Mystery patients uncover flaws surveys don't find
Patients may be too nice to tell you the truth
Patients may sometimes go easy on you in a satisfaction survey. If they like their doctors, they may discount the annoyance factor of a long wait or curt receptionist.
But those flaws won't pass muster with a participant observer - better known as a mystery patient.
Medical groups use mystery patients when they want to find out more about the patient experience or gauge customer service based on set criteria.
"A patient will usually tell you what you want to hear [on surveys]," says Gale Stoner, president of the MileStone Advisory Group, a health care consulting firm in Murfreesboro, TN.
"They don't want to be confrontational. The natural tendency is to say everything's fine. When we go to a restaurant and it's a below average meal or service, we make the decision never to go back. Then the server walks up and says, `How was everything?' And we say 'fine.' People are reluctant to talk about it. They just make a conscious decision to choose another physician or another clinic," she explains.
Mystery patients can come from a consulting firm, another office of the medical group's health system, or even a college student with a script and a checklist of customer service standards.
They count how many times the phone rings before it's answered. They mark down how long it takes them to schedule an appointment and how long they wait in the lobby. They notice if the plants are dying or the staff fail to call them by name.
What are normal expectations?
"There are some things that patients may perceive as normal that really shouldn't be," says Dan Lazar, OD, chief of eye care at Capital Health Plan in Tallahassee, FL, who used Stoner as a mystery patient, then followed up with customer service training for his staff.
"I want to know as much as possible, even if it's bad, so we can work on those areas," says Lazar. Some of the issues may be minor but still contribute to an overall image. "One of our receptionists had a bag of Fritos in her jacket pocket," he says. "Would a patient comment on that? No. But it was unprofessional."
Meryl Luallin principal with Sullivan/Luallin health care consulting firm in San Diego, often visits as a mystery patient before she begins customer service training at a medical group. She is looking for aspects of interpersonal relations - body language, tone of voice, and eye contact. "Those are nuances that don't show up on a survey," she says. Yet those elements are important to the sense of rapport that patients build with physicians.
What do doctors and nurses think about mystery patients? They won't like it unless you warn them in advance and stress that the intent is to improve quality patient care, says Eugene Nelson, DSc, director of quality education measurement and research at The Hitchcock Clinic and professor at Dartmouth Medical School in Hanover, NH. "[The term] mystery shopper has a nice feel," he says. "If we called them patient spies, it would have another feel to it."
Nelson used mystery patients to study variation in preventive care services and access to appointments. He stressed the learning value of the exercise and gained physician and staff support.
Alfredo Czerwinski, MD, principal with Lawson & Associates consulting firm in Sacramento, CA, recalls a medical group that didn't prepare physicians for the appearance of mystery patients. The program ended when it provoked angry responses from physicians.
"It's important to let your workers know you're going to do it," he says. "If the intent is that it not be punitive, say so." You also may point out that mystery customers are used in other industries that put a premium on service, such a retail stores and airlines.
Your patient doesn't always have to be incognito to learn about your practice. Physicians and administrators can learn a lot just by walking through the front door and observing the waiting area, rather than coming through a staff entrance, Czerwinski notes.
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