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.
I DO remember that there was no one in the waiting room when I arrived; that registration and triage were quick and efficient; and that the triage nurse was quite pleasant and friendly, making me feel that I had made the right decision by coming to the Emergency Department.
I also remember that — aside from the ED doctor who I thought was cold and insensitive, and the hospitalist who was in a hurry and seemed to have no interest in me — the nursing and tech staff were kind and mostly responsive. Like most patients, I could not judge the competence of the staff, and to be fair, I was placed in a monitored bed on a unit where they typically don’t care for people with my problem. But because I’m older than 39, they placed me in a monitored bed — “just in case.”
I’m telling you this personal story because it highlights why I do what I do as a mystery shopper.
Like most patients, now that I’m back to my normal routine, I can’t remember many of the specifics of my visit to the ED or my subsequent admission. I didn’t have a “bad” patient experience so I don’t feel compelled to complain about my treatment in a letter to administration or fill out the satisfaction survey from Press Ganey. Sure, I could comment that I didn’t like the ED doctor or the hospitalist, and that I waited what seemed to be a long time in the exam room without communication after the blood work was done — but I didn’t.
I recall that one of the tests ordered required that I have no red or orange jello, yet two of my trays included raspberry jello. Although eating it could have resulted in an incorrect test result, I didn’t do anything more than tell the nurse.
I don’t remember receiving any transfusion while I was in the hospital, yet a letter that was sent from the doctor who performed the tests to my primary care doctor stated that I had received two units of packed cells. (I’ve just requested a copy of my medical record to see if that actually happened.)
But if I had been wearing my “mystery shopper” hat, my companion and I would have chronicled almost EVERYTHING that happened from door to door, including every staff member and physician I encountered and at what time, what was done for me, by whom and when. Because our mystery shoppers do become ED and inpatients (though not as direct admits from the ED to an inpatient unit), hospital management would have learned not only the facts of the visit, but what was going through my mind and that of my companion during each encounter or as a result of each event.
At the end of my visit, I would have completed a detailed narrative of my experiences, completed four different questionnaires and a timeline. My reports would have been a combination of facts, and my responses to and my observations of the people, processes and events of the visit.
Management would have learned, specifically, why I described the ED doctor as insensitive and the hospitalist as uninterested. I would have documented the actual (rather than perceived) length of waiting time in the ED, the lack of communication about my admission, the “jello incident,” etc. On the flip side, I would have described, in detail, all the positive aspects of my care and the kind staff members who took care of me.
And of course, a typical mystery shopping report from my firm would reflect not just my experience, but the interactions and insights of at least two to five other “mystery patients” — assuring the hospital of a balanced and detailed view of the facility, shaped by multiple experiences with different areas of operation and staff members.
With the looming threats of reduced reimbursement under performance measures that include the patient experience, mystery shopping offers a real opportunity for hospitals to have a direct positive impact on the bottom line.