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Patient Experience Journal
Volume 7, Issue 2 – 2020, pp. 92-94
Patient Experience Journal, Volume 7, Issue 2 – Special Issue: Sustaining a Focus on Human Experience in the Face of COVID-19
© The Author(s), 2020. Published in association with The Beryl Institute
Downloaded from www.pxjournal.org 92
Case Study
Out of sight, but not out of mind: Keeping connections alive during
COVID-19
Katie Braun, VA Pittsburgh Healthcare System, [email protected]
Abstract
The Veteran Affairs Pittsburgh Healthcare System (VAPHS) completed over 750,000 outpatient appointments during
fiscal year 2019. With changes occurring around COVID-19, VAPHS saw a significant decline in veterans on campus.
VAPHS employees are strongly connected to the mission of serving our nation’s hero’s, while veterans find trust,
support and comradery at the VA. The VAPHS Office of Veterans Experience (OVE) realized the impact that COVID-
19 isolation may have on veterans quarantined at home and seized the opportunity to continue to build relationships,
develop trust and keep connected through the VAPHS Birthday Club. Over 1,300 calls have been placed to provide a
non-clinical wellness check-in and provide a warm birthday wish. The gesture of ‘calling because we care and we’re
thinking of you’ has provided employees and veterans a way to connect on a human level during a scary and
unpredictable time. Hearing the stories of the men and women who borne the battle for our freedoms only reinvigorates
our commitment to serving. While some calls last only a few minutes, there are veterans who have requested a follow-up
call and now have a standing weekly conversation with a team member. These check-in calls have provided proactive
assistance to our veterans by initiating communication between the veteran and healthcare provider, assisting with
medication refills or updating demographic information in the chart. While these are all positive outcomes of the
program, the most rewarding are the personalized relationships being built with veterans and the happiness and
engagement of our employees.
Keywords
Patient experience, patient & family centered care, communication, COVID-19, birthday, veterans, employee
engagement
Acknowledgements
Author would like to acknowledge the original VA Pittsburgh Birthday Club team members who are dedicating their
time, efforts, and voices to this program including Mrs. Paula Bibza, Mrs. Margaret Felkay, Mrs. Marilyn Tarver-Rice.
Thank you to the interdisciplinary team of volunteers also working on this program from the VAPHS PM&R, Woman's
Health, and Prosthetic departments. A special thanks to Mr. Stanley Jarzynka, Ms. Nicole M Teuteberg, Ms. Rebecca J
Harmon, Ms. Chrisanne O McDuffie, Dr. Kaneen Allen, and Mr. Donald Koenig for their contributions and support.
Description of the Issue
The United States Department of Veterans Affairs (VA)
identifies our shared purpose as building trusted, lifelong
relationships with veterans, their families, caregivers and
supporters. This guiding principle should not be impacted
by external forces, even a pandemic. During the response
to COVID-19, VA employees across the country
continued to build these veteran centric relationships
through innovative ideas and the use of virtual
technologies despite new barriers. For some of our
nation’s veterans, they have deep connections to their VA,
the employees and to their brother and sister veterans.
Face-to-face interactions with the VA play a significant
medical and social role for those we serve.
At VA Pittsburgh Healthcare System (VAPHS), our face-
to-face interactions with veterans declined as social
distancing and measures to protect veterans and
employees were implemented during the response to
COVID-19. The VAPHS is the most complex and largest
healthcare system, consisting of two medical centers and
five outpatient clinics within the fourth Veteran Integrated
Service Network.
During fiscal year 2019, VAPHS served 79,934 unique
patients, a 1.6% increase from the previous fiscal year.
Outpatient visits for the system totaled 758,505 for the
same fiscal year. Due to COVID-19 precautions and
guidance received from VA Central Office, face-to-face
outpatient visits were transitioned to virtual appointments
or phone calls as clinically indicated. Prior to COVID-19
response measures, VAPHS, including its outpatient
clinics, conducted an average of 1,055 outpatient visits per
Keeping connections alive during COVID-19 at VA Pittsburgh, Braun
93 Patient Experience Journal, Volume 7, Issue 2 – 2020
day. In response to safety measures, outpatient visits
declined to an average of 96 per day. The VAPHS Office
of Veterans Experience (OVE) realized the potential
impact these significant changes and isolation may have on
veterans quarantined at home and seized the opportunity
to continue to build relationships, develop trust and keep
connected to veterans in a new and creative way.
Practices, Processes and Programs Applied
With the drastic change in the operations at the VA and
the impact it may have on the population we serve, OVE
considered how we could continue to support veterans
through the idea of a COVID-19 wellness check-in call
program. The goal of these non-clinical calls was to offer a
few moments of friendly conversation during this time of
isolation, uncertainty and change. We wanted to remind
the veterans they are at the center of everything we do and
provide them a little distraction from what’s going on in
the world today.
As planning progressed for the wellness check-in call
program, we needed to identify how to best focus our
efforts. In a facility the size of VAPHS, we needed to take
a targeted approach. Referrals were sought from service
lines, providers, outpatient clinic managers and social work
leaders. Those on the referred list were veterans with
known limited social support at the home, a diagnosis that
could be exacerbated during these stressing times or
simply someone that expressed feeling alone. While
obtaining referrals, we learned that our primary care
providers would be contacting our clinically high-risk
veterans, and so we wanted to expand the reach of
VAPHS by focusing on additional cohort of veterans. This
is when the idea we now call the ‘VAPHS Birthday Club’
was established. Due to COVID-19 precautions and social
distancing, we knew there may be veterans unable to be
with their families, caregivers or supporters on their
birthday. We wanted to assure they knew the VA was
thinking of them on their special day. OVE set out to
complete COVID-19 wellness check-in calls to those who
were referred but also to those with birthdays during that
month.
An interdisciplinary team helped to make this endeavor
possible. First, to acquire the cohort of veterans, we
enlisted the assistance of the local data team. The VAPHS
data team utilized a data warehouse to obtain a database of
active veterans, defined as being seen within the last 24
months, assigned to a VAPHS Primary Care team and had
a birthday in April or May. Records that had a date of
death listed were removed from the database. The results
of the data report included names of 6,778 veterans.
Next, VAPHS leadership felt it was important the
COVID-19 wellness check-in and birthday calls were
documented in the electronic medical record (EMR). This
assures the call contact is visible to the veteran’s healthcare
team, provides easier communication between service lines
and expedites potential referrals from the call. The
VAPHS clinical informatics team quickly built a template
for use along with a unique note title for documentation.
The template includes an overview of the general
information discussed on each call including resources on
Whole Health Basics and managing stress associated with
the COVID-19 virus outbreak. The contact information
for the Veterans Crisis Line and the VAPHS OVE was
also provided. The template also includes documentation
of any service line referrals which were indicated based on
the discussion, if the veteran was amenable to
hardcopy/electronic resources, if a return phone call was
accepted by the veteran and the length of the call.
Documenting in the EMR also provided the opportunity
for the team member to provide additional information
regarding the call through free text.
Measurable Outcomes
To date, the VAPHS Birthday Club has completed over
1,300 COVID-19 wellness check-in and birthday outreach
calls. Results of this initiative have been hugely successful.
Although some calls may only last for a few minutes, each
veteran we spoke to was receptive to hearing from
VAPHS. In addition to wishing veterans a happy birthday
and having pleasant conversations, during these calls the
team has been able to proactively assist with coordinating
care between primary care, behavioral health, pharmacy,
social work and the veteran. Resources on grocery delivery
or food bank services have been provided. The team has
also helped facilitate the transferring of a veteran’s care
from one VA site to another along with facilitate changes
of address or phone numbers and additions of emails to
veteran’s EMR profile. Questions regarding how VAPHS
is managing appointments, procedures, prescriptions and
the actions taken in response to COVID-19 have been
addressed during these conversations as well.
Veterans are extremely thankful for the wellness check-in
calls, and their priceless reaction to us wishing them a
happy birthday has been the most rewarding and positive
outcome of these efforts. Many veterans stated that our
call was the only birthday wish they had received, and their
surprise, gratitude and appreciation were palpable even
over the phone. Wishing a veteran a happy birthday has
provided an avenue for the veteran and caller to establish
open lines of conversation. During our conversations, we
have heard about veteran’s dogs and families, the hobbies
our veterans pursue and how they’ve been spending their
time in quarantine. Veterans have opened up and provided
insight into their time in the service, where they served and
when they served. Celebrations occurred for birthdays of
all ages, ranging from 25 years old to 102 years old, along
with a 49-year wedding anniversary.
Keeping connections alive during COVID-19 at VA Pittsburgh, Braun
Patient Experience Journal, Volume 7, Issue 2 – 2020 94
Through this initiative, two team members have built a
particularly strong connection and relationship with an 89-
year-old veteran. This veteran was surprised and happy for
the initial call, as he didn’t think anyone would remember
his birthday. He asked to be sung ‘Happy Birthday,’ as no
one had sung to him in years. Our team member happily
obliged, which ended up leaving both in tears from the
touching experience. From there, our team has provided
this veteran a weekly call, per his request outside of the
‘Price is Right’ hour, to converse about everything from
birdwatching to his previous employment to family
vacations. He often ‘plays favorites’ with the team
members and jokes about making the other teammate
jealous during their calls. He ended one call by stating, “I
love you and everything you do for us veterans.” This
veteran, along with others, are now requesting to meet the
team in person when feasible. It will be a sight to see when
the team members meet this veteran. We look forward to
expressing our gratitude for him in person one day soon.
Although some veterans may initially be cautious at the
onset of the call, it has quickly turned to surprise and
thanks for the personalized birthday wish. On occasion,
these calls have provided a personal touch resulting in a
positive outcome that influenced a VA skeptic. In
response to receiving their birthday call, a veteran
responded stating, “Wow, that was refreshing that
someone took the time to notice my birthdate in my chart.
That shows that you actually care. I want to thank you and
thank everyone at the VA. You have brought back my
faith in the VA system.” One veteran was surprised the
VA cared enough to check in on him and joked, “I was
trying hard not to like you all, and then you do something
like this and remember me on my birthday and check in to
make sure Corona didn't get me.”
Our team was excited to be a part of celebrations for a
World War II veteran that had turned 100 years old.
During the call, the veteran’s daughter shared the local
news outlets were present to provide coverage of the
veteran’s drive-by parade including a visit by the local
Mayor. The veteran stated to our caller, “This was so
much fun today. I told everyone, ‘let’s do this again
tomorrow’.” Before ending the call, the veteran then asked
OVE if we would remember to call him to help him
celebrate 101.
Implications, Suggestions and Open Questions
Moving into what the new normal, post-COVID
experience will look like is still quite uncertain. A certainty
that will remain is the VA’s desire to provide consistent,
exceptional experiences for our veterans, their families,
caregivers and supporters. The implementation of this
initiative has been an opportunity to connect, care and
own the moment with those we serve on a level that we
have not experienced before.
While the outcomes presented here have been anecdotal,
further research could investigate the impact of simple
initiatives such as this on patient perception and
experience data points within a healthcare facility. From
our experience, reaction to the call differs slightly on age.
Additional research could investigate the impact and
perception based on age and/or gender perhaps providing
information for a more targeted approach.
In addition, while the initial intent of the COVID-19
wellness check-in calls and VAPHS Birthday Club was to
be a service for veterans, the initiative has been a positive
activity for our employees as well.
Anecdotally, it has boosted moral, increased engagement
and has provided the staff with a positive outlook during
this unnerving time. A team member working with the
COVID-19 wellness check-in calls and birthday club
stated, “[Making birthday calls] has made the VA seem a
little more like working at a small private practice.” Future
research could further investigate the impact such
initiatives have on employee engagement.
With the positivity around this initiative, we recommend
facilities consider adopting similar programs to cultivate
connections with the patients they serve. Leadership buy-
in and assistance from local subject matters experts for
data retrieval and documentation were key drivers in the
building of a successful program at VAPHS. Involving
interdisciplinary volunteers has also been impactful as we
work to continue the VAPHS Birthday Club while
resuming of hospital operations. Clear expectation,
training material and having a project lead has also been
helpful in facilitating the ongoing development of the
COVID-19 wellness check-in calls and VAPHS Birthday
Club program.
Although trusted relationships may take time to build,
every interaction with our veterans has the potential to be
a positive step toward that relationship. With each check-
in and birthday call we make, we’ve taken a step in the
right direction. On a call, a veteran stated, “Talking to you
put a smile on my face. I thank you for that.” The action
of making someone smile has been a mutual one for both
those making and receiving the calls. We are looking
forward to continuing to build relationships with our
veterans through this program. And veterans are looking
forward to their next call too, with one veteran stating
“You can call me this time next year to wish me happy
birthday again!” We’ve already marked our calendars.
