The Healthcare Entrepreneur Blog

Mystery shopping in healthcare: Helpful or harmful?

by Tannus Quatre PT, MBA | June 22nd, 2008 | 2 responses

Mystery shoppers pose as regular customers in order to experience customer service from the customer point-of-view.  Used in conjunction with satisfaction surveys, mystery shoppers help paint a picture of the actual level and quality of services provided, helping businesses to continually improve the customer experience.

I’ve seen this used in the healthcare industry, and like many standards that find controversy when applied to healthcare, mystery shopping is no exception.  Some feel that mystery shopping with sham patients may interfere with the allocation of medical resources toward patients who are truly sick or suffering.  This case is most easily understood in the emergency department where seconds are critical and spending time with a mystery shopper may take away from the true needs of other patients in critical need.

Personally, I acknowledge that there are some tricky implications associated mystery shopping in healthcare, but I don’t think they warrant a rejection of the entirety of the concept.  Mystery shopping does two very important things for service providers, regardless of industry: (1) It provides a means by which to evaluate providers to ensure they are meeting the standards expected of them, and (2) knowledge that a medical practice uses mystery shoppers to evaluate service and performance helps to encourage best practices and good service in all customer interactions.

I feel that as healthcare providers we should be held to a higher standard than found in a number of non-healthcare industries, and we should expect that our providers are ethical, patient-centric and service-oriented in all circumstances.  Having worked in a number of healthcare settings myself, I know that this ideal is very much not the case and it is our responsibility as administrators and managers of healthcare organizations to place the proper systems in place to facilitate the best service possible.

This article in the San Francisco Chronicle discusses a recent potential endorsement of the concept of mystery shoppers in healthcare by the American Medical Association (AMA).

Now the ethics council of the American Medical Association is pressing the doctors group to endorse such practices. AMA delegates are expected to vote on the proposal, along with dozens of others, during their five-day meeting beginning Saturday.

Some doctors are outraged at the idea.

Dr. Richard Frederick, of the University of Illinois College of Medicine in Peoria, called it “official deceit” that could have disastrous consequences. He wrote a commentary in May’s edition of Virtual Mentor, the AMA’s online ethics journal.

“In some instances sham patients have presented to overcrowded emergency rooms with chest pain,” he wrote. “How could the hospital administration defend this exercise to someone who suffers an adverse outcome while waiting his turn behind the person who is only pretending to be sick?”

The proposal to the AMA does include restrictions that address that and other concerns. The recommendation is to have a system that: makes sure fake patients don’t interfere with treating real ones; gives doctors a heads-up that undercover patients might be visiting; and ensures that bad reviews aren’t used to punish doctors.


Tannus Quatre PT, MBA
Tannus Quatre is a private practice consultant and principal with Vantage Clinical Solutions, Inc., a nationwide healthcare consulting and management firm located in Bend, OR and Denver, CO. Tannus specializes in the areas of healthcare marketing, strategy, and finance, and can be reached through the Vantage Clinical Solutions website.
  • Gregory D. Pawelski

    One of the problems with hospital and nursing home inspections is they depend on the paperwork to verify that patients and residents are getting good care. The facilities pay nurses to make sure the paperwork is perfect, thereby ensuring a good inspection.

    To really inspect a health facility, they should have decoy patients or residents to actually experience and observe what goes on in that facility on a day to day basis. Or else have an inspector be hired as a staff nurse and work there for a few weeks to see what is really happening.

    We are facing a huge increase in the need for quality in nursing home care. It strikes me that for the past almost eight years, our federal government has been run by an administration that has little regard for running good government. With private equity groups like the Carlyle Group taking-over facilities like Manor Care, nursing home care has gotten worse.

    The desire for profit margins translates into less staffing at nursing homes, less training for the staff that they do have, less food (or a lower quality of food) for the residents, and less management and oversight. A conflict arises between saving dollars and providing good care.
    There would be a much higher level of care given to patients if adequate staffing were provided. However, Administrators benefit from the amount of profit generated by the nursing home they manage, usually paid annual bonuses based on bed-count. They must choose between increasing the profit margins of their individual facilities or supplying more support staff for the care of residents.

    Another way residents don’t receive the care they need because of profit concerns, ranges from which ambulance service the nursing home calls, to whether or not a patient even goes to the hospital after a fall or other calamity.

    Even nursing home abuse may occur because of the desire for profit. Caregivers who work in nursing homes are often stretched beyond their ability. They try to do the best job that they can, but the lack of additional support restricts what they can do to help patients.

    You’ll never catch these discrepancies with facility inspections depending on paperwork to verify patients and residents are getting good care. Self-reported and audited paperwork (data reported by the facilities themselves and no oversight agency verifies audits to ensure that it is even true).

  • The American Medical Association provided guidelines that should be followed when implementing a mystery shopping program. (e.g. ensuring the shoppers are properly trained, ensuring shoppers don’t interfere with anyone needing real care, etc.) As long as these guidelines are followed and a skilled company is facilitating the program, the use of mystery shoppers will be a huge benefit for actual patients. It will also allow medical practices that are willing to invest in the experience their patients receive to really separate themselves.