Mystery Shoppers Can Help Physicians Improve the Patient Experience

Mystery shoppers have been used for years in retail and service industries ranging from banks and hotels to restaurants and department stores. More recently, however, these faux fatales can be found in hospitals and physician offices complaining of assorted aches and pains. The AMA is considering endorsing the use of these undercover patients as a way to better gauge consumers’ healthcare experience.

It’s a development that is not sitting well with some physicians.

“People in general don’t like to be evaluated,” says Alan Cooper, MD, vice president of the Center for Learning and Innovation for the North Shore-LIJ Health System, which has instituted undercover patient programs at several of its hospitals. “Any time you get an employee review or receive feedback, it can be uncomfortable. But I don’t think [healthcare organizations] are looking to hide anything.”

Uncomfortable or not, use of undercover patients is a rapidly growing trend that can be a benefit to hospitals and physician practices alike.

Beyond patient surveys

Healthcare organizations have conducted patient satisfaction surveys for years. Cooper says it is standard procedure upon patient discharge. But in 2006, North Shore-LIJ wanted to get more of a first-person view of the patient experience, so it instituted a 1-year undercover patient program at five of its hospitals and at a sixth hospital in 2007.

“It was a great program,” says Cooper. “It confirmed what our patients were telling us in the surveys. Without a doubt, we will do it again.”

Kristin Baird, a healthcare consultant and faculty member of The Beryl Institute, a provider of outsourced customer interaction services in healthcare, says that the patient experience is different from the way healthcare providers see things, and that it’s important to see things through the patient’s eyes.

“I remember having a conversation years ago with physicians,” recalls Baird. “I asked them, ‘When does the patient experience really begin?’ And they said, ‘When the doctor walks in the door to the exam room.’ Not when the patient walks in. They didn’t know what they didn’t know. That’s the eye-opener with mystery shoppers; it’s forcing medical practice management and physicians to look at the experience through the eyes of the patient.”

Cooper echoes that it starts before the touch point between the caregiver and the patient. “How easy is it to get an appointment? How do people speak with you on the phone? How was parking [at the healthcare facility]? How was reception? All of those things go into the experience that the patient just had.”

Guarding against pitfalls

Perhaps the greatest argument against use of undercover patients is that they draw valuable resources away from needy patients. But Baird stresses that mystery patients are not sent to a doctor’s office during the busiest times, nor are they “given symptoms” that would result in costly exams or MRIs. Cooper confirms that a similar approach was taken during North Shore-LIJ’s programs.

“There was always a physician at the hospital—either the medical director of the hospital or a department head—who knew [who the undercover patient was],” Cooper explains. “We didn’t schedule the patients at the busiest times, but we also didn’t schedule them at the quietest times. They were quieter times, and there was always a safety mechanism. So if need be, the physician could step in and say wait, this is a secret shopper. Go take care of that other patient.” Some patients were directly admitted to the hospital, others came through the emergency room. “Those who came through the ER had fairly benign symptoms so we wouldn’t take resources from someone who really needed the medical care. The program was tightly controlled to avoid those things.”

Benefits for all

Baird points out that the tendency is to think of the negative where a mystery shopper is concerned; what problems were uncovered? However, the “shoppers” employed by The Beryl Institute are always asked to describe the shining moment in their experience. “Who are the shining stars, and what was it they did to make you feel so good about your encounter? You can turn that information over to the practice and say this is an internal best practice. You want to do more of this.”

Cooper agrees, stressing that all physician practices and all hospitals should conduct undercover patient programs from time to time. “Especially in a busy practice, where the doctors are so busy seeing patients that they may not know what’s going on at the front end. We’ve done this within our system for some of our out-patient locations.”

And, says Baird, physicians need to look at the bigger picture. “Mystery shopping is done to improve the patient experience, not to scrutinize the physician and give them a letter grade on their clinical prowess. And I think that’s physicians’ biggest fear.”

Ed Rabinowitz is a veteran healthcare reporter and writer. He welcomes comments at edwardr@ptd.net.