Taking the Voice of the Veteran to the Next Level with Real-Time Feedback

A Case Study

Published by The Beryl Institute


The VA New Jersey Health Care System (VANJHCS) has long considered listening to the voice of the Veteran as an important dynamic in providing the highest quality care to those who have served our nation. In accordance with this dedication, in 2002 the VANJHCS launched a strategic plan to achieve excellence in patient- centered care (PCC). To facilitate this, employees from leadership to front-line teams were educated on the importance of a model which measures performance improvement and recognizes individuals and teams based on exceptional care delivery.

After some initial success, the VANJHCS adopted yet another improvement model to enhance their already impressive attention to the voice of the Veteran and patient-centered care. This model added elements to facilitate continuous process improvement across the continuum of care and helped to develop an infrastructure to support sustainable culture change. Even with all of this improvement, something was still missing. Leadership asserted that while post-discharge Survey of Healthcare Experiences of Patients (SHEP) scores were important for benchmarking insight, in the same manner as Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores provide the same opportunity in private health systems, that real-time insight on the Veteran experience would provide a means for faster and more relevant performance improvement. Thus, another opportunity for improvement was born.


Realizing that there was a need to more rapidly hear the voice of the Veteran through real-time, point-of- care feedback, the VANJHCS and the other VA health systems within the same VA geographic network (VISN 3), implemented TruthPoint – a technology enabled point-of- care patient feedback and performance improvement solution, allowing the VANJHCS to begin to see valuable feedback in real- time. In addition, working with TruthPoint’s Performance Improvement Coaches, a process improvement plan was developed that would foster sustainable rapid-cycle performance improvement and a more patient centered culture.

To optimize their strategy, VANJHCS implemented a performance improvement collaborative model that engaged and empowered front-line leaders and staff. VANJHCS established a team that included a TruthPoint Performance Improvement Coach, VANJHCS PCC staff and Nurse Managers from the inpatient units. This group met to identify and establish goals based on the VA SHEP data and the Attributable Effects Report.

The Attributable Effects Report provides information both about the drivers of existing satisfaction and performance elements that have the potential to bring about increases in satisfaction. Based on the team’s review, it was decided to focus on improving nursing responsiveness, a composite score that included two of the top four key drivers from the Attributable Effects Report. The post-discharge survey questions that served as the lag measures to determine Veteran satisfaction with responsiveness included:

  1. During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?
  2. How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted?

Nursing staff were empowered to identify solutions to address response times. They shared patient perceptions of responsiveness during staff meetings, implemented time standards for answering call bells, documented nursing rounds, and developed protocols for rapidly responding to Veteran needs.

The real-time Veteran insight obtained from TruthPoint was used as a leading indicator to monitor rapid-cycle improvements around responsiveness as well as to reward and recognize individual employees and teams. In an effort to improve responsiveness scores, each month the medical and surgical units engaged in a friendly competition to see who could be the most responsive nursing unit to Veteran needs. A “Traveling Trophy” award was created by this team to recognize the most responsive nursing unit based on the data for the previous month. As more and more teams rallied behind the “Traveling Trophy” program, the VANJHCS began to see increases in SHEP satisfaction data and noticed a buzz within the walls of the hospital.

Individual staff recognition was based on real-time comments from Veterans about staff that provided exemplary care. Kenneth Mizrach, the facility’s most senior leader, and Nurse Managers would then recognize individual employees in their respective inpatient units during “TruthPoint Kudos” presentations. To communicate the importance of patient-centered care, the VANJHCS employed several methods including sharing photos from the TruthPoint Kudos presentations which would then be sent to all employees in conjunction with weekly messages such as the “Quote of the Week,” which acknowledges caregivers for their dedication in delivering exceptional care. These efforts, still in place today, helped to establish a feeling of “team” within VANJHCS.

“During the course of our patient-centered journey, we have made many positive changes in the way we deliver health care to our nation’s Veterans. Now that we are able to hear our Veterans’ voices in real-time, we can see right away if our efforts are making a difference and quickly respond if needs are not being met. Our Veterans deserve no less than the best in health care.”

– Kenneth Mizrach, Director


The VANJHCS is a consolidated facility comprised of two main campuses located in East Orange and Lyons, NJ.

  • Inpatient beds = 183
  • Community Living Center beds = 251
  • Outpatient clinics = 9
  • Specialty clinics = 26
  • Employees = 3,325
  • Providers = 240 Physicians; 621 Nurses; 1,164 Other Clinical Staff; 1,177 Administrative Staff; and 123 residents

The VANJHCS was identified as a Center of Innovation for Patient- Centered Care by the VA Office of Patient-Centered Care and Cultural Transformation. VANJHCS has achieved 2013 Planetree Bronze Recognition for Meaningful Progress in Patient-Centered Care which demonstrates a significant milestone in the organization’s culture change journey. The VANJHCS was the first health care organization to be awarded Bronze-level recognition since Planetree first introduced the recognition level in 2012. VANJHCS was the first VA Medical Center nationwide to achieve recognition for its patient- centeredness, further establishing itself as a national leader in delivering Veteran-centered care.


TruthPoint partners with over 50 health care systems to improve patient experience through point-of-care patient feedback. Timely, personal and relevant feedback along with guidance from a dedicated Performance Improvement Coach empower TruthPoint clients to improve individual and team performance, care process and most importantly, help establish a more patient centered culture.

Submitted by:
Kenneth H. Mizrach, Director; Mary Therese Hankinson, Patient- Centered Care/Planetree Coordinator; Ana Paiva, Patient-Centered Care/Planetree Specialist; Daniel Lambert, Patient-Centered Care/ Planetree Specialist; Selena Balecha, Patient-Centered Care/ Planetree Specialist; Sandra Warren, Public Affairs Officer and Kimberly Decataldo, Patient-Centered Care/Planetree Specialist, VA New Jersey Health Care System

Micah Benson, Senior Performance Improvement Coach, TruthPoint



10 Improvement in Veteran perceptions of call-light responsiveness
(FY13 76.3%; FY14 86.2%)
6 Improvement in bathroom assistance
(FY13 85.2%; FY14 91.4%)

Resulting in:

9 Improvement in overall rating of care
(FY13 57.2%; FY14 66.6%)
7 Improvement in likely to recommend
(FY13 57.4%; FY14 64.2%)
Current overall rating of care and responsiveness scores are the highest in four years