Spies in VA

Jonathan Kaupanger
March 23, 2018 - 12:51 pm

Photo by PA Images/Sipa USA


That could be a spy sitting next to you in the VAMC waiting room. Don’t worry too much though, these are the good guys – unannounced standardized veterans - and they are actually there to make your life better!

Actually, these guys are more like a retail secret shopper. A person who’s trained to go in and make sure medical staff is doing what they should be doing. 

“One thing we found is that what doctors put in the chart is often not what actually happened during a visit, “said Dr. Saul J. Weiner in an article from VA’s Research Currents.  “A physician might enter, ‘I helped the patient on smoking cessation,’ whereas maybe all they did was say, ‘you need to stop smoking.’ But they didn’t use an evidence-based approach.”  Weiner is VA’s deputy director of the Center for Innovation for complex Chronic Healthcare which is located at the Jesse Brown VA Medical Center in Chicago.

This idea isn’t new, it’s been happening in hospitals since at least the early 1970’s when a psychologist and his team posed as patients to test how well doctors could diagnose psychotic symptoms. For the VA’s purpose, it’s a bit more complicated. These actors have to be trained to act like patients and veterans. 

Often the actors are paired with veterans so they have a backstory. “It’s just like actors in a movie,” said Weiner. “If someone is portraying a Vietnam veteran, we pair them with a Vietnam veterans so they have a comprehensive backstory, and are prepared to have conversations.” 

Often the VA doctor is a veteran or comes from a military family, so when these doctors start asking too many questions, the actors are trained to deal with that too. “We give our actors techniques to deal with that type of situation,” says Weiner. “If they feel they’re getting into uneasy territory, they say things like, ‘I was somewhat traumatized, and I’d rather not talk about that.’”

And then there’s the technology side of things. The VA is set up so that random people just can’t walk in and get care. “Initially, it was really easy to create a fake patient,” said Weiner. “The recordkeeping was paper-based. Someone could show up and it was not hard to portray yourself as being a VA patient.  We could create fake notes.”

Electronic health records are becoming increasingly sophisticated, so Wiener and his team have to partner with different departments just to create fake patient records in the database. Then after the visit, the fake data needs to be deleted so it doesn’t corrupt the database. 

VA is also using these fake veterans to come up with best practices and eventually make these standard across Veterans Affairs. Last year, 30 Community Resource and Referral Centers (CRRC) had unannounced standardized veteran visits as a way to see how VA was dealing with veteran homelessness. The actors used represented a variety of veterans experiencing homelessness and each actor also  visited several different CRRCs.

In this particular test, some actors were told they had to go to VAMC’s to register for a program. Some CRRCs had shuttle busses, others did not. Once finished, the results were compiled and a process gets worked out. Based on the findings, VHA Homeless Programs Offices decided to streamline phone registration for programs and send the process out to all the CRRCs.

“What’s compelling about it is, other facilities can’t say, well you don’t understand, our patients are different,” said Weiner.  “No they’re not – we sent you the exact same patient!”