The evolution of mystery shopping for healthcare

Patients answer patient satisfaction survey questions based on their perception, however there is limited context for the healthcare provider. It leaves one asking the questions – with whom do they interact, what was said, when did it happen, and how capable and reliable is the patient to make those interpretations? So instead of setting up a committee to explore the causes of poor outcomes, healthcare mystery shopping provides healthcare customers with the research intelligence needed to make real-time improvements.

In an era of value-based purchasing with an emphasis on inpatient stays, I’ve estimated that more than 80% of people affected by health systems in this country are not patients at all, but rather family members, visitors, outpatients, and consumers of everything. From equipment to Starbucks. By all means, keep the patient’s room environment as clean and silent as possible, communicate effectively with the patient, and ensure they are fully prepared for discharge, but the focus must remain on patient perception. Feedback, opinions and ultimately consumer decisions are derived from this source.

The increasing importance of patient satisfaction data means that as the data is internalized, more and more questions will arise. For example, the questionnaire will tell you that there is concern about the radiology staff’s friendship. Rather than creating a broad customer service program for the radiology department, the next logical step is to determine how end users understand the department, what the department’s behavioral weaknesses are, and who among the staff exhibits these behaviors.

Together, patient satisfaction data and healthcare mystery shopping can begin to focus on meaningful solutions that get providers to say, “From patient satisfaction we know there is a problem and from mystery shopping we know what this problem is and who is primarily responsible.”

While it is desirable that managers look for training opportunities by observing their employees on the job, they are less likely to expect them to change the service culture because they are often the ones who created the culture. Because this type of research is strictly consumer perception, it provides an unbiased view of the culture of a department or organization. This gives managers a third party perspective that increases coaching opportunities.

Types of healthcare secret shopping

Since those early days of healthcare mystery shopping, healthcare providers’ requests have become more creative, targeted, and complex. For example, a customer might request something like a 24-hour hospital stay where the shopper is admitted for 24 hours to rate the patient’s experience from check-in to check-out. Or shoppers may be asked to call doctors’ offices for appointments with the intent of determining how long it will be before they are seen relating research to more efficient use of resources.

In 2008, healthcare mystery shopping received a lot of national press when the American Medical Association attempted to take a stand on the practice. What is not readily reported is the fact that the issue has been put forward indefinitely. In fact, it was already common practice for one of the leading providers (before the accusation that healthcare mystery shopping was unnecessarily taking a doctor’s time) to make use of what they call process notes. This type of mystery shopping, which is most effective in emergency departments, avoids taking up the patient’s valuable time by having the shopper join the patient as a friend as they go through the patient’s experience.

Two of the most useful types of cognition research are: 1) competition shopping, and 2) individual employee evaluation. It’s called spying, many do, but it’s important to know your competitors’ culture. For example, what do they believe in, how is it passed on to the patient, and can the anecdotal stories I’ve heard be verified?

A great deal of value can be gained from conducting individual employee evaluations. For a number of reasons – cost is certainly a factor – this works better in a departmental environment and gives managers an apples-to-apples comparison of each employee as it relates to specific criteria ie is Cindy more likely to take patients than Geoff right away (setting up a training opportunity for Jeff)? Or, did Jeff do a great job with cross-selling services and should be commended?

Health care mystery shopping also gives managers concrete examples of specific behavior that “motivates patients”. This creates the perfect opportunity to introduce the behaviors that the organization would like to emulate to employees while giving mentions to the employee who exhibits them.

Quantitative and qualitative appeal

Healthcare mystery shopping appeals to managers and administrators whether they have their left brain (numbers focused) or their right brain (narrative focused). On the other hand, Mystery Shopping is about storytelling. Fred Lee writes in If Disney Ran Your Hospital, “What appears to be a major component of both loyalty and dissatisfaction are stories. A satisfied person has no story to tell.” Stories are important in explaining the who, what, when, where and how of a patient or consumer experience. The right-brain approach to mystery shopping allows customers to clearly discern the difference between a completely satisfactory experience and all the different aspects that went into it, and which elements of the experience displeased or frustrated. At the same time, healthcare mystery shopping is an effective compliance tool. Healthcare industry-specific, and therefore measurable, standards are mixed with regulatory-specific standards to create a quantitative mix in which data can be broken down in any way necessary. Healthcare mystery shopping primarily answers the question – how well is your organization doing on the behaviors and processes you’ve told your employees are important? In addition, it allows organizations to measure those standards against perception-based goals.

The flexibility of healthcare mystery shopping

Patient satisfaction surveys are, for the most part, consistent. They don’t change for a reason. On the contrary, healthcare mystery shopping is more flexible. It can be designed as a program that measures the same parameters or processes over time, or studies can be developed to determine exactly which behaviors or processes are being performed.

Healthcare mystery shopping can also be “quickly” redirected if the desired goals are not met. For example, to their surprise, a doctor who was asking shoppers for appointments discovered that they were not accepting new patients. Another practice that was evaluating customer service for its registrants discovered that none of the calls were answered by a “live” person. Either way, practice put on the brakes until they could fix the problem. One hospital was asking shoppers to go to their website to look up specific information and then have them ask for a response. What this revealed was that requests were piling up on a computer that wasn’t being used. This finding allowed the hospital to avoid upsetting hundreds of consumers who felt they were being rudely ignored.

How does one know if a service initiative is really working? Mystery shopping for healthcare is an excellent complement to any service initiative. It can be directed in such a way as to provide real-time verification of the effectiveness of the initiative. Anything from unloading to valet parking can be shopped at different times to ensure that the initiative message is received and executed.

However, flexibility does not extend to internal programmes. Sometimes in the name of saving money, healthcare providers will launch a do-it-yourself program. They’re trying to get staff or volunteers to do the same job that obscure professional healthcare shopping companies do. This rarely works for any length of time for obvious reasons. Insiders have internal biases and, despite their best intentions, are no longer able to be objective. Another reason this isn’t effective is that staff (and even volunteers) can think of a million things they should or would prefer to do. The lack of viability for a do-it-yourself program also places an enormous burden on the manager tasked with running the task.

What customers are looking for

Hospitals, health systems, and physician practices seek out healthcare mystery shopping sellers for a number of reasons. In some cases, they want to validate the “good news”. For example, a health system customer entered into a long-term relationship with the primary goal of demonstrating the superiority of their services over the competition they were also marketed for. A recent benchmarking study of more than 300 “stores” conducted for a large hospital on the East Coast concluded that fewer than 76% of their employees received the highest five-point score for greeting consumers with a smile. This finding was indicative of a culture that does not treat consumers in a “memorable and personal way”. However, mystery shopping for healthcare allowed them the advantage of validating their original fears, isolating where that concern radiated from, and using the language of the shopper to inform employees why it was important for people to salute public perception. Just like satisfaction surveys, healthcare mystery shopping is able to monitor improvement over time, but with the added benefit of storytelling to identify problems. It can also be helpful in identifying the specific nature of anxiety and identifying where weaknesses are located.

A health care mystery shopping executive who is undergoing treatment for breast cancer wrote in a blog recently, “What matters to health care organizations are things like the number of steps needed to examine a patient, written greetings for frontline staff, and record keeping to make sure billing is correct.” and clinical training on new safety procedures.However, as a patient, I notice if the person checking me in for chemotherapy smiles and greets me because they care, not if I provide a written sentence.Next, I notice if the nurses on the chemotherapy field, working as a team, greet me Personally (they should know me in two months). But more important to me is whether or not the clinical staff is in line with my recovery goals.”

While this CEO may be more attuned to his surroundings than most patients and able to articulate what he means to her, the goal of any mystery shopping healthcare program is to use the shopper’s heightened sense of awareness and ability to effectively communicate their experiences in a clear and concise manner.