By Camille D. Ford | November 2025
Summary
Dr. Elizabeth Burke, Chief of Quality and Patient Safety at VA Tennessee Valley Healthcare System, transforms her grandfather’s warning to never work at VA into a decades-long mission to make veteran care so excellent that families choose it first. Leading more than 100 process improvement projects in fiscal year 2025 alone, she helped elevate TVHS to a five-star rated health care facility from the Centers for Medicare and Medicaid (CMS) Services. Her philosophy: quality work is about creating unwavering excellence that veterans can trust.
The Warning That Became a Mission
Dr. Elizabeth Burke’s grandfather was a career Army veteran. He saw things during his service that he never fully shared, experiences that shaped him in ways his family could only glimpse. He always told his granddaughter clearly: never visit that VA hospital. Never work there.
Most people would have listened. Dr. Burke did the opposite.
“I always knew I wanted to work for VA,” Dr. Burke recalls. “I remember growing up, he told me, ‘Never go to that VA hospital, never work there,’ and I thought, hold up. Hold on.”
The more Dr. Burke learned about VA, the more she felt it. That pull. That mission. “I had that feeling, like, I’ve got to make it better. I’ve got to want my family to come here.” Her grandfather went to VA once. He never went back. He passed away when Dr. Burke was in middle school, and that loss crystallized something for her. She would spend her career making sure no other family felt what her grandfather felt.
“I always had that passion for making things better,” Dr. Burke explains. “Having some connection with the military, I felt like this was the way that I could do it. And I always knew I wanted to work in quality, even going through school and getting to the next steps. So, he’s really the reason why I did it. I wanted it to be an excellent experience and a safe experience for everybody.”
Dr. Burke started as a psychiatric nurse practitioner, but she always knew where she was headed. Her grandfather’s criticism became her calling. His warning became her mission statement. Every patient she would help, every system she would improve, every protocol she would strengthen would be an answer to that warning from decades ago.
Beyond the Checklists
When most people hear Chief of Quality and Patient Safety, they think checklists and compliance. The person who catches you doing something wrong.
Dr. Burke sees it completely differently.
“Of course, there will always be checklists and metrics and all of that, but really, you’ve got to get to the why,” Dr. Burke explains. “Why are there all of these checklists? Why are all of those things that we’re looking at? It’s because there is research to support that these things matter.”
Every checkbox represents a lesson learned. Every protocol reflects research. Every safety measure exists because somewhere, someone learned the hard way what happens when you skip that step.
“There’s research behind checking the expiration dates,” Dr. Burke says. “There’s research behind doing things a certain way. There are many lessons that we have learned through failures and successes, and we want to repeat the successes. That’s why we have regimented ways to ensure that we are doing the best possible things for veterans.”
That regimentation is not about control. It is about care. It is about taking the collective wisdom of health care research, the painful lessons from past errors, the proven protocols from successful outcomes, and building them into systems that protect every veteran who walks through the door.
Excellence in Everything
TVHS is working toward becoming a High Reliability Organization, striving for continuous improvement and the highest possible standards in everything they do. What does that commitment to excellence look like in practice?
“You would see teammates working together, and everybody on the team having a voice,” Dr. Burke says. She points to the principle of deference to expertise. The concept is simple but powerful: you defer to whomever has the expertise in that specific situation.
Sometimes that is the nurse. Sometimes that is the physician. Other times it may be a clerk, an environmental management specialist, or an engineer. “You will see a partnership and a leaning into the expertise that each of the team members have,” Dr. Burke explains. “It’s having that team-based approach, and we’ve really focused on clinical team training so that we’re all on the same page about where we’re going.”
Excellence is not about one person knowing everything. It is about every person knowing their part and respecting everyone else’s expertise.
Five Stars and What It Really Means
TVHS recently earned a five-star rating from the Centers for Medicare and Medicaid Services (CMS), the highest quality rating a health care facility can earn from CMS. The achievement represents years of work across mortality rates, readmissions, patient experience, timely and effective care, and safety measures. It is the kind of recognition that some facilities chase for decades without achieving.
When asked what the achievement means to her, Dr. Burke does not talk about rankings or bragging rights.
“It’s really about being a learning organization that has a partnership with the team members and pride in striving for excellence,” Dr. Burke says. “We will make mistakes, but it’s how you learn from those mistakes. How do you continue to get better? We will continue to learn, no matter what. I mean, we’re five stars now. Yes, of course, we are so proud.”
But Dr. Burke emphasizes this is not about individual achievement. “This is a team effort. This is not about one person or one group. Everybody is striving toward the same mission. That’s really what it means to me. We have some excellent, excellent staff who care, and you cannot teach caring.”
That last line hits differently when you understand Dr. Burke’s story. Her grandfather encountered a VA where people did not care, or at least where that care was not evident in his experience. He made one visit and never returned. Decades later, his granddaughter helped build a VA where caring is not just present but unmistakable, measured, and celebrated.
Building a Just Culture
High reliability organization is built on a culture where everyone from surgeons to housekeeping feels empowered to speak up about safety concerns. That sounds good in theory. Actually building that culture is something else entirely.
How do you get people to report concerns rather than stay silent?
“We have such great leadership support, number one,” Dr. Burke says. “Number two is that it’s not punitive. So, if you say something, you have the ability to stay anonymous, but actually, most people don’t because they feel empowered to speak up.”
TVHS calls it a “just” culture. People always feel like they can speak up, say something, do something. But the crucial part is what happens next. Leadership does not just listen. Leadership acts.
“They’re active listeners and they do something,” Dr. Burke clarifies. “They see something, they say something, they do something, and they really follow through on the situation.”
When people see that speaking up leads to actual change rather than punishment or dismissal, they keep speaking up.
The proof is in the numbers. Since Dr. Burke has been in her role, TVHS has seen a significant increase in safety reporting. More reports do not mean more problems are happening. They mean people are actually saying something about what they see.
“The more reports that you have, the better the health care industry will be. All of these things have happened for years in health care,” Dr. Burke explains. “The difference is when people say something, we are able to learn, inquire, and improve.”
Dr. Burke has also seen more transparency and more difficult conversations happening. Problems are not hidden. Mistakes are discussed openly. Improvements are implemented visibly. That transparency is not comfortable, but it is necessary for continuous improvement.
The Consultants, Not the Police
Quality and safety work often means delivering hard truths and uncomfortable feedback to clinical teams. How do you hold people accountable while maintaining trust and collaboration? How do you point out problems without becoming the enemy?
Dr. Burke reframes the entire question.
“I think that we’re more consultative in our group rather than accountability-focused,” Dr. Burke explains. “What that means is that we make a lot of recommendations to leaders. We make a lot of recommendations to frontline staff. We really focus on getting the stakeholders together.”
Dr. Burke sees her team as the people who connect the dots. “I feel like we’re the people who connect the dots or help connect the dots,” she says. They get nursing together with engineers. They get the prosthetics department with whomever else they need to talk to. Different departments have little pieces of information, fragments of the puzzle. Dr. Burke’s team assembles those fragments into a complete picture and helps people take action based on what they see.
“It’s not really about accountability per se from a quality standpoint,” Dr. Burke says. “It’s about being consultative so that we get the best outcomes for the patient. It’s not about discipline. It’s not about getting people in trouble. I think that is a misconception about quality, or it can be.”
Dr. Burke and her team demonstrate a proactive and results-driven approach. Their goal is to get people to make changes, to implement improvements, to solve problems collaboratively. “That’s our goal. We’re action-oriented folks,” Dr. Burke says. The emphasis on consultation rather than enforcement changes everything about how her team interacts with the rest of TVHS.
One Hundred Projects and Counting
When asked about a small system change or safety protocol that had a surprisingly big impact on veteran outcomes, Dr. Burke laughs. Not because she does not have examples, but because she has too many.
“I’m struggling so much because we literally have hundreds,” Dr. Burke says. “I cannot choose one.”
In fiscal year 2025 alone, TVHS completed over 100 lean projects. That means over 100 different staff members helped guide, lead, and implement data-driven process improvements. The work was not concentrated in Dr. Burke’s office or limited to the quality department. It happened everywhere, across every unit, driven by frontline staff who saw opportunities to make things better.
Dr. Burke oversees not just patient safety but also Systems Redesign, a Lean Methodology program that trains and mentors frontline staff across the facility to develop continuous process improvements. The program gives staff the tools and permission to fix the problems they encounter every day.
“So, within patient safety, we also have Systems Redesign, which is a Lean Methodology program,” Dr. Burke explains. “We train and help mentor staff, frontline staff across the agency to develop continuous process improvements.”
The sheer volume of innovation happening makes it impossible to pick just one example. Every unit has stories. Every department has wins. The environmental services team improved cleaning protocols. The pharmacy streamlined medication verification. The surgical units enhanced pre-op safety checks. The outpatient clinics reduced wait times. It is happening everywhere, constantly driven by people who care about making things better.
When you have transformed organizational culture to the point where 100-plus improvement projects happen in a single year, picking one feels like diminishing all the others.
Learning From Every Case
This work can be heavy. Dr. Burke deals with errors, near misses, and harm. She reviews cases where things went wrong, where protocols were not followed, where patients were put at risk or actually harmed. Every day brings reports of complications, system failures, and human mistakes.
Dr. Burke does not approach this work with despair. She approaches it with purpose.
“I know that at the end of the day, we are going to learn something and get better for another veteran,” Dr. Burke says. “That’s the end-all, be-all. Having these instances or not, there will always be some type of good that can come from it as long as we learn from it. That’s what matters.”
The perspective is essential to work. Health care will never be perfect. Mistakes will happen. Systems will fail. People will be human. But the difference between an organization that improves and one that stagnates is what happens after the mistake. Do you hide it? Punish the person involved? Move on quickly and hope no one notices? Or do you examine it, learn from it, share the lesson, and build better systems so it does not happen again?
Dr. Burke chooses learning. Every single time. Every error report becomes a case study. Every near miss becomes a training opportunity. Every system failure becomes a catalyst for redesign. The goal is not to achieve perfection; it is to ensure that every imperfection makes the system stronger.
That mindset permeates throughout TVHS. When something goes wrong, the question is not “who messed up?” The question is “what can we learn?” Not to avoid accountability, but to focus energy where it matters most: preventing the next mistake, protecting the next veteran, improving the next outcome.
It is the same philosophy that drives the just culture that Dr. Burke and her team have built. Reporting is not about blame. It is about improvement. When staff know that reporting an error or near miss will lead to system improvements rather than punishment, they report more. When they see that their reports lead to actual changes that make care safer, they stay engaged. When they understand that the goal is learning rather than finger-pointing, they become partners in quality rather than subjects of enforcement.
Dr. Burke’s ability to stay grounded in this difficult work comes from that focus on the future. Yes, something went wrong. Yes, a veteran may have been harmed. But dwelling in that moment, letting the weight of it paralyze the team, helps no one. What helps is asking: What can we learn? How can we prevent this? What system can we build? What training can we provide? What protocol can we strengthen?
Every case, no matter how difficult, contains lessons. Dr. Burke’s job is to extract those lessons and translate them into action. That is how heavy work becomes meaningful work. That is how tragedy becomes transformation.
The Future of Safety
Looking three to five years ahead, Dr. Burke has a clear vision for what she hopes to see in patient safety and quality at TVHS.
“I would really love to see more automated, data-driven analytics that become more available,” Dr. Burke explains. “There’s a lot of effort toward artificial intelligence and really using data to support learning. I’d really love to see just continued evolution of all of the amazing things that technology can do.”
The future Dr. Burke envisions is not about replacing human judgment. It is about augmenting it. Technology that can spot patterns humans might miss. Systems that can predict problems before they happen. Analytics that can guide continuous improvement with unprecedented precision.
Right now, quality and safety involve reviewing reports, analyzing incidents, identifying trends, and making recommendations. Much of that process is manual, time-intensive, and limited by human capacity to process vast amounts of data.
Dr. Burke sees a future where artificial intelligence helps identify patterns across thousands of data points, subtle correlations between medication timing and adverse events, connections between staffing patterns and patient outcomes, and early warning signs that a process is beginning to drift toward failure.
Technology would not make decisions. It would inform them. It would give Dr. Burke and her team the ability to intervene earlier, target improvements more precisely, and allocate resources more effectively. Instead of discovering problems after they have affected multiple patients, they could identify risk factors and address them proactively.
“I’d really love to see just continued evolution of all of the amazing things that technology can do,” Dr. Burke says.
The emphasis is on evolution, not revolution. She is not imagining a future where machines run health care. She is imagining a future where technology empowers the caring, dedicated staff at TVHS to do their jobs even better, to catch problems even sooner, to protect veterans even more effectively.
That future is already beginning. Data analytics are becoming more sophisticated. AI tools are being developed specifically for health care quality and safety applications. The question is not whether the technology will arrive, but how quickly it can be implemented and how effectively it can be integrated into existing workflows.
Dr. Burke is ready. Her team is ready. TVHS is ready. They have already proven they can transform culture, implement hundreds of improvements, and achieve five-star excellence. The next frontier is using every tool available, human expertise and technological innovation working together, to make veteran care even safer, even more excellent, even more worthy of the trust veterans place in the system.
The goal remains the same as it has always been building a VA that Dr. Burke’s grandfather would have trusted. A VA where veterans receive not just good care, but excellent care. A VA where safety is not hoped for but engineered into every system. A VA where quality is not an aspiration but a daily reality.
Technology is just another tool in service of that mission. And like every other tool, protocol, and system Dr. Burke has implemented, it will be judged by one measure: Does it make care better for veterans?
Not the Bad Guys
What is one misconception people have about patient safety or quality metrics in VA that Dr. Burke wishes she could correct?
“That we are the bad guys,” Dr. Burke says immediately. “I’ve worked really hard not to be the bad guys. We’re the friendly ones.”
She laughs, but she is serious. The perception that quality and safety teams exist to catch people doing wrong, to get people in trouble, to be the enforcers, is pervasive and damaging. Dr. Burke has spent years fighting that perception.
“We are here to help,” Dr. Burke emphasizes. “We’re not here to catch you doing anything wrong. I mean, I guess you could say we’re here to catch what’s being done wrong, but the intent is to get to patient safety and to get that quality level so that we can provide excellent care for veterans.”
Dr. Burke wants health care providers, veterans, and families to understand one thing: the goal of quality and safety work is striving for excellence. “It’s an unwavering commitment to helping support the rest of the facility in providing excellent veteran care,” she explains.
“We are here to support the frontline staff. We are here to make sure that there’s integrity behind all of the work that’s done here, that there are checks and balances. Veterans can trust that there are really high standards, and we attempt to meet those high standards as well.”
A Culture Thing
“I’m just very, very proud of Tennessee Valley as a whole,” Dr. Burke says. “I’ve seen some really excellent change and improvement over the past several years. It’s not because of one person or one group. It’s a culture thing. It’s a culture change. And we will continue to improve and get better.”
That culture change is what her grandfather never got to see. He experienced VA at a different time, under different leadership, with different standards. The VA facility he visited did not earn his trust or his return.
Dr. Burke has spent her career proving that judgment does not have to be permanent. Organizations can change. Cultures can transform. Excellence can become the standard rather than the exception.
Veterans Day and the Pause That Matters
“I think it’s a day of honor and a day of just taking a breath to remember,” Dr. Burke says. “We are so busy in our work, in our lives, the chaos, the noise we pay attention to. I think that Veterans Day really gives us an opportunity to pause and remember that silence in the midst of the noise really matters.”
For Dr. Burke, serving veterans is deeply personal. It goes back to her grandfather, the career Army veteran who saw things that changed him, who went to VA once and never returned.
“It kind of goes back to my grandfather,” Dr. Burke reflects. “I have that connection so much with him. He was a career Army veteran and saw a lot. Obviously, I was too young to hear all of the stories, but I know that there were some things that he saw that other people in my life have seen, and that impacted them.”
“It just means a lot to know that I can provide care,” Dr. Burke continues. “When I was doing mental health work, and also now, I still have that ability to ensure that everybody across the facility is getting the highest quality care.”
Proving Grandfather Wrong
When asked to summarize her mission in one sentence, Dr. Burke’s answer connects directly back to where her story began. “I’ve got to make it better. I’ve got to want my family to come here.”
Her grandfather told her never to go to VA, never to work there. Dr. Burke went anyway, and she has spent years building the kind of VA her grandfather would have trusted, the kind of VA her family would choose, and the kind of VA that earns five stars through genuine excellence.
At VA Tennessee Valley Healthcare System today, Veterans and their families choose VA. Staff report safety concerns without fear. Leaders listen and take action. More than 100 improvement projects happen in a single year, driven by people who care.
That is not just quality improvement. That is redemption. That is exactly what Dr. Elizabeth Burke means when she says she had to make it better.
Resources for Veterans & Healthcare Professionals
VA Healthcare & Patient Care Services
- VA Health Care Enrollment: How To Apply For VA Health Care | Veterans Affairs
- My HealtheVet: How To Apply For VA Health Care | Veterans Affairs
- Veterans Crisis Line: Dial 988, then press 1 | Text 838255
Mental Health & Wellness Support
- Vet Centers: Find VA Locations | Veterans Affairs National Center for PTSD: ptsd.va.gov
Quality & Patient Safety
- VA Office of Quality and Patient Safety: Quality and Patient Safety (QPS) Home
- Tennessee Valley Healthcare System: VA Tennessee Valley Health Care | Veterans Affairs
VA Careers & Employment
- VA Careers: VA Careers
- Tennessee Valley Healthcare System Careers: Work With Us | VA Tennessee Valley Health Care | Veterans Affairs
About Dr. Elizabeth Burke
Dr. Elizabeth Burke serves as Chief of Quality and Patient Safety at VA Tennessee Valley Healthcare System, where she oversees risk management, accreditation readiness, infection prevention, and patient safety initiatives across two level 1A medical centers serving more than 146,000 veterans. Her portfolio also includes Systems Redesign, a Lean Methodology program that supported over 100 staff-led process improvement projects in fiscal year 2025. Under her leadership, TVHS achieved five-star CMS status, reflecting excellence in mortality, safety, timeliness, and patient experience. A former psychiatric nurse practitioner, Dr. Burke is driven by a personal mission to make VA the kind of health care system her grandfather would have trusted.
Veteran Excellence Magazine celebrates outstanding leadership in veteran health care and services.