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 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:
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:
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 report — detailed 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.
Today’s patients are armed and potentially dangerous – but not with handguns or grenades. Their weapon is the Hospital Consumer Assessment of Health Providers and Systems, or HCAHPS. And how patients respond to this standardized national survey could be risky to your facility’s bottom line.
When asked to participate in the HCAHPS survey, many patients are telling it like it is – or at least the way they perceive it to be. But perception is a problem with this tool that promises a more consistent and comparable way to measure patient satisfaction. That’s because perception is subjective, and even though participants can respond with only one of four answers — either “always,” “sometimes,” “usually” or “never” — their responses can still be skewed by their perception of how they and their care were handled.
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?
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.