Patients answer patient satisfaction survey questions based on their perception, yet there is limited context for the healthcare provider. It leaves one asking the questions: who were they interacting with, what was said, when did it happen, and how capable and trustworthy was the patient in making those interpretations? So instead of convening a committee to explore the reasons for low scores, healthcare mystery shopping gives healthcare customers the investigative intelligence needed to make improvements in real time.
In an era of value-based purchasing with a focus on inpatient stays, I’ve estimated that over 80% of the lives touched by healthcare systems in this country are not patients at all, but family members, visitors, outpatients and consumers of everything. from computers to Starbucks. By all means, make the patient’s room environment as clean and quiet as possible, communicate effectively with the patient, and ensure they are fully prepared for discharge, but the emphasis should still be on patient perception. Consumer observations, opinions, and ultimately decisions are derived from that source.
The elevated importance of patient satisfaction data means that as the data is digested, more and more questions will arise. For example, a survey will tell you that there is concern about the friendliness of radiology staff. After creating an overall customer service program for the Radiology Department, the next logical step is to determine how end users perceive the department, what the department’s behavioral weaknesses are, and who among the staff exhibits those behaviors.
Together, patient satisfaction data and healthcare mystery shopping can start to focus on meaningful solutions that make providers say, “We know from patient satisfaction there’s a problem, and from mystery shopping we know what that problem is.” and who is primarily responsible”.
While it is recommended that managers seek training opportunities by observing their employees in action, they are less likely to be expected to disrupt the service culture since, for the most part, they created the culture. Because this type of research is strictly consumer insight, it provides an unbiased view of the culture of a department or organization. This gives managers a third-party perspective that increases training opportunities.
Types of Health Care Mystery Shopping
Since those early days of health care mystery shopping, requests from health care providers have become more creative, more specific, and more sophisticated. For example, a customer may request something as comprehensive as a 24-hour hospital stay where the purchaser is admitted for a 24-hour period to assess the patient experience from registration to discharge. Or buyers may be asked to call medical offices to schedule appointments to determine how long it will be before they are seen linking research to more efficient use of resources.
In 2008, health care mystery shopping received a great deal of national press when the American Medical Association attempted to take a position on the practice. What was not so easily reported was the fact that the issue was postponed indefinitely. In fact, it was already the custom for one major provider (before the accusation that health care mystery shopping was needlessly taking up doctor’s time) to use what they call process observations. This form of undercover shopping, which is most effective in emergency departments, avoids taking up valuable patient time by having a shopper join a patient as a friend as they go through the patient experience.
Two of the most beneficial types of perception research are: 1) buying the competition and 2) evaluating individual employees. Call it spying, many do, but it’s important to know the culture of your competition. For example, what do you believe and how is the patient transferred, and can anecdotal stories that he has heard be verified?
A great deal of value can be derived from conducting individual employee evaluations. For a number of reasons (cost is certainly a factor), this works best in a departmental setting and gives managers an apples-to-apples comparison of each employee against specific standards, i.e. Cindy is more likely to greet the patients that jeff. immediately (setting up a training opportunity for Jeff)? Or, does Jeff do a great job of cross-selling services and should he be commended?
Healthcare mystery shopping also provides managers with concrete examples of the specific behavior that “turns patients on.” This creates the perfect opportunity to introduce staff to behaviors the organization would like to emulate while congratulating the employee displaying them.
Quantitative and Qualitative Appeal
Healthcare mystery shopping appeals to managers and administrators, whether they are left-brained (number-focused) or right-brained (narrative-focused). On the one hand, Mystery Shopping consists of telling stories. Fred Lee wrote in If Disney Ran Your Hospital: “What seems to be a major component of both loyalty and dissatisfaction are stories. A satisfied person doesn’t have a story to tell.” Stories are important in articulating the who, what, when, where, and how of the patient or consumer experience. The right-brain approach to mystery shopping allows customers to clearly discern the difference between a completely satisfying experience and all the various facets that went into it, and those elements of an experience that triggered displeasure or frustration. At the same time, healthcare mystery shopping is an effective compliance tool. Standards that are specific to the healthcare industry and therefore comparable are combined with organization-specific standards to create a quantitative amalgamation into which data can be spliced in any way needed. Healthcare mystery shopping primarily answers the following question: How well is your organization performing on the behaviors and processes you have told your people are important? Additionally, it allows organizations to measure those standards against perception-based targets.
The flexibility of healthcare mystery shopping
Patient satisfaction surveys are, for the most part, static. They are changing for a reason. By contrast, healthcare mystery shopping is much more flexible. It can be designed as a program that measures the same standards or processes over time, or studies can be developed to determine exactly what behaviors or processes are taking place.
Healthcare mystery purchases can also be redirected ‘on the fly’ if the desired goals are not met. For example, to their surprise, a medical office that asked buyers to schedule appointments found that they were not accepting new patients. Another practice that was evaluating the customer service of its registrars found that none of the calls were being answered by a ‘live’ person. In both cases, the practice slowed down until they could fix the problem. A hospital asked shoppers to visit its website to search for specific information, and then asked for a response. What this found was that requests were piling up on a PC that wasn’t being used. This finding allowed the hospital to not upset hundreds of consumers who felt they were being rudely ignored.
How do you know if a service initiative is really working? Healthcare mystery shopping is an excellent complement to any service initiative. It can be directed in such a way that it provides real-time verification that the initiative is working. Anything from an onboarding process to valet service can be purchased at various times to ensure the message of the initiative is received and implemented.
However, the flexibility does not extend to internal programs. Sometimes, in the name of saving money, healthcare providers launch a do-it-yourself program. They try to get employees or volunteers to perform the same function that professional healthcare mystery shopping companies perform. This rarely if ever works for any length of time for obvious reasons. Insiders have internal biases and, despite their best intentions, can no longer be objective. The other reason this isn’t effective is that employees (and even volunteers) can think of a million things they should be doing or would rather be doing. And the lack of staying power for a do-it-yourself program places a huge burden on the manager assigned to manage the task.
What customers are looking for
Hospitals, healthcare systems, and medical practices seek healthcare mystery shopping providers for a number of reasons. In some cases, they want to validate “good news.” For example, a client of the health system entered into a long-term relationship with the main objective of demonstrating that her services were superior to those of the competition that she also bought. A recent targeting study of more than 300 ‘stores’ conducted for a large hospital on the East Coast found that less than 76% of its employees received a top five score for greeting consumers with a smile. This finding was indicative of a culture that did not treat consumers in “a personal and memorable way.” However, healthcare mystery shopping gave them the advantage of validating their original concern, isolating where this concern is most prevalent, and using shopper language to convey to staff why greeting people was critical to overall perception. Like satisfaction surveys, healthcare mystery shopping can track improvement over time, but with the added benefit of storytelling to identify problems. It can also be instrumental in determining the specific nature of the concern and identifying where weaknesses exist.
A healthcare mystery shopping executive, who is undergoing therapy for breast cancer, recently blogged: “What matters to healthcare organizations are things like how many steps it takes to register a patient, written greetings for frontline employees, record keeping for billing, and clinical training for new safety measures.However, as a patient, I notice if the person who signs me up for chemo smiles and greets me because they care, not if they say a sentence Next, I notice if the nurses in the chemo area are working as a team and greeting me personally (they should know me after two months). But more important to me is whether or not the clinical staff is aligned with my recovery goals “.
While this executive may be more in tune with her surroundings than most patients and can articulate what it means to her, the goal of any healthcare mystery shopping program is to utilize the shopper’s heightened sense of awareness and ability to effectively communicate their experiences in a clear and concise manner.