**Note to Reviewer**

1\. Please note that the electronic version of the VHA Restructuring
Plan ("Vision for Change") does not replicate every table or figure
exactly as contained in the hardcopy version of the plan, nor are the
pages numbered exactly as they are in the hardcopy version. The
information contained therein, however, is the same.

2\. The inexact replication is due to the conversion of information from
formats contained in the original to the electronic copy that can be
posted on a bulletin board. Nevertheless, all copies of the hardcopy
version are included in the electronic version.

3\. Information contained in the chapters and appendices is as follows:

**Chapter 1** is an introduction and executive summary.

**Chapter 2** meets the stipulations of 38 U.S.C. §510(b), which
requires a report to Congress for certain reorganization proposals. In
fulfillment of this requirement, Chapter 2 outlines the plan to convert
the VHA field organization to 22 VISNs. It also provides cost estimates
for the field reorganization, discusses the transition process and
delineates a plan to establish Support Services Centers (SSCs), a new
VHA organizational component designed to assist the VISNs and
headquarters in the transition from larger regions to smaller, more
cohesive integrated service networks.

**Chapter 3** describes the restructuring of VHA Central Office into a
new VHA National Headquarters. While the headquarters reorganization
does not require a report pursuant to 38 U.S.C. §510, the chapter
nevertheless provides information similar to that required by law for
the field reorganization. It describes a flatter and less hierarchical
headquarters having reduced day-to-day operational involvement, but
increased responsibility for providing leadership, guidance and
systemwide quality monitoring. The chapter also describes the new
behaviors and values that will be expected for successful performance by
the headquarters staff.

**Chapter 4** briefly describes the new performance measurement and
monitoring system that will ensure accountability in the new
organization. The chapter discusses performance contracts for network
directors, and includes examples of specific performance criteria that
can be used to establish more consistency of care and service delivery
across the VISNs. Performance contracts will be a critical aspect of the
proposed reorganization.

**Chapter 5** addresses additional implementation issues and priorities,
and also discusses the Under Secretary's vision for the future of the
Veterans Health Administration.

Finally, a number of appendices are included that amplify upon concepts
or provide supplemental details to material contained in the text.

\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*

**Table of Contents**

***Preface*** 7

Acknowledgment 9

**Chapter 1** Introduction and Executive Summary 11

**Chapter 2** VHA Field Reorganization 21

**Chapter 3** VHA Central Office Reorganization 49

**Chapter 4** VISN Performance Measurement and Systems Monitoring \....
61

**Chapter 5** Implementation and Transition 73

***Appendices***

**Appendix 1** VHA Medical Care Appropriation, 1980 - 1995 79

**Appendix 2** A List of VHA Facilities by VISN 83

**Appendix 3** A List of VHA Vet Centers 97

**Appendix 4** VHA Field Reorganization Budget Estimates and

Comparisons 105

**Appendix 5** Functional Statements for VHA Headquarters 109

**Appendix 6** Additional Information on Selected VHA

Performance Measurement Programs 127

**Appendix 7** References
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