   | not adversely impact or   |   | o |     |   |   |    |             |
|   | directly interere with    |   | f |     |   |   |    |             |
|   | program or field          |   | f |     |   |   |    |             |
|   | activities or operations. |   | u |     |   |   |    |             |
|   | The writer adds that the  |   | n |     |   |   |    |             |
|   | CIO should be both a      |   | c |     |   |   |    |             |
|   | policy and support        |   | t |     |   |   |    |             |
|   | function, but not a       |   | i |     |   |   |    |             |
|   | function to which all     |   | o |     |   |   |    |             |
|   | program information       |   | n |     |   |   |    |             |
|   | components need to        |   | s |     |   |   |    |             |
|   | organizationally report.  |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | q |     |   |   |    |             |
|   |                           |   | u |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | h |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | C |     |   |   |    |             |
|   |                           |   | I |     |   |   |    |             |
|   |                           |   | O |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | z |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | g |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
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|   |                           |   | l |     |   |   |    |             |
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|   |                           |   | d |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
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|   |                           |   | s |     |   |   |    |             |
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|   |                           |   | . |     |   |   |    |             |
|   |                           |   | S |     |   |   |    |             |
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|   |                           |   | e |     |   |   |    |             |
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|   |                           |   | a |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | V |     |   |   |    |             |
|   |                           |   | H |     |   |   |    |             |
|   |                           |   | A |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | r |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | f |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | d |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

<table>
<colgroup>
<col style="width: 4%" />
<col style="width: 32%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 7%" />
<col style="width: 5%" />
<col style="width: 2%" />
<col style="width: 6%" />
<col style="width: 16%" />
<col style="width: 9%" />
<col style="width: 9%" />
</colgroup>
<tbody>
<tr class="odd">
<td><p><strong><u>Ref No.</u></strong></p>
<p><strong>1.49</strong></p></td>
<td colspan="5"><p><strong><u>Recommendation:</u></strong></p>
<p>Determine which information resource management functions of the
Office of Construction should be transferred to the CIO.</p></td>
<td></td>
<td><strong><u>A/D/O</u></strong></td>
<td><strong><u>Remarks-K</u></strong></td>
<td></td>
<td></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></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td><strong>1.49.1</strong></td>
<td>Transfer Construction Management IRM Personnel to the CIO.</td>
<td colspan="2">CCMO</td>
<td>Oct. 1, 1995</td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td><strong>Comments</strong></td>
<td><strong>A/D</strong></td>
<td colspan="4"><strong>Rationale</strong></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td>1.49</td>
<td>One writer emphasized concern that by assuming the CM IRM functions
and staff, clear responsibility and functional statements need to be
provided. The implication is that the CIO will assume responsibility for
VHA HQ information systems infra structure support. The writer says that
the argument used to support the transfer of CM IRM staff to the CIO is
that the CIO office ‘provide direction, leadership and management over
information management activities at the Administration level.’ The
writer emphasizes that the basic justification underlying this transfer
needs to be reexamined. The writer adds that CM has developed an IRM
support function because one was not provided by MIRMO or VHA
Administration. The activity performed by the CM IRM improves the work
environment and efficiency of the CM organization. It does not compete
with or affect IRM policy or process decisions or functions managed by
MIRMO or the CIO. The writer notes that transfer of this function sends
a strong negative message to all organizations that is certain to limit
creative solutions to organizational issues.</td>
<td></td>
<td colspan="4">Commentary is noted. However, the CCMO will determine
with input from the new CIO which functions and/or staff are appropriate
for realignment to the CIO.</td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td colspan="4"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td colspan="4"></td>
<td></td>
<td></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></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
</tr>
</tbody>
</table>

+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | **[Recom                  |   |   |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |   |   |     |   |   | *[ | marks-K]{.u |
| [ |                           |   |   |     |   |   | A/ | nderline}** |
| R | Integrate the present     |   |   |     |   |   | D/ |             |
| e | Library and Satellite TV  |   |   |     |   |   | O] |             |
| f | into the CIO organization |   |   |     |   |   | {. |             |
| N | structure. 3.0 FTEE in HQ |   |   |     |   |   | un |             |
| o | and 5.0 FTEE (Washington, |   |   |     |   |   | de |             |
| . | Cleveland, Salt Lake, and |   |   |     |   |   | rl |             |
| ] | St. Louis) in the field.  |   |   |     |   |   | in |             |
| { |                           |   |   |     |   |   | e} |             |
| . |                           |   |   |     |   |   | ** |             |
| u |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| d |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| r |                           |   |   |     |   |   |    |             |
| l |                           |   |   |     |   |   |    |             |
| i |                           |   |   |     |   |   |    |             |
| n |                           |   |   |     |   |   |    |             |
| e |                           |   |   |     |   |   |    |             |
| } |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
|   |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 5 |                           |   |   |     |   |   |    |             |
| 0 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Action Required**       | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | Integrate the Library,    | C |   | D   |   |   |    |             |
| * | and Satellite TV into the | C |   | ec. |   |   |    |             |
| 1 | CIO organization.         | M |   | 1,  |   |   |    |             |
| . |                           | O |   | 1   |   |   |    |             |
| 5 |                           |   |   | 995 |   |   |    |             |
| 0 |                           |   |   |     |   |   |    |             |
| . |                           |   |   |     |   |   |    |             |
| 1 |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
| * |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| * | The CIO will develop a    | C |   | D   |   |   |    |             |
| * | plan and time frame for   | C |   | ec. |   |   |    |             |
| 1 | the out placement of      | M |   | 1,  |   |   |    |             |
| . | existing staff to the     | O |   | 1   |   |   |    |             |
| 5 | field or VISN Service     |   |   | 995 |   |   |    |             |
| 0 | Support Centers, as       |   |   |     |   |   |    |             |
| . | necessary. This plan      |   |   |     |   |   |    |             |
| 2 | should include the        |   |   |     |   |   |    |             |
| * | development of education  |   |   |     |   |   |    |             |
| * | and cross training        |   |   |     |   |   |    |             |
|   | programs to produce a     |   |   |     |   |   |    |             |
|   | positive transition.      |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Comments**              | * | * |     |   |   |    |             |
|   |                           | * | * |     |   |   |    |             |
|   |                           | A | R |     |   |   |    |             |
|   |                           | / | a |     |   |   |    |             |
|   |                           | D | t |     |   |   |    |             |
|   |                           | * | i |     |   |   |    |             |
|   |                           | * | o |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
|   |                           |   | a |     |   |   |    |             |
|   |                           |   | l |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
|   |                           |   | * |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
| 1 | One writer questioned the |   | N |     |   |   |    |             |
| . | accuracy of the FTE count |   | o |     |   |   |    |             |
| 5 | associated with this      |   | t |     |   |   |    |             |
| 0 | function. The writer asks |   | e |     |   |   |    |             |
|   | if it is the intention to |   | d |     |   |   |    |             |
|   | include both the National |   | . |     |   |   |    |             |
|   | Library Program Office    |   | T |     |   |   |    |             |
|   | and VHA's Library and     |   | h |     |   |   |    |             |
|   | Visual Information staff  |   | e |     |   |   |    |             |
|   | within the CIO. The       |   | H |     |   |   |    |             |
|   | writer notes that an      |   | Q |     |   |   |    |             |
|   | hierarchial relationship  |   | w |     |   |   |    |             |
|   | does not exist between    |   | o |     |   |   |    |             |
|   | these two functions.      |   | r |     |   |   |    |             |
|   | However, it is logical to |   | k |     |   |   |    |             |
|   | place both activities     |   | g |     |   |   |    |             |
|   | under the CIO, and if     |   | r |     |   |   |    |             |
|   | this is the intent        |   | o |     |   |   |    |             |
|   | further clarification of  |   | u |     |   |   |    |             |
|   | the number is needed. The |   | p |     |   |   |    |             |
|   | writer points out that in |   | n |     |   |   |    |             |
|   | addition to the sites     |   | o |     |   |   |    |             |
|   | noted in the              |   | t |     |   |   |    |             |
|   | recommendation, FTE are   |   | e |     |   |   |    |             |
|   | physically located also   |   | d |     |   |   |    |             |
|   | at Birmingham and Durham. |   | m |     |   |   |    |             |
|   | Also the writer notes     |   | a |     |   |   |    |             |
|   | that conceivably some of  |   | n |     |   |   |    |             |
|   | these FTE could be placed |   | y |     |   |   |    |             |
|   | in the Employee Education |   | i |     |   |   |    |             |
|   | Office since a large      |   | n |     |   |   |    |             |
|   | portion of their work is  |   | c |     |   |   |    |             |
|   | associated also with      |   | o |     |   |   |    |             |
|   | education and RMEC        |   | n |     |   |   |    |             |
|   | support.                  |   | s |     |   |   |    |             |
|   |                           |   | i |     |   |   |    |             |
|   |                           |   | s |     |   |   |    |             |
|   |                           |   | t |     |   |   |    |             |
|   |                           |   | e |     |   |   |    |             |
|   |                           |   | n |     |   |   |    |             |
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|   |                           |   | U |     |   |   |    |             |
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|   |                           |   | H |     |   |   |    |             |
|   |                           |   | . |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   | **Proposed Revision**     | * |   | **  | * |   |    |             |
|   |                           | * |   | Tar | * |   |    |             |
|   |                           | A |   | get | A |   |    |             |
|   |                           | c |   | Dat | c |   |    |             |
|   |                           | t |   | e** | t |   |    |             |
|   |                           | i |   |     | u |   |    |             |
|   |                           | o |   |     | a |   |    |             |
|   |                           | n |   |     | l |   |    |             |
|   |                           | O |   |     | D |   |    |             |
|   |                           | f |   |     | a |   |    |             |
|   |                           | f |   |     | t |   |    |             |
|   |                           | i |   |     | e |   |    |             |
|   |                           | c |   |     | * |   |    |             |
|   |                           | e |   |     | * |   |    |             |
|   |                           | * |   |     |   |   |    |             |
|   |                           | * |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+
|   |                           |   |   |     |   |   |    |             |
+---+---------------------------+---+---+-----+---+---+----+-------------+

+---+---------------------------------------------+---+----+-------------+
| * | **[Recommendation:]{.underline}**           |   | *  | **[Re       |
| * |                                             |   | *[ | marks-K]{.u |
| [ | Transfer the DSS from the CFO to the CIO. - |   | A/ | nderline}** |
| R | 70 FTEE which includes HQ and field units.  |   | D/ |             |
| e |                                             |   | O] |             |
| f |                                             |   | {. |             |
| N |                                             |   | un |             |
| o |                                             |   | de |             |
| . |                                             |   | rl |             |
| ] |                                             |   | in |             |
| { |                                             |   | e} |             |
| . |                                             |   | ** |             |
| u |                                             |   |    |             |
| n |                                             |   |    |             |
| d |                                             |   |    |             |
| e |                                             |   |    |             |
| r |                                             |   |    |             |
| l |                                             |   |    |             |
| i |                                             |   |    |             |
| n |                                             |   |    |             |
| e |                                             |   |    |             |
| } |                                             |   |    |             |
| * |                                             |   |    |             |
| * |                                             |   |    |             |
|   |                                             |   |    |             |
| * |                                             |   |    |             |
| * |                                             |   |    |             |
| 1 |                                             |   |    |             |
| . |                                             |   |    |             |
| 5 |                                             |   |    |             |
| 1 |                                             |   |    |             |
| * |                                             |   |    |             |
| * |                                             |   |    |             |
+---+---------------------------------------------+---+----+-------------+

  ------------ ---------------------------- ---------- --------------- ---------- ---------- ----- --------------
               **Action Required**          **Action                   **Target   **Actual         
                                            Office**                   Date**     Date**           

  **1.51.1**   Realign the DSS function     CIO                        Oct. 1,                     
               from the CFO to the CIO.                                1995                        
               (Reference also action                                                              
               1.45.5).                                                                            

               **Comments**                 **A/D**    **Rationale**                               

  **1.51**     The Deputy Asst Secretary    **A**      Matrixed                                    
               for Financial Mgt. does not             functions of                                
               disagree with the                       DSS between CIO                             
               realignment of the DSS                  and CFO will be                             
               function to the CIO.                    addressed in                                
               However, it is emphasized               the performance                             
               that the CFO responsibility             contract of                                 
               for the cost accounting                 each official.                              
               component in DSS should be                                                          
               clarified. It is not                                                                
               addressed in the report that                                                        
               the CFO will have the lead                                                          
               responsibility for ensuring                                                         
               implementation of                                                                   
               governmentwide and                                                                  
               department cost standards                                                           
               associated with DSS.                                                                

                                                                                                   

                                                                                                   

               **Proposed Revision**        **Action                   **Target   **Actual         
                                            Office**                   Date**     Date**           

                                                                                                   
  ------------ ---------------------------- ---------- --------------- ---------- ---------- ----- --------------

+---+---------------------------+-----+-----+---+---+----+-------------+
| * | **[Recom                  |     |     |   |   | *  | **[Re       |
| * | mendation:]{.underline}** |     |     |   |   | *[ | marks-K]{.u |
| [ |                           |     |     |   |   | A/ | nderline}** |
| R | The Management and        |     |     |   |   | D/ |             |
| e | Administration Support    |     |     |   |   | O] |             |
| f | Office (MASO), in         |     |     |   |   | {. |             |
| N | conjunction with Human    |     |     |   |   | un |             |
| o | Resources and/or other    |     |     |   |   | de |             |
| . | appropriate HQ program    |     |     |   |   | rl |             |
| ] | offices, will initiate    |     |     |   |   | in |             |
| { | prompt action to develop  |     |     |   |   | e} |             |
| . | and/or revise a variety   |     |     |   |   | ** |             |
| u | of personnel related      |     |     |   |   |    |             |
| n | issues and/or activities  |     |     |   |   |    |             |
| d | necessary to implement    |     |     |   |   |    |             |
| e | the new HQ organization.  |     |     |   |   |    |             |
| r | These issues/activities   |     |     |   |   |    |             |
| l | include, but are not      |     |     |   |   |    |             |
| i | limited to the following; |     |     |   |   |    |             |
| n | organizational and        |     |     |   |   |    |             |
| e | staffing charts,          |     |     |   |   |    |             |
| } | functional statements,    |     |     |   |   |    |             |
| * | mail symbols, telephone   |     |     |   |   |    |             |
| * | numbers, space            |     |     |   |   |    |             |
|   | allocations, time and     |     |     |   |   |    |             |
| * | leave unit designations,  |     |     |   |   |    |             |
| * | title changes and mass    |     |     |   |   |    |             |
| 1 | change actions.           |     |     |   |   |    |             |
| . |                           |     |     |   |   |    |             |
| 5 |                           |     |     |   |   |    |             |
| 2 |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
+---+---------------------------+-----+-----+---+---+----+-------------+
|   | **Action Required**       | **  | **  | * |   |    |             |
|   |                           | Act | Tar | * |   |    |             |
|   |                           | ion | get | A |   |    |             |
|   |                           | Of  | Dat | c |   |    |             |
|   |                           | fic | e** | t |   |    |             |
|   |                           | e** |     | u |   |    |             |
|   |                           |     |     | a |   |    |             |
|   |                           |     |     | l |   |    |             |
|   |                           |     |     | D |   |    |             |
|   |                           |     |     | a |   |    |             |
|   |                           |     |     | t |   |    |             |
|   |                           |     |     | e |   |    |             |
|   |                           |     |     | * |   |    |             |
|   |                           |     |     | * |   |    |             |
+---+---------------------------+-----+-----+---+---+----+-------------+
| * | Initiate appropriate      | M   | To  |   |   |    |             |
| * | documents to obtain       | ASO | be  |   |   |    |             |
| 1 | approval of the Secretary |     | D   |   |   |    |             |
| . | as appropriate.           |     | ete |   |   |    |             |
| 5 |                           |     | rmi |   |   |    |             |
| 2 |                           |     | ned |   |   |    |             |
| . |                           |     |     |   |   |    |             |
| 1 |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
+---+---------------------------+-----+-----+---+---+----+-------------+
| * | Initiate revisions to     | M   | To  |   |   |    |             |
| * | Organization and Staffing | ASO | be  |   |   |    |             |
| 1 | Tables immediately upon   |     | D   |   |   |    |             |
| . | approval.                 |     | ete |   |   |    |             |
| 5 |                           |     | rmi |   |   |    |             |
| 2 |                           |     | ned |   |   |    |             |
| . |                           |     |     |   |   |    |             |
| 2 |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
+---+---------------------------+-----+-----+---+---+----+-------------+
| * | Initiate requests to      | M   | To  |   |   |    |             |
| * | Program Offices/Strategic | ASO | be  |   |   |    |             |
| 1 | Health Care Group Leaders |     | D   |   |   |    |             |
| . | for revised functional    |     | ete |   |   |    |             |
| 5 | statements and positions  |     | rmi |   |   |    |             |
| 2 | descriptions.             |     | ned |   |   |    |             |
| . |                           |     |     |   |   |    |             |
| 3 |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
+---+---------------------------+-----+-----+---+---+----+-------------+
| * | Identify needed changes   | M   | Se  |   |   |    |             |
| * | in space allocation, cost | ASO | pt. |   |   |    |             |
| 1 | centers, mail symbols,    |     | 15, |   |   |    |             |
| . | telephone numbers, and    |     | 1   |   |   |    |             |
| 5 | PAID language.            |     | 995 |   |   |    |             |
| 2 |                           |     |     |   |   |    |             |
| . |                           |     |     |   |   |    |             |
| 4 |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
+---+---------------------------+-----+-----+---+---+----+-------------+
| * | Develop priority          | M   | Se  |   |   |    |             |
| * | Personnel Placement       | ASO | pt. |   |   |    |             |
| 1 | Program, in conjunction   |     | 15, |   |   |    |             |
| . | with Office of Human      |     | 1   |   |   |    |             |
| 5 | Resources Management.     |     | 995 |   |   |    |             |
| 2 |                           |     |     |   |   |    |             |
| . |                           |     |     |   |   |    |             |
| 5 |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
+---+---------------------------+-----+-----+---+---+----+-------------+
| * | Initiate mass change      | M   | Se  |   |   |    |             |
| * | actions.                  | ASO | pt. |   |   |    |             |
| 1 |                           |     | 29, |   |   |    |             |
| . |                           |     | 1   |   |   |    |             |
| 5 |                           |     | 995 |   |   |    |             |
| 2 |                           |     |     |   |   |    |             |
| . |                           |     |     |   |   |    |             |
| 6 |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
+---+---------------------------+-----+-----+---+---+----+-------------+
| * | Maintain dialogue with    | M   | O   |   |   |    |             |
| * | Labor Organizations.      | ASO | ngo |   |   |    |             |
| 1 |                           |     | ing |   |   |    |             |
| . |                           |     |     |   |   |    |             |
| 5 |                           |     |     |   |   |    |             |
| 2 |                           |     |     |   |   |    |             |
| . |                           |     |     |   |   |    |             |
| 7 |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
| * |                           |     |     |   |   |    |             |
+---+---------------------------+-----+-----+---+---+----+-------------+

  ------------ ---------------------------- ---------- ----------------------- ---------- ---------- ----- --------------
               **Comments**                 **A/D**    **Rationale**                                       

  **1.52**     Individuals (2) expressed    **A**      This will be referred                               
               concern that no                         to MASO for                                         
               recommendations were made to            incorporation into new                              
               assure effective                        functions.                                          
               communications with HQ                                                                      
               employees. A clarification                                                                  
               of the plans that MASO have                                                                 
               made to enhance                                                                             
               communication and control                                                                   
               the rumor mill was                                                                          
               requested.                                                                                  

  **1.52.4**   The Deputy Asst Secretary    **A**      Refer to MASO for                                   
               for Financial Mgt recommends            consideration/action.                               
               that changing cost center                                                                   
               codes only be accomplished                                                                  
               at the beginning of the                                                                     
               fiscal year due to core                                                                     
               system impacts (FMS,                                                                        
               PAID,etc.) and emphasizes                                                                   
               the need to coordinate                                                                      
               changes with IRM/OFM.                                                                       

  **1.52.5**   The Assistant Secretary for  **A**      Refer to MASO for                                   
               Human Resources and                     consideration/action.                               
               Administration notes that                                                                   
               clarification with VHA                                                                      
               regarding the personnel                                                                     
               placement program is needed.                                                                
               If the intent is to develop                                                                 
               a HQ special placement                                                                      
               program, that would in                                                                      
               ordinary circumstances be                                                                   
               appropriate; however, given                                                                 
               prospective budget levels,                                                                  
               many other HQ elements may                                                                  
               also need to be downsizing.                                                                 
               If the intent is to focus on                                                                
               outplacment within VHA (HQ                                                                  
               and field) or on other                                                                      
               alternatives, this would                                                                    
               represent a different                                                                       
               situation.                                                                                  

               **Proposed Revision**        **Action                           **Target   **Actual         
                                            Office**                           Date**     Date**           

                                                                                                           
  ------------ ---------------------------- ---------- ----------------------- ---------- ---------- ----- --------------