Health Care Taps 'Mystery Shoppers'
Wall Street Journal
By Shirley S. Wang
To Improve Service, Hospitals And Doctors
Hire Spies to Pose As Patients and Report Back
When James Loden, an ophthalmologist, recently peered into a patient's
eyes, he was evaluating her for laser surgery to correct her vision.
But her eyes were sharp enough to have already scanned Dr. Loden's
Nashville, Tenn., office, noting a small water stain on the ceiling
in the hallway, the technician's missing name tag, and that exactly
55 minutes elapsed between when she came in the door and when
she was seen.
This patient, armed with a quick smile and a hidden tape recorder,
was actually a "mystery shopper" from a service paid by Dr. Loden
to evaluate his own office. After her appointment, she sat in
her car and jotted down notes for her employer, Las Vegas-based
Examine Your Practice, which then reported back to Dr. Loden on
the experience.
"Perception is reality," says Dr. Loden, who has made a number
of changes in his practice based on reports from mystery shoppers.
"The patient's perception is all that really matters."
The health-care industry has never been noted for its customer
service. But as competition builds amid efforts to encourage patients
to comparison-shop for health care, medical facilities and hospitals
are increasingly looking for ways to improve the patient experience.
Some are turning to mystery-shopping services -- a mainstay of
the retail and hotel industries -- which send employees to pose
as customers and later report back on how they were treated.
Although health-care mystery shopping made up just 2% of the
$600 million in revenue for the mystery-shopping industry in 2004
-- the latest data available from the Mystery Shopping Providers
Association -- medical revenues doubled from the prior year. "Before
18 months ago, we hadn't had a single inquiry from health care,"
says Jeff Hall, president of Ann Arbor, Mich.-based Second to
None Inc., a general mystery-shopping company. "We fielded half
a dozen in the last year."
Health-care facilities that use mystery shoppers say the reports
have led to a number of changes in the patient experience, including
improved estimates of wait times, better explanations of medical
procedures, extended hours for hospital administration workers,
escorts for patients who have gotten lost, and even less-stressful
programming on the television in the waiting room.
One big impetus for focusing on patient experience: Beginning
Oct. 1, the U.S. Centers for Medicare and Medicaid Services will
begin assessing patient satisfaction at hospitals across the country
and making that data public. Patients can already compare some
measures of clinical care at a Department of Health and Human
Services Web site, www.hospitalcompare.hhs.gov. But the new survey
will be the first time potential patients can directly compare
satisfaction scores across hospitals nationwide.
"No one wants to be at the bottom of the list," says Brad Neet,
president of Saint Michael's Hospital in Stevens Point, Wis.,
who enlisted mystery-shopping patients in his hospital in December
2004. The experience spurred the hospital to improve how it communicates
what patients can expect during an exam, and the purpose of tests,
says Mr. Neet.
Patient satisfaction is also being incorporated more frequently
into hospital executive pay. More than 55% of hospital chief executive
officers surveyed last year have "some compensation at risk,"
based on patient satisfaction, up from only 8% to 10% a dozen
years ago, according to Mel Hall, president and CEO of Press Ganey
Associates Inc., a South Bend, Ind., company specializing in patient-satisfaction
assessment that commissioned the study.
Mystery-shopping services work in a number of ways. Generally,
the hospital or doctor's office will know only a range of time
during which mystery patients may show up, which can run anywhere
from a week to a year. In some cases patients reveal themselves
at the end of a visit. Other times the facility may never know
who the mystery patients were. Generally, patients pose as uninsured
patients, and the fees for health care are paid by the health-care
facility.
Mystery patients may make inquiries over the phone, go to a doctor's
office or emergency room for a checkup, or in extreme cases, fake
symptoms. Barbara Gerber, president of medical mystery-shopping
company Devon Hill Associates in La Jolla, Calif., says she once
kept hospital staff fooled for 12 hours that she had multiple
sclerosis so she could check out a rehabilitation hospital's inpatient
unit.
To remember details while remaining undercover, shoppers resort
to hiding tape recorders in their bags, jotting details down in
appointment books or crosswords, and going to bathrooms to take
notes.
Observations can range from the minor to the serious. Courtney
Lee once posed as an uninsured patient for 24 hours on an inpatient
unit at a Midwestern hospital for Indianapolis-based Perception
Strategies mystery-shopping service. When she asked for an additional
pillow, she says a nurse said to her, "Why don't you have your
husband or friend get you one from the dollar store?"
The hospital was also noisy, according to Ms. Lee, who got a
headache from being awakened by staffers walking into her room.
"By the time I left, I was exhausted," says Ms. Lee, who was pretending
to have the flu.
Medical mystery shopping can raise some thorny issues -- among
them the fear that mystery patients will take up time and resources
needed by truly sick patients. Mystery-shopping firms say that
when shoppers are evaluating emergency rooms, they may be told
to visit only during less-busy hours, so they won't make suffering
patients wait to see medical staff.
Hospitals and doctor's offices typically tell their staff that
mystery shoppers will be showing up (without saying exactly when)
and staff and doctors sometimes feel spied on. The medical facilities
say that staffers usually do come around and learn to appreciate
the value of improving service. And mystery patients also note
positive interactions.
OhioHealth, a nonprofit organization of 15 hospitals and other
health-care services in Ohio, began rewarding employees who got
praise from mystery shoppers with small cash prizes, gift cards,
better parking spaces, and public recognition, such as engraving
their name on a wall plaque. (The program now includes feedback
from other patients and staff, too.) OhioHealth's employee turnover
rate dropped to 11.5% in 2006 from nearly 18% in 2000, in part
due to the new incentives, says Becky Zuccarelli, system vice
president for customer service. OhioHealth spent $44,000 on mystery
shopping with Perception Strategies, which covered 240 mystery
patient visits over one year. The organization has since established
in-house mystery shopping.
When Medical City Dallas Hospital learned from reports by Devon
Hill shoppers that patients' level of psychological comfort was
low, the hospital developed new scripts for speaking with customers.
Now, rather than just asking "Can I get anything for you?" staffers
are told to add, "I have the time," according to Britt Berrett,
Medical City's CEO and president.
Medical City also simplified terminology and enlarged the font
on its signs in response to mystery-shopper complaints. Mr. Berrett
says the more than $10,000 the hospital spent on the shopper service
was "the best money I ever spent."
Dr. Loden, the Nashville ophthalmologist, responded to his shopper
feedback by spending more time with his patients during the initial,
free consultation for laser eye surgery and is addressing patient
wait times. The percentage of patients who decided after consultation
to go through with the surgery rose to over 70% in June and July
from 50% in May, which was before he made any changes based on
the shopper reports. While it isn't definitive that mystery shopping
is the reason for this increase, Dr. Loden says that he is pleased
and plans to continue hiring mystery patients on a yearly basis
as a checkup.
