Reforming an institution the size of the VA is extremely difficult. It may not, in fact, be possible to reform it. If it is, though, it is a monumental challenge. MikeD says it's like eating an elephant, one bite at a time. Here's his first three bites:
Every hospital administrator of a VA hospital that has hidden "bad numbers" is to be immediately fired. Their position is to be given to the next in line at that same hospital. They are to be given explicit warning that bad numbers may be concerning, but that hiding them are grounds for immediate termination. So too for the VA hospitals where patients were sickened by unsanitary instruments. That strikes me as an excellent first step.
For a second step, require all VA hospitals to undergo an investigation into their backlogs by anoutside third party agency. The days of the fox guarding the hen house must end. And for a third step (or perhaps step zero?) Shinseki must go. Period. Once again, five years is more than sufficient time to demonstrate leadership and take action to turn things around. He has done nothing but demonstrate that he is incapable (or unwilling) to do so. He must go. The fact that he has not even offered his resignation is indicative to me of his attitude towards command. He does not accept an OUNCE of responsibility for the malfeasance that has occurred under his watch.