VHA Office of Rural Health
VHA Restructure for Impact and Sustainability Effort (RISE) Summary
VHA RISE: What It Means for You
Under Secretary for Health John Bartrum and Chief Operating Officer Gregory Goins discuss VHA RISE. VIDEO LINK
The Veterans Health Administration (VHA) is undergoing its most significant reorganization in more than 30 years. It is called the Restructure for Impact and Sustainability Effort — or VHA RISE.
This page answers the most common questions about RISE — for Veterans, family members, caregivers, and VA employees. The answers are drawn directly from public interviews with the two leaders responsible for making RISE happen: John Bartrum, Under Secretary for Health, and Gregory Goins, VHA Chief Operating Officer. Their words are quoted here so you can hear it from the people leading this effort.
Watch the full interview on the Department of Veterans Affairs YouTube Channel.»
Read more details on the Department of Veterans Affairs RISE page.»
Why is VHA making such big changes right now?
VHA is the largest health care system in the country. Over many decades, layers of process built up — not because of bad intentions, but because organizations grow and change. What worked 30 years ago no longer works as well today. RISE is the effort to fix that.
"We have a sacred obligation to take care of our Veterans. That's why we're doing this."
— Under Secretary for Health John Bartrum
"I would have serious concerns that our VA doesn't exist in the future if we don't make these changes. As a Veteran, I want this system to exist."
— Chief Operating Officer Gregory Goins
Bartrum speaks to duty and mission. Goins speaks as a Veteran who uses VA health care himself. Together, they make the same point: this change is not optional. It is necessary.
Key Takeaways
- VHA RISE is the biggest VA reorganization in over 30 years.
- The goal is better, faster, more consistent care for Veterans.
- No jobs are being eliminated.
- 18 VISNs will become 5, supported by 18 Health Service Areas.
- A new Medical Operations Center will deliver clear, consistent guidance to facilities.
- Facility directors will have fewer bosses and clearer direction.
- Implementation will take 18 to 24 months — phased and careful.
- Veterans earned this care. RISE exists to honor that commitment.
What does this mean for my care as a Veteran?
Your care will not be interrupted. The changes happening under VHA RISE are above the facility level — at the regional and national levels. Your doctors, nurses, and care teams are not changing. The goal is to make it easier for them to focus on you.
"We're here to put Veterans first. This is not a benefit to them — this is an entitlement they earned by raising their right hand and swearing an oath to our country."
— Under Secretary for Health John Bartrum
"The quality of our care is far higher than the private sector in most cases. Our access is better in most cases. I don't want to lose that — but there has to be a better way of doing business to make sure it's sustained into the future."
— Chief Operating Officer Gregory Goins
Bartrum frames it as a matter of honor. Goins frames it as a matter of results. Both agree: the care Veterans receive at VA is excellent, and RISE exists to protect and strengthen it.
Will I still see the same providers at the same clinics?
Yes. The reorganization is happening above the facility level — at regional and national leadership layers. Medical centers, community clinics, and the providers inside them are not being reorganized. The changes are designed to make those facilities run better and receive clearer support from above.
Why has it been so confusing to get consistent answers from VA?
This is one of the most common and fair criticisms of VA. When a policy comes from the national level, it often reaches facilities through many channels — and gets interpreted differently along the way. That leads to 18 different answers from 18 different regions, and sometimes dozens more at the facility level.
"It's kind of like the child's game of telephone. You get a direction from the national office. Everybody interprets it their own way. And then you get 18 or 20 or 50 different approaches."
— Chief Operating Officer Gregory Goins
"When a policy is developed at headquarters, we're creating a Medical Operations Center. Those operation centers will then translate that into guidance that will go to all of the VISNs and all of the medical centers — so it will be consistent."
— Under Secretary for Health John Bartrum
Goins describes the problem plainly. Bartrum describes the fix. Together, they show that VHA leadership understands the frustration — and has a concrete plan to address it.
Will my enrollment, eligibility, or benefits be affected?
No. RISE does not change your eligibility or enrollment status. It does not affect the benefits you have earned. One of the goals of RISE is to make administrative services — like enrollment and eligibility — more consistent and easier to navigate, no matter which VA facility you visit.
"If I walk into a VA in Hawaii and enrollment falls under Health Care Administrative Service — but in Hampton, Virginia, the same office is called Medical Administration Service — that's confusing to Veterans and to the people trying to help them."
— Chief Operating Officer Gregory Goins
Standardizing names, processes, and services across all VA facilities is a core goal of RISE. Veterans should be able to walk into any VA and find the same services in the same place.
I am a VA employee. Will I lose my job?
No. VHA leadership has been direct and consistent on this point: RISE is not a reduction in force (RIF). No positions are being eliminated. Roles may shift and reporting structures may change — but the workforce stays.
"Anybody who has a job today will still have a job tomorrow. You might report to a different leader. You might be in a different organizational structure. But we are not restructuring — we are not eliminating jobs."
— Under Secretary for Health John Bartrum
"If you're in this organization for the right reasons — to serve Veterans — you have a job here. May not be for the same boss, may not be in the same department, may not even be the same title. But this organization is here to serve Veterans, and if you want to do that, we've got a place for you."
— Chief Operating Officer Gregory Goins
Same message. Bartrum delivers it as a commitment from leadership. Goins delivers it as a personal promise from someone who has worked at every level of this organization.
How will this make my job easier?
One of the biggest challenges for VA employees — especially facility directors and front-line staff — is receiving conflicting direction from too many sources at once. RISE is designed to fix that. Clearer policy, standard procedures, and a new Medical Operations Center will mean employees spend less time figuring out what to do and more time doing it.
"As a medical center director, I would get direction from a VISN, from a national program office, from policy, from the COO — and sometimes they were all in conflict. The bigger priority is always what's best for the Veteran. But as you can see, that's a big problem."
— Chief Operating Officer Gregory Goins
"This allows our providers, our nursing staff, and our ancillary staff to actually take care of Veterans and provide the care that they need."
— Under Secretary for Health John Bartrum
How long will this take? When will I notice a difference?
VHA RISE is planned to be fully implemented within 18 to 24 months. Some changes are already underway. Others will roll out in phases. Leadership has been clear that speed should never come at the cost of quality — this will be done carefully and in stages.
"We cannot be so focused on hitting a deadline that we break things that ultimately harm patients. We cannot just leave on a Friday, flip a light switch, and come back on a Monday and all of a sudden we're good."
— Chief Operating Officer Gregory Goins
"We're moving forward already. Some of these organizational changes are lift and shift — and you will see some updates because some of these will occur in early February."
— Under Secretary for Health John Bartrum
Change is already happening — but it will be done right, not just fast.
What if something does not go as planned?
VHA leadership has acknowledged openly that not everything will go perfectly. That is expected and planned for. The commitment is to the destination — not to a rigid plan that cannot adapt.
"Any time you do this amount of change, there are going to be things that don't go exactly as planned. Just like in the military — you have a battle plan, but when the first bullet fires, things almost always change. Our azimuth is still there. We're still headed to that final state."
— Chief Operating Officer Gregory Goins
VHA employees and Veterans are encouraged to speak up, share ideas, and be part of the solution. This workforce, as both leaders have said, is full of problem solvers.
RISE Update: Where Things Stand Now
Over the past year, Under Secretary Bartrum has traveled across the country, listening directly to Veterans and employees. That input — combined with thousands of hours of planning by VHA teams — has shaped the next phase of RISE. VHA is now moving from designing the structure to putting it into action.
What to Expect Next
- Senior leaders are moving into new roles under the RISE structure.
- Initial Operating Capability (IOC) launches May 1.
- Full Operating Capability (FOC) is planned for end of September.
- A new Policy Council will streamline how policies are developed and reviewed.
- A new self-inspection program will reduce the number of review teams visiting facilities.
- 90% of VHA employees in facilities will see little to no impact.
"It's like a symphony — at some point they'll all be operating together. That's when we'll hear the music."
— Under Secretary John Bartrum
"Our job is to put Veterans first. All of this comes down to that."
— Under Secretary John Bartrum
What has VHA accomplished so far with RISE?
The first nine months of RISE were spent studying other large organizations and designing the new structure. That work produced the new five-VISN model, the Medical Operations Center, a Business Operations Center, a Community Care Hub, and a Financial Operations Center. VHA then mapped every role and function in the organization to figure out where each one belongs in the new structure. Thousands of employees have been involved in that process.
"We had to look at what are the roles and responsibilities of each of these functions — and map what is a policy role versus what is an implementation role versus a standardization or execution role."
— Under Secretary for Health John Bartrum
That groundwork is now complete. VHA is moving from planning to doing.
What does "IOC" and "FOC" mean, and why does it matter?
These are military planning terms that describe how a major change rolls out in stages. IOC stands for Initial Operating Capability — the point where the new structure starts working in a limited way. FOC stands for Full Operating Capability — when the entire new structure is up and running. VHA is using this phased approach to make sure nothing breaks while care for Veterans continues without interruption.
"We're running a health care organization and we're not stopping. So we don't have room for massive errors or failures in how we implement this."
— Under Secretary for Health John Bartrum
The plan: IOC begins May 1. Full operating capability is targeted for the end of September. Fine-tuning will continue for 6 to 12 months after that.
How is VHA fixing the way policies get made?
Right now, VA policy development is slow and complicated. A single policy can take years to finalize because it is sent to all employees for comment — all 400,000 of them. That creates a bottleneck. Under RISE, a new Policy Council will oversee policy from the start, making sure the right people are involved at the right time. Policies will be coordinated with a targeted group of subject matter experts rather than the entire workforce.
"Having a structured policy approach where we streamline and do a representative sample of organizations will give us a faster feedback loop than we have today."
— Under Secretary for Health John Bartrum
The result: faster, clearer, better-coordinated policies that reach the field without years of delay.
What is the new self-inspection program?
Right now, VA program offices send inspection teams to facilities about every ten days. That is a heavy burden for facility staff. Under RISE, those separate inspections will be replaced by a single integrated self-inspection team. This team will give facility leaders a complete picture of where they stand — not just one program at a time. It will also be a resource for new facility leaders who want a full assessment when they start a new job.
"One program office was in here and told me to go right. Another program office the next week told me to go left. I don't know which way I'm supposed to go — I'm standing still."
— Facility staff member, shared by Under Secretary John Bartrum
The self-inspection program is designed to end that confusion and give facilities one clear, coordinated source of feedback.
What is the message to VA employees right now?
Under Secretary Bartrum has heard directly from employees across the country. The message back to them is clear: RISE is about empowering the people closest to Veterans — not adding more layers above them.
"We want the hospital directors to be hospital directors. We want people to know that if they have a question, they have one belly button to ask — and they can get a clear, concise answer."
— Under Secretary for Health John Bartrum
Employees are encouraged to stay engaged, follow the RISE website for updates, and trust that this process — built with input from thousands of staff — is designed to make their work more meaningful and less complicated.
Rural Health Navigation
- Office of Rural Health Home page:
https://www.ruralhealth.va.gov/index.asp - Enterprise-Wide Initiatives (EWI) page:
https://www.ruralhealth.va.gov/Enterprise-Wide-Initiatives-EWI.asp - Veterans Rural Health Resource Centers (VRHRC) page:
https://www.ruralhealth.va.gov/Veterans-Rural-Health-Resource-Center-VRHRC.asp
About This Page: This Q&A was developed using publicly available information, including VHA RISE leadership interviews featuring Under Secretary for Health John Bartrum and Chief Operating Officer Gregory Goins, available on the VA YouTube Channel. All quotes are drawn directly from public video transcripts. No internal or non-public information was used. This page was prepared with the assistance of Claude, an artificial intelligence tool developed by Anthropic (claude.ai) that is available for government use. Content was reviewed for accuracy, plain language, and neutrality prior to publication.
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