Devon Hill Associates provides healthcare mystery shopping services

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 access to the participants by the ethnographers and “thick” descriptions of the feedback. Participants include “real” patients and their family members, as well as caregivers inside the facility, and sometimes after discharge. Ethnography can be quite useful in identifying patient expectations and highlighting the difference between what people say (interview) and what they do (observation).

What Are the Limitations?

With the exception of calls, the primary limitations of mystery shopping and ethnography are sample size, staff “suspicion” of the feedback, the subjectivity of analysis and not uniformly generalizable results — particularly for ethnography. Therefore, mystery shopping or ethnography may not become the sole basis for decision-making — but, rather, a key supplement to other forms of patient research and feedback.

Let us help you uncover impediments to patient satisfaction and an outstanding patient experience. Contact Devon Hill Associates at 858-456-7800 or visit our website at