could be, but my understanding is that the VA is federally funded. (which means that under Bush, its budget was ridiculously slashed - my dad fights to keep up with his ever-increasing caseload because it's easy for Republicans to slash veteran's services while simultaneously piously praising The Troops).

Even so, your point holds generally in that any given institution (whether public or private) lives or dies on the strength of its individual managers. Bad management of one VA hospital (or private hospital, as I'm sure we've also all experienced) will lead to a poor hospital.