There are very well documented problems at the Veterans Administration (VA) where soldiers must wait many months for treatment. The bureaucracy and politicians are almost entirely separated from the consequences of bad performance.
How can we get full focus, commitment and dedication to solving the problems ?
Legislation and hiring at the Veterans Administration should focus on hiring those with skin in the game and changing the rules to create alignment and impact for those who are fixing the problems and the results. Where possible those who work at the VA should get their own and their family medical care via the same VA system. They and their families should be in the same queue and scheduling system.
Where possible hire those who receive VA services or have close family members who depend on getting timely care.
Those who worked in the factories in World War 2 were totally committed to building quality machines and weapons. They personally knew many of the soldiers who depended upon them. Also, they recognized that if the war was lost then they would personally be at risk of being injured or killed or having their lives ruined.
Israel still has the knowledge of true peril for each person or their close family. This is why Israel with a population of 7.9 million has perhaps the second best military in the world. They get the most out of their equipment. The Israeli tanks are the most survivable for their crews. The factory workers and designers know the people in the military whose lives depend upon getting it right.
NASA in during the Gemini, Mercury and Apollo programs had those developing the systems very closely involved with the astronauts.
If those who have to fix the bureaucracy are in the same boat as the soldiers who are getting bad care then they will be truly motivated to fix the problems.
There would also need to be auditors and verifiers of no cheating in the VA system who are those with skin in the game.