VA Midwest Health Care Network, one of twenty-one Veterans Integrated Service Networks (VISN) within the U.S. Department of Veterans Affairs (VA), oversees the provision of health care provided to veterans residing in Iowa, Minnesota, Nebraska, North Dakota, South Dakota and bordering states of Kansas, Illinois, Missouri, Wisconsin, and Wyoming. Also know as VISN 23, the  Network delivers VA's comprehensive benefits package through an integrated system of medical centers (8), community based outpatient clinics (35), domiciliaries (4), and nursing home care units (7). In Fiscal Year (FY) 2006 VISN 23 served 270,273 enrolled veterans with a budget of $1.5 billion.

       The Network's organizational structure focuses on the benefits of both a  facility based structure and a patient care service line structure.  Each facility has a "traditional" senior leadership team consisting of a Medical Center Director, Associate Director, Chief of Staff, and Nurse Executive.  An Executive Leadership Council (ELC), chaired by the Network Director, and comprised of senior leaders from across the Network, Medical Centers and Patient Care Service Lines serve as the governing body.  Three sub-councils of the ELC guide operations - the Coordinating Council, the Organizational Performance Council, and the Workforce Development Council.  Each Council includes representative from each medical center, service line, and employee bargaining unit.  Executive leadership includes Dr. Robert A. Petzel, Network Director; Cynthia Breyfogle, Deputy Network Director; and Dr. Barry Graham, Chief Medical Officer.