Why we love mystery shoppers (And you should, too!)

Mystery shoppers can reveal provider organization's hidden patient experience problems

A friend recently told me about her 100-year-old mother who had undergone successful surgery. While she was thrilled that her procedure went well and she was going home, what she couldn't stop raving about was the special care she received from the nurses. They came into her room and saw how distraught she was about how her hair looked. So they arranged to have it styled before she left the hospital, ensuring that she'd look great returning to her nursing home.

Exceptional patient experience, you ask? Yes, and it was the most memorable part of her hospital stay. In fact, she told everyone at the nursing home about it. Is that how you and your nurses worry about your patients? Do you aim to have them feeling better and looking better? Do you want them raving about the care they received, but even more about the caring that you promise and the compassion you showed? Isn't that really what a great patient experience is all about?

Kaiser Health News recently ran an article about hospitals, such as Inova in Falls Church, Va., and Cleveland Clinic, hiring executives from the hospitality industry to create and finally deliver on the exceptional patient experience. While hospitals have hired from hotels for a long time, the renewed interest in hospitality recruiting stems in part from the Medicare penalties for poor HCAHP scores. There's finally a realization that the patient experience really does matter and healthcare institutions, such as Cancer Centers of America, are getting it right.

Moreover, patients can easily scan the online Medicare results to evaluate institutions. As competition for inpatient revenues intensifies, so will demands for appropriate, person-centered experiences. I do not say "patient-centered," because this is far more about the person, as they told us in our recent research. "I am not about 'patient-centered care' or 'doctor-focused' or even 'dollar-focused' care. I am a 'person.'" That pretty much sums up what most people told us.

It's that entire experience from how the phone is answered to how staff interacts with and cares for the person, to how the care is continued at home. It's far more experiential and intangible than the clinical delivery of care – although that's all part of that hospitality experience.

What far too many healthcare organizations, be they hospitals or physician offices, fail to recognize is that people judge the intangible experience as a reflection of — and at times even more important than — the clinical skills of the practitioners treating them.

Hotels continuously change their lobbies and the entire hospitality experience as they compete for guests, knowing that many choices exist. Several years ago, Marriott had anthropologists conduct research in their lobbies to see what was actually happening. What they found was very unsettling. People were rearranging the furniture, so they could sit together. They needed plugs for their electronics but could not find any. Meetings were taking place in makeshift arrangements. This research spurred a system-wide redesign of Marriott's lobbies, including the addition of food centers and meeting areas.

Healthcare is now competing for new consumers with more choices, large out-of-pocket deductibles and strong opinions they're willing to share with friends, families and their social communities. In social media, it's no longer what you say about your institution that matters most. It's what people say about your institution that will really drive other people toward your care — or away from it. And once stories of disappointing experiences go viral, they never really go away.

Here's what you should consider when you're ready to diagnose and improve your person-centered experience — that one you once thought was "patient-centered." And this is why we love mystery shopping and you should as well.

1. Don't ask people what they want. They can barely tell you what they get.

Henry Ford put it best over 100 years ago: "If I had asked people how to improve their transportation, they would have told me to make their horses go faster!"

The human brain is great at seeing what it wants to see and discarding the rest. That lovely elderly woman we mentioned could hardly tell her nurses she wanted a hair wash and a stylist. She just wanted to look pretty going home.

Let me give you another example of the problem. One terrific example surfaced in Price Waterhouse Coopers' 2012 research on customer experiences in healthcare. On a basic questionnaire, a patient gave a hospital low scores for room cleanliness and was contacted later to find out why. It turned out that he actually thought the room was clean, but he was bothered by the cleaning schedule and expected one similar to what you would find at a hotel.

Instead of several people appearing at different times of the day and night to clean the bathroom, change the sheets, remove food trays or perform similar functions, he wanted one major visit each day where everything was cleaned. The nuances behind what he considered a clean room could only emerge through a more careful examination of his experience.

Some surveys are fine, but they limit what you ask and what you can learn. Let's think beyond the survey solution for that diagnosis of the person's experience.

2. Mystery shopping matters. You have to see it to believe it!

As anthropologists, we know from our training that to really "see what's happening" you have to observe it with an outsider's eyes. We're advocates of living the experience and turning to mystery shopping.

Mystery shoppers offer an unvarnished view of your patient experience, as their observations encompass all of the little things — both negative and positive — that are often overlooked when you ask patients their opinions on a survey.

Kris Baird, president of The Baird Group and a national expert in mystery shopping for healthcare organizations, recently conducted a webinar on the virtues of mystery shopping as part of our series, Healthcare Innovation: Trends from the Trenches.

During her webinar, she shared that "the way we got into mystery shopping 20 years ago was that we started realizing people would not accept the data at face value and see their patient satisfaction as anything other than positive. So we started to work with qualitative research to help bring the stories to life: with focus groups, with in-depth interviews, and then with mystery shopping."

Mystery shopping examines a hospital's culture to see how its values are working — and where they could be improved. That's largely because the culture — how the hospital gets things done — has the largest impact on the patient experience.

To illustrate this point, Ms. Baird told us about a large academic medical center that asked her to assess the reasons why constant complaints were issued from potential patients calling the organization seeking help with their ailments.

Ms. Baird captured hundreds of calls to this medical center over six weeks, where mystery shoppers ranked the following: the greeting, the closure, friendliness, sincerity, and empathy, as well as call center representatives' knowledge and their ability to ask appropriate questions.

Finally, mystery shoppers were asked: "How likely are you to seek future care at this organization?"

The results were overwhelming. A whopping 46 percent of mystery shoppers said they were unlikely to ever call or seek future care at this organization.

This statistic encouraged Ms. Baird to dig deeper. She talked to the head of the switchboard, who explained that call center employees "were measured on getting rid of the caller in 15 seconds or less."

These employees were simply following the hospital's rules. They passed the calls off as quickly as they could, even if those calls landed with the wrong hospital contacts.

Just imagine the impact that policy had on the organization's revenue stream. Chances are good that they lost almost half of their potential customers before they even walked in the door.

So the mystery shoppers learned why so many callers complained — which was the original goal of the exercise. But their research showed so much more — it exposed practices that might have promoted efficiency, yet ultimately backfired by polluting the patient experience, sending nearly half of the callers elsewhere for their care.

The mystery shoppers' findings also pointed to key solutions that the hospital could use to resuscitate the ailing patient experience.

Cringe-worthy problems can lead to the best solutions

While many of these findings from mystery shopping exercises could make healthcare practitioners and administrators cringe, the time is right for them to see their patients and their practices with fresh eyes. We don't see things as they are; we see them as we are. And we don't look so good.

The only way to tackle problems with the patient experience is to find and recognize those issues first, and then learn enough about them to implement lasting solutions.

For more information on mystery shopping, feel free to email me at asimon@simonassociates.net. You also can go to our webinars section at simonassociates.net and view our webinar with Kris Baird.

Either way, I'm confident that you'll see why we love mystery shoppers and you should, too.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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