Through the Eyes of Patients: Snapshots of the ED and the Floors

Management of a 250+ bed hospital was committed to improving the patient experience and overall patient satisfaction. In addition to HCAHPS reimbursement implications, the hospital wanted to be recognized as a place with a passion for making the healthcare experience an outstanding one. Management viewed mystery shopping as a next step — a way to look at the hospital’s current level of service through the eyes of patients, and to identify where improvements needed to be made.

The hospital engaged Devon Hill Associates to conduct a mystery shopping project in the Emergency Department and on two of its nursing units. Mystery shoppers, posing as real patients, presented at the ED, were triaged, assessed, seen by an Emergency Department physician and subsequently admitted to two different nursing units for 24 hours. The Emergency Room Director (a physician) and the Hospitalist were involved in the project in order to ensure that the patients were admitted.

Mystery shopping that includes a direct admit from the ED is a complicated project that requires carefully selected, seasoned, and willing “shoppers” who are able to act well enough to make their symptoms believable to staff, be willing to undergo various tests, and make copious notes while doing so. To help the patients with these responsibilities, Devon engaged mystery shopper companions who had specific responsibilities for keeping track of staff members’ names, functions, greetings, introductions, in and out times, and a variety of additional activities.

The mystery shopper patients spent several hours in the ED before being transferred to a nursing unit. One of the patients underwent a stress test as part of her stay on one of the inpatient units.

After finishing their visits and returning home, the patients’ and their companions were debriefed by Devon, and transcripts were made of the debriefings. With the help of their companions’ notes, the mystery patients completed detailed narrative accounts of both the ED and inpatient visits, plus comprehensive questionnaires. The companions created detailed timelines of both visits. The feedback provided a wealth of valuable data about the patients’ perceptions of their experiences — detailed snapshots from the patients’ point of view. Seven common threads emerged from the two ED visits and nine key finding emerged from the two inpatient visits.

The feedback from the mystery shopper patients and companions’ reports were compiled and analyzed, and two comprehensive reports were submitted to hospital executive management and the Director of Customer Service. The results were later reported out to the hospital directors and managers by this consultant at one of their monthly meetings. Appropriate parts of the reports were distributed to the Emergency Department Director, the Chief Nursing Officer and specific department directors who were then expected to address the issues identified in the reports.

Devon does not know that specific actions taken by the individual departments. Patient rounding was increased and the rounding process was enhanced. According to the project coordinator, the hospital’s HCAHPS scores improved dramatically as a result of the mystery shopping project (“our scores in Octorber for HCAHPS are awesome”), and eventually leveled off.

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Devon Hill Associates is a mystery shopping, marketing and sales training company that focuses on the healthcare and long-term care industries. We specialize in mystery shopping for hospitals, HMOs, clinics, nursing homes, assisted living and retirement communities nationwide. Devon Hill Associates is located in La Jolla, California. For information on mystery shopping and other services, call 1-858-456-7800.

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