Investigates the challenges that Dr. Kenneth W. Kizer confronted in seeking to create organizational change at the largest integrated health care system in North America, the Veterans Health Administration (VHA). Kizer was appointed as the Under Secretary of Health, to oversee the VHA, in 1994. Upon Kizer's arrival, it was immediately apparent that the management style that pervaded the VHA was ineffective and out of date. At the same time, the VHA faced inefficient health care delivery systems coupled with a steadily increasing number of patients. Kizer started to make plans to change the VHA into a modern, responsive, efficient, and effective health care organization. However, success in executing on his plans would require challenging a bureaucratic system with a long history. Documents progress, including organizational efficiencies gained that include consolidation of health care facilities, and illuminates leadership actions that facilitate this progress. Clearly, many challenges still lie ahead. Near the end of the case, Dr. Kizer awaits news from Congress on his reappointment for another four-year term.

Managing an organizational transformation is a risky and difficult endeavor. This article examines the lessons learned from the transformation of the Veterans Health Administration (VHA), one of the largest agencies in the federal government. The transformation, which has proven to be highly successful, has focused on changing the agency from a health care delivery system emphasizing inpatient-oriented tertiary care to a health care delivery system that can meet the growing needs of veterans for outpatient-oriented primary care. The VHA's experience reveals the importance of selecting leaders whose qualifications match the needs of the transformation, developing a coherent transformation plan, maintaining a focus on key transformation goals, and managing external changes to complement internal ones. In addition, the VHA's experience reminds us that a transformation often raises significant issues concerning employee training and education, communication with frontline employees, and the balance between centralized control and operating unit flexibility.