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:

“Little Things” That Trigger Patient Dissatisfaction

It’s great that hospital leaders, managers and staff are doing more rounding on patients. No doubt, rounding helps staff understand their patients better and helps patients understand what’s happening to them and why. But rounding doesn’t always identify what patients or their families are thinking and feeling about the staff, systems and procedures they encounter. Things that your staff might consider trivial may actually create distress and dissatisfaction among others.

Over the many years that we’ve been mystery shopping in hospital Emergency and Outpatient Departments, and on the floors as inpatients, we’ve been able to detect certain “little things” that tend to occur frequently and make patients and families feel disrespected, dissatisfied or unimportant. What follows are the most common:

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.

Taking the Mystery Out of Medical Mystery Shopping

Since my firm first started marketing its “mystery shopping” service 22 years ago — first to long-term care facilities and retirement communities and then to hospitals and clinics across the country — we’ve discovered that it often inspires one of two strong reactions: immediate interest or on-the-spot suspicion.

Whether you love or hate the concept, mystery shopping has grown in popularity, and it’s important to understand what it can (and can’t) do for your organization. For example, it’s not a quick-fix way to identify an organization’s sales or customer service woes. Nor is it, as some employees fear, a cleverly covert way for managers to achieve their hidden agenda.