In the era of Yelp, Facebook and online forums, where patients can report anything at all to the Googling masses; where your competitive advantage partially rests on patients’ perceptions of your listening, caring and respect, gathering detailed, objective, comprehensive and actionable accounts of patient experiences are even more important than ever. The usual research methods of focus groups, surveys family councils and rounding, etc., help in various ways, but they don’t tell the whole story of the patient experience. To do that requires a very special kind of knowledge and insight that can only be acquired through multiple and comprehensive patient experience accounts or exhaustive direct observation of people and processes. It’s why service industries such as hotels, airlines and restaurants use Mystery Shoppers to evaluate the customer experience. Today, mystery shopping is a 2 billion dollar plus industry. However, only a small amount is healthcare’s share, perhaps because its methods, benefits, opportunities and/or perceived threats are not widely understood. Whether that may be changing is unclear.
In today’s world of Facebook, Yelp, online communities, forums and rating websites, there are plenty of opportunities for patients to communicate their complaints and opinions publicly about their medical experiences — both good and bad. Yet, for the most part, patients tend to reserve their feedback for family and friends, unless specifically asked.
Barriers such as…
- Public website criteria for critiques
- Physicians’ particular sensitivities about their reputations (e.g. requiring that patients sign agreement promising not to post comments on public sites, even though these agreements may not be enforceable), and
- The “risks” to dissing providers publicly, or even, conceivably, being sued
can be deterrents to the public communication of patient complaints
In addition to the above barriers, there are the deterrents of time and energy. Creating an effective factual, verifiable description of your problem or complaint, searching for the appropriate website, or composing a letter to the hospital president, the physician or to the clinic manager take too much time, energy.
A Personal Story
I’ll never forget my experiences a couple of years ago when my husband had a life threatening bout with MRSA/sepsis. In an earlier blog, I mentioned a few of the particulars of our experience in the registration/triage areas of the Emergency Department before my husband was admitted to the hospital. But the story didn’t end there. Although he went on to be seen by a wonderful ED physician who suspected the seriousness of my husband’s condition, and to have excellent doctors in the hospital who put him on the road to recovery, when my husband was discharged 17 days later, late in the day, with a PIC line and orders for IV antibiotics twice a day from a home infusion provider — things fell apart. No antibiotics were delivered. No nurse was assigned by the home health provider to administer the first three IVs, or teach me how to do it. How did this happen?
Unbeknownst to us, the infusion company was confused about my husband’s unusual drug coverage and came to the erroneous conclusion that he had no coverage. As a result, the infusion company did not deliver the antibiotic that was ordered. Then the staff member responsible for verifying his insurance failed to inform the company’s care coordinator, the hospital or us about the problem before discharge. To make matters worse, the infusion company did not make arrangements with an approved home health company to provide the nurses who would manage my husband’s care or administer the first dose of antibiotics.
Faced at home with this stressful situation, the natural response of most patients and families would be to call the primary care doctor and/or return to the ER. But, it was evening, and my husband refused to go back to the hospital. Rather than fight that battle right then, I started making phone calls.
Fortunately, because of my prior experience in hospital management and some (limited) understanding about insurance coverage, I was able figure out whom to call, what questions to ask, what to say and what to demand. Nevertheless, it took an enormous effort on my part, including multiple phone calls, pleading, offering to pay cash for the medicine, and even screaming at people to persuade the infusion company’s regional manager to approve having several doses of the antibiotic delivered and to get a nurse from the home health company to our home late that night.
With the final ED – CAHPS survey (The Emergency Department Consumer Assessment of Healthcare Providers and Systems) expected to become mandatory sometime in late 2015 or early 2016, now is the time for hospitals to make sure they have sufficient, in-depth, feedback about patients’ perceptions of their experiences in their emergency department. The survey from CMS will assess information about the patient experience during arrival in the Emergency Department, during care, and after being admitted to an inpatient unit or discharged from the ED.
More specifically, the final surveys will ask questions about how quickly patients receive initial care, the perceived quality and timeliness of communication with nurses and doctors, wait times, medication and pain handling, interpreter services and discharge instructions — plus the overall rating of care and likelihood to recommend the hospital to others. The Centers for Medicare & Medicaid Services (CMS) is still testing the draft surveys.
Similar to HCAHPS on the inpatient side, CMS’s goal in developing the Emergency Department version of CAHPS is to better understand the ED experience from the patient’s perspective, allow for objective comparisons of the care that patients receive, and improve the quality of Emergency Department visits across the country. Likewise, a portion of Emergency Department reimbursement is expected to eventually be tied to the hospital’s ED-CAHPS scores.
The research methods that produce the richest insight into patient satisfaction and the patient experience tend to be qualitative – e.g. mystery shopping, ethnographic studies. Qualitative methods can be messy, harder to analyze and less conclusive than quantitative research, but they often provide abundant, detailed information about systems and behavior not uncovered by quantitative methods alone. When patients tell you in their own words what happened, how they perceived what happened and “why” they felt the way they did, powerful insights and actionable information emerge.
Which Technique Should We Use?
Mystery shopping — Mystery shopping uses incognito “shoppers” posing as real patients to provide detailed feedback about their experiences. The mystery shoppers make surreptitious notes about each interaction as it occurs. Afterwards, they prepare detailed reporting about their experiences. Even a small group of reports can be very useful for uncovering patient expectations and presenting a graphic picture of your strengths and opportunities for improvement.
The kinds of mystery shopping assessments DHA professionals can perform are almost limitless. Those requested most include telephone calls, outpatient, inpatient, ER, clinic and competitor visits. In most cases, the mystery shoppers proceed through the entire inquiry, scheduling, registration, treatment and discharge processes. We’ve even gone up to the point of surgery. Occasionally we have requests for observation only visits, “shadowing,” or pairing mystery shoppers as companions to real patients.
Ethnography — Ethnographic studies depend on one or more observations and interviews conducted by DHA consultants. Ethnography is a relatively long-term, labor-intensive process. It requires consent from carefully chosen participants, sufficient …
In the September 2013 issue of the Allegheny Medical Society Bulletin, Dr. Fred Rubin provides a first-hand account of his experience as a patient in the hospital where he works. He recalls the various tests, procedures, diagnosis and care he received in the Emergency Department and during his 14-day hospital stay.
Dr. Rubin describes the frustration of sleep-disrupting procedures and the helplessness he felt as he lost control of his body. In summarizing the “good and the bad” of his time spent as a patient, he concludes that his overall hospitalization was a “terrible experience.”
Although this likely wasn’t what hospital management wanted to hear, Dr. Rubin’s knowledge of the hospital’s policies and procedures — along with his expertise as a physician — put him in the ideal position to suggest changes to improve the patient experience.
I had a similar opportunity when my husband, a physician, needed emergency care last fall. My background as a hospital executive and a medical mystery shopper enabled me to “see” instances worth reporting to management as I sat by my husband’s side during his visit to the hospital’s Emergency Room, his 17-day hospital stay and discharge to home care. Like Dr. Rubin’s account, there were good and not so good experiences.
Long gone are the days when nursing applicants were the only ones that needed to create favorable first impressions during interviews.
With demand for qualified nurses exceeding supply, the tables have turned. Nowadays, qualified nursing applicants have many options when choosing where they want to spend their working hours. So, in order to attract “the best of the best,” your nurse recruitment team and processes must also impress potential applicants.
As always, nursing applicants want information about the job, the pay, and the benefits. But today’s applicants are looking beyond facts and figures to find the “right fit” when evaluating job options. Believe it or not, their initial impressions about a potential employer are often influenced by simple, subtle details such as how a staff member handles their calls, how long they’re made to wait for a response, and how communication is handled before, during and after an interview.
At all times, staff convey important messages about your organization’s culture, operations, and attitudes toward employees, physicians, patients or residents. Positive messages can influence potential applicants to choose your organization over a competitor’s.
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.