But take a look anyway, if you have an interest in process improvement in hospitals. This is a collection of my best posts on this topic.

Sunday, March 18, 2007

There is no mystery in Mystery Shoppers

Nobody wants to be thought of like Ernestine, Lili Tomlin's rude telephone operator! We have been trying to improve customer service in our hospital. Academic medical centers are often not great at helping patients navigate their way through their clinics, and we are hoping to set a higher standard at our place.

We have borrowed the concept of "mystery shoppers" from other service industries. We train people to pretend they are patients or patients' family members, and then we send them into a clinic to make observations and take notes. We also do this with our call centers, so we can see how our people serve the public on the telephone.

We then share the results with the chiefs, the clinic managers, and, of course, the front-line staff. As in the case of clinical improvements, we do not engage in the "blame game", but rather we use the shoppers' reports to offer helpful suggestions to people. Often, too, the problem is not with the front-line person, but there is some systemic problem behind the scenes that needs to be fixed.

Curious? OK, here are samples from two of our clinics. In the first, the Emergency Department after a very busy day, you can see areas for improvement. In the second, the more sedate Infectious Disease clinic, things look pretty good. (Excuse the stream-of-consciousness feel of the reports. We ask our shoppers to maintain a running commentary of what they see and hear.)

Remember, these take place in the waiting rooms -- not the patient care areas. These particular surveys are designed to review service quality, not the quality of the medical care offered in the exam rooms.

The Emergency Dept wait area is comfortable, well designed area with corner views of the Medical Center area. It is well lit with natural Department and fluorescent lighting. Area is modern but messy and dirty. On today’s visit, which occurred late in the day after the ED had been on diversion, there was litter strewn about, empty soda bottles on side tables and food crumbs all over the floor. Entryway is free of obstruction to passage. The first group of seating is reserved for patient triage. Security greeted me as soon as I entered and told me where to wait. The guard would not allow me close to the desk area unless I required nursing assistance. I wasn't sure how patients were actually checked-in, since the security guard primarily interacted with the patients who arrived and he asked them to have a seat. There is a large C shaped desk that seemed to be shared by security and nursing that was part of the wait area. Once I took a seat further back in the area I was not acknowledged again. Co-payment and referral signage were not posted. Patient Rights and Health Care Proxy information were available in various languages on a nice turnstile rack that needed restocking. There was no PRC information. Infection control information was posted throughout the area. One box of tissue was on a side table; no Calstat bottles. There is a vending machine in the back along with restrooms. Restrooms needed cleaning. General appearance of the waiting area was messy. At the check-in desk there were soda bottles and a coffee cup. Area was lacking in entertainment reading; there were a couple of old, torn magazines scattered around. Addresses were visible and there were no instructions for coping. Several informative brochures were neatly arranged on a long side table. Area had a plasma screen television which was on, tuned to nightly news. RN triage area is further along the large C shaped desk area and provides for privacy. Ten patients arrived within fifteen minutes of one another and overall the staff managed the patients efficiently through the triage area. Information regarding waits was not provided once in rear wait area. Staff was pleasant and courteous. Name tags were visible. Nursing personnel wore lab coats. At times personal conversations occurred between security and nursing but were not overheard. The security guard was chewing gum. I asked security (my only option) for directions to the cafeteria. He instructed me on how to proceed to the Farr Building then said -- "you’ll find it". My assessment of customer satisfaction in this clinic would be 3.0 -- good patient flow system but lacking in friendliness.

The Infectious Disease Clinic shares a good size waiting area with the Travel Clinic. Area is up to date, warming, inviting and comfortable. When first entering the French doors you see the water cooler and excess bottles. It does not pose an obstruction to passage. The reception assistants made eye contact with me immediately. I chose a seat in the corner as she inquired how they could be of assistance. There was no posted signage on the walls or framed on desks. Kleenex was on all side/reception tables. One Calstat dispenser was on the wall by the entrance area; no others visible in the area. Appearance of the waiting area was more than satisfactory -- clean, neat and orderly. Plenty of updated reading material for entertainment and infectious disease related. None of the magazines had stickers with copying instructions. Names were blacked out. Most of the magazines were addressed to MDs in the Lowry Building. There was no television in the waiting area, more than adequate seating and no clutter on the reception desk. A small bouquet of fresh flowers was in the room along with several healthy appearing plants. One of the staff members was caring for the plants and making pleasant small talk with those waiting. I would rate the area a strong 5 in the customer satisfaction area. There were 3-4 attendants behind the desk at all times. They spoke quietly, discreetly and professionally. None wore lab coats but were dressed in professional work attire. All had their name tags visible but I was unable to obtain names without further calling attention to myself. Twice 2 different attendants approached me in the corner and asked how they could be of assistance. Therefore, I was addressed/approached a total of 3 times in 22 minutes. One gentleman was seated several chairs next to me the entire time who was never approached. But he seemed content. One patient was identified by their first name but it was clear they had an established relationship. Physicians in the area wore lab coats, walked in the wait area to greet their patient, shook hands and lead them to the exam area. A physician approached one gentleman to offer an explanation of the wait after I was there approximately 15 minutes. As I was exiting the area I asked directions to the bathroom -- interrupting a work related phone conversation. The attendant was extremely pleasant, giving specific directions. As I was exiting the area a physician who heard my request offered additional instructions.

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