I read a post this week on the Society of Participatory Medicine’s blog about a nightmare attempt to obtain medical appointments as new patients. You’ve faced the poor listening skills, conflicting information about the availability of appointments, lack of sharing information about you within the clinic or insurance company, poor or no follow-up, waiting, waiting, waiting, that the author describes.

I’ve dealt with it, too, as a patient, caregiver, clinician, and quality management leader. So, how do health care clinics and insurance companies know about the challenges their patients/customers live through? The most common is through surveys. Surveys are blunt (not sharp) and fairly useless. Most health plans require clinics to administer the CGAHPS Clinician and Group Survey. Three questions on the survey include:

  1. Patient got appointment for urgent care as soon as needed
  2. Patient got appointment for non-urgent care as soon as needed
  3. Patient got answer to medical question the same day he/she contacted provider’s office

You can answer Never, Sometimes, Usually, Always.

Most health plans survey patients about health plan service:

  1. In the last 12 months, when you needed care right away, how often did you get care as soon as you needed?
  2. In the last 12 months, how often did you get an appointment for a check-up or routine care at a doctor’s office or clinic as soon as you needed?
  3. In the last 12 months, how often was it easy to get the care, tests, or treatment you needed?

See, not very informative. A score might be more than 80% of patients say Usually or Always? That could mean that 19 of 100 people responding are unhappy with their experience. Wow. How can anything be changed based on that result?

A person could write a comment on the survey, the person on the phone gave me wrong information. Takes maybe about 1 to 10 minutes. As a quality management lead, I closely examined comments written on surveys. These comments are more informative than scores, especially when the writer leaves their name and we could follow-up. Someone can complain. That can take from about 10 minutes (if you know who to call, what their number is, and have your rap down) to many hours (if you don’t). I combined complaints and comments to better inform survey results. Complaint management is labor intensive and valuable.

Another approach is Mystery Shoppers. According to Wikipedia:

Mystery shopping (related terms: mystery consumer, secret shopper) is a tool used externally by market research companies, watchdog organizations, or internally by companies themselves to measure quality of service or to gather specific information about products and services. The mystery consumer’s specific identity and purpose are generally not known by the establishment being evaluated. Mystery shoppers perform specific tasks such as purchasing a product, asking questions, registering complaints or behaving in a certain way, and then provide detailed reports or feedback about their experiences.

According to a Beryl Institute White Paper mystery shoppers can be on-site as a patient or visitor, be a prospective employee or have a phone encounter.

“Patients” will use real life situations tailored to each particular area of the organization, from a physician’s office to the emergency department, to inpatient and outpatient settings. These mystery “patients” may have another mystery shopper accompany them as a family member in order to supply additional details from that important point of view. Visitors’ Perspective Mystery shoppers who are “visitors” to the facility can provide general impressions about directions, clear signage, atmosphere and housekeeping. They may spend time in public areas, listening to and observing staff interactions and other customers’ reactions and comments. A mystery visitor may act as if she is lost in order to assess how well employees respond to both unsolicited and solicited needs.

Another valuable source of information is the mystery shopper who poses as a “prospective employee.” Does the organization seem welcoming to the job-seeker? Are his potential co-workers professional in their interactions? How easy is it to find and fill out a job application, either in-person or on-line? How quickly does the organization respond to an on-line application? When organizations spend upwards of one hundred thousand dollars on employee recruitment, it is wise to assess what happens when a prospective employee makes contact.

Phone-in mystery shoppers will have different criteria than in-person shoppers, but are able to glean a number of important details from a phone call to the switchboard, department, call center or office. How many rings it took to get an answer, how many times they were transferred, how long they were on hold, how soon they could schedule an appointment — all of these details can shed revealing light on customer experiences. The caller will also determine how the phone call influenced her attitude toward future contacts. A mystery shopper will grade the organization on this question: “Based on this phone encounter, how likely are you to make future contact with this clinic?”

None of this is any good if the organization lacks the commitment to change workflow or training to correct the problems they learn about through surveys, comments, complaints, or mystery shoppers. It’s actually the rare organization that has that commitment to change. Change is tough.