Mystery Patients Lend Eye Opening Insight into Healthcare Operations

In the January 2, 2014 Hospital Impact blog, Jason A. Wolf, president of the Beryl Institute suggested that finding the greatest opportunities for excellence and improvement in the patient experience comes back to a willingness to constantly ask questions, try new things and avoid being lured in by promises of “best practices” or prepackaged solutions.

I found Jason’s comments interesting when thinking about why more healthcare organizations don’t try mystery shopping to take their service and patient satisfaction to the next level. Unlike other service industries that routinely use mystery shopping reports to increase customer satisfaction and retention, many healthcare leaders are reluctant to take advantage of this powerful decision-influencing tool. It’s sometimes perceived negatively as a “gotcha” program rather than a way to make factual observations or a way to assess performance against standards.

The mystery shopping report

Mystery shopping reports are produced by individuals who know how to think, speak, and behave like “real” patients. These individuals have fictitious but believable symptoms, complaints or needs. Sometimes a doctor or two is involved in the plan. As ER patients, outpatients and inpatients, or as callers scheduling appointments and making inquiries, the mystery shoppers inconspicuously take notes about their encounters and observations, and turn these notes into a clear and insightful first-hand account of their entire experience. Depending on what the organization wants to know about its operations, the compilation of these individual accounts plus associated questionnaire responses are then turned into detailed reports that:

The Mystery Shopping Report: An Invaluable Tool for Revealing the Patient’s Perspective

Today’s hospital leaders are devoting significant time and resources developing approaches to better understand the key drivers of the patient experience and create a culture of service excellence. They’ve encouraged and supported patient advisory councils, focus groups, patient experience committees and hourly rounds on patients. Their staff’s are instituting daily “huddles” to keep care teams informed and focused on patient service. They’re analyzing the costs versus the benefits of patient perks such as enhancing the physical environment and ambience, creating tasty meals, adding valet and concierge services, and extending visiting hours.

What many of these leaders are not doing, however, is taking advantage of a powerful tool that affords them an unmatched view of what patients liked and disliked during random investigations of the hospital. That tool is a mystery shopping reportdetailed compilations of individual experiences created by various incognito “patients” from the time of registration or admission all the way through to discharge.

Mystery shopping reports are produced by individuals who have received specialized training on how to think, speak, and behave like a patient. These individuals have fictitious but believable symptoms or complaints. Sometimes a doctor or two is involved in the plan.

Positive Inpatient Experiences are Nice AND Necessary

The New Year brings a new change in the way DRG reimbursement is distributed. The reimbursement implications are significant, and many hospitals either have lost or will lose much needed federal funding, or collect sizeable incentive payments.

Which outcome will your hospital achieve?

As you know, one factor that determines whether your hospital receives an incentive payment or gets hit with a reduction in DRG reimbursement is inpatient satisfaction. That’s because Medicare’s Value Based Purchasing Program weighs inpatient satisfaction as 30% of a hospital’s performance score.

For this year, up to 1% of DRG reimbursement was at stake at underperforming hospitals. Next year, the percentage increases to 1.25% and increases again in 2017 to 2%. Even if yours is considered a top-performing hospital in its region, its DRG reimbursement may still be at risk because your facility is now being compared to the top 5% of ALL hospitals, with rolling benchmarks.

In anticipation of this change, hospital executives have been retraining staff and revising policies and processes with the goal of improving quality and increasing patient satisfaction at their facilities. Perhaps that’s what you’ve done, too.

My Hospital Emergency — And What I Missed

A few weeks ago I had a medical emergency and ended up being a direct admit to the hospital. I arrived at the Emergency Department in the evening and was discharged 26 hours later with a camera in my small intestine. I’m happy to say that all the testing indicates that there is nothing seriously wrong. It’s just some kind of blood vessel malformation that I’ve probably had all my life.

But the experience hit home an important lesson to me: It’s very different being a “real” patient than a “mystery” patient. As a “real” patient I didn’t feel inclined to make notes of any encounters or events. As a result, I can’t remember everything that happened or who I met during the visit; what went through my head as I was processed through registration, triage, testing, admission to the nursing unit, more testing and the inevitable waiting.

Mystery Shoppers Provide a Healthy Look at Your Medical Facility

Retail and food service organizations already know that mystery shopping is a proven way to ensure customer satisfaction and increase profits. And the same thing is true in healthcare. Whether you are currently pro or con on the subject, or have never given it any thought, we will arm you with the unbiased information you need to make the right decision about mystery shopping for your organization.

Is There a Downside?