Mystery shoppers an issue in EDs?

[DwayneEMTP]

This seems like a good idea to me. Though I also thought testing teachers regularly was a good idea...so there you have it...

Any thoughts?

http://www.emsresponder.com/article/articl...p;siteSection=1

Mystery Shoppers Uncover ED Weaknesses

AHC Newsletters

via NewsEdge Corporation

'Mystery shoppers' can uncover ED weaknesses

'Patients' present unannounced, report findings

"The next patient you see in your ED may be a "mystery shopper" — and you won't even know it. Companies, such as Devon Hill Associates in San Diego, are being retained by hospital CEOs to have individuals come to their facilities to be "treated" and to report back on their findings. The findings then are shared with the different departments in the hospital, with an eye toward improving patient safety and satisfaction.

While the individual patient/mystery shopper will not be known, the ED manager probably will not be totally blindsided. "If I'm doing it, I insist they tell the entire hospital that mystery shopping will take place as part of their quality improvement or patient satisfaction plans," says Barbara Gerber, MPH, CHE, a former hospital administrator who is founder and president of 10-year-old Devon Hill. "Usually, all department managers will know." However, she adds, the ED manager would not now the "when" or the "who" of the visit.

Gerber says a project solely involved the ED would cost between $7,000 and $10,000 and involve three to five mystery shoppers. "It's better with five," she asserts. There are a few other companies that provide similar services, she adds, including Dee Peterson & Associates in Houston, and Perception Strategies in Indianapolis.

Bruce G. Jones, DO, medical director of the ED at Doctors Hospital in Columbus, OH, says, "As an ED director, I think this is a good thing. Anything that can provide valuable information to improve your process or the physical plant or interactions with patients is a valuable thing in your management role."

Jones says there have been mystery shoppers in his department. As a physician, Jones reacts a bit differently to what he calls the "dishonesty" of the scenario. "As an ED doc, I may have seen one and not known it, and clinically thought it was really a patient," he shares.

Gerber concedes that is a valid concern. "It always comes up in the ED. People ask why they should take care of three people who are not real patients when it takes time away from treating some very sick patients," she says. "While that's valid, the CEO will respond that out of thousands of visits a year, 70% to 80% may not be real emergencies; and if the ED can't take care of three patients out of the 15,000-20,000 nonemergent patients they might see, then they really have a problem."

How it works

Gerber, who says she has posed as an ED patient many times, says her company creates a variety of scenarios. She would not, however, provide much detail.

"A lot depends on the area we are in, but in general we use scenarios where the illness or condition is such that no one will be able to pick the fact that we are not real patients," she says.

Some pseudoconditions are minor, while others are more major, she continues. "We are able to do this because we have a number of mystery shoppers who have conditions that might make it necessary to go through certain processes or procedures," Gerber explains.

There are certain issues that show up often in EDs, says Gerber. "We frequently find a lack of good communication — not letting people know how long they might expect to wait," she notes. "People are left alone in rooms with no communication for 40 or 50 minutes."

Gerber says she often has been handed a form and not been told what it was that she was supposed to be signing. "A lot of that happens with a busy ED, and staff forgets they really need to communicate," she asserts.

Discharge instructions are another area where EDs commonly fall short, she continues. "Instead of having them explained in a manner the patient understands, the provider is gone very quickly, and the patient leaves not knowing what they are supposed to do," she asserts.

Gerber has also observed a lot of little things that she would correct. For example, patients often are not offered a pillow, asked which gurney position they prefer, or asked whether they want the TV turned on. "These things would make them feel they mean something to the caregiver," she notes.

EDs take note

Several EDs visited by Gerber or her staff have made important improvements following the visit. "Some EDs have developed systems where someone on the staff makes rounds on patients every 15-20 minutes — or they might have a patient advocate or volunteer responsible for making those visits," she shares.

Her mystery shoppers frequently uncover safety issues, such staff not wearing gloves or not washing or sanitizing their hands in front of the patients. "Maybe they do it between patients, but the perception is that it is not happening," she explains. "When it has been brought to their attention, some EDs have had sanitizers installed in the rooms so the process is now more obvious."

While Jones says he has not yet received any feedback from mystery shopper visits, he prefers to take a broader, more process-oriented approach. "We track productivity per doc every hour of every day, as well as a lot of other measures," he says."

Dwayne

[Just Plain Ruff]

ok, this has disaster written all over it, mystery shoppers in the ED.

First off, you have people posing as patients when there is nothing wrong with them. They then tie up a bed that someone could use in order to critique the staff and docs.

I would be pretty upset if I'm taking care of a mystery shopper when I could be taking care of someone who is really sick.

Talk about a waste of resources

Plus, what happens with all the patient information that the mystery shopper hears, they are no way involved in patient care and they hear confidential patient info. Isn't that some sort of hipaa or pseudo hipaa violation?

But the wastage of resources that could be used better elsewhere is what gets me

[DwayneEMTP]

I can see your point Ruff, but is 5 visits or so a year really that big of a drain?

My opinion from the outside looking in...

When I did my ER time for basic, I was very curious to see what went on in the ER. It seems, as a patient way too many times growing up, that as I sat there waiting while nothing much seemed to be happening behind the glass...I had a hard time believing that was very cost efficient, so tended to think I just didn't understand all that occurred, when it appeared nothing was occurring.

So I was pretty shocked to find that pretty much nothing was going on while I was there!! The waiting room was packed full, a nurse would triage (allowing me to help) and then put someone in a room, or back out into the waiting area. Soon, the rooms were full...and I watched the Doc talking to the nurses...then he would hurry into a room...spend 10 mins or so dealing with an issue...then go back to the nurses station and visit for a half hour or so, then repeat the process. At first I though perhaps he needed to wait for an important phone call or something else that wasn't obvious...but as I paid attention I found that he was in fact just visiting.

During this first 12 hours I found that even the nurses were disgusted with him. Though there were so many nurses, 6 I think, plus two Techs (paramedics) that they seemed to want to stay busy, but with so many, and no patients going anywhere any time soon, they were mostly bored as well.

I am amazed at the wasted resources, and lack of motivation to actually move people through, as it seems that moving people through would provide the profit incentive for the hospital. I just wonder if the "mystery shopper" possibility wouldn't have been the motivation (partially) needed to operated at a more efficient level. Assuming that things happened in the ER the way I describe them it seems obvious that there are more issues here than can be solved via this method...but maybe it couldn't hurt.

Also, I am still very open to the possibility that I have no idea what was going on...I would imagine there are much smarter people than I designing the ER staffing profiles, so I don't pretend to understand everything that I saw...

Anyway...just my thoughts.

Dwayne

[ERDoc]

We already have such a program. It is called Press-Ganey (www.pressganey.com). They are the people that have hospital administrators bending over and taking it. Of course, it doesn't stop there, the rectal probing rolls downhill. The Press-Ganey surveys are based on real pts opinions and are very well conducted scientific studies. They compare your hospital to all other hospitals and to hospitals of similar sizes. Administration is so bent on getting high marks that patient satisfaction is often put above pt care (Dilaudid dispenser in the waiting room anyone?). There are so many things in medicine that are not regulated by doctors that they make caring for pts so much more difficult. Have a look at this thread from another forum to see what I mean (http://forums.studentdoctor.net/showthread.php?t=250169).

Dwayne, I'm sorry about your experience, but I can tell you that what you saw is the exception. The guy was probably not ER residency trained. Almost anyone who has been through an ER residency is obsessed with, "moving the meat," and something like this would never fly. It bothers me when there are charts in the rack.

[Ridryder 911]

Total B.S. I hope that they can "fake" their illness right into a nice medication allergy reaction. ER's is already over whelmed as it is. Here is a nice reminder to all "....Emergency Department's are not HOTEL ROOMS"... and should not be considered as one!. I got so fed up with the "fluff and puff " attitude is why I left the ER full time.

One does not have time to treat the legitimate ..sick .. patients, because I am running my arse off having to answer the ringing of nurse call lights of demands change my t.v. channel, I want something to eat, adjust my pillow...' Meanwhile, the next bed I have a GSW that requires a chest tube, the next bed to that is a AMI, and the one beside that is dental caries pain for 6 years.. Now yes, each patient received a nice little report card.. a less than excellent score was called upon and followed up. After many of us voiced anger with management, they defined our roles as more of our role is giving "attentive care, than medical care".. WTF? So, I can fluff your pillow, while the next room is not breathing?

Many nurses are leaving ER in droves due to more and more because management is more worried about their "image" instead of true patient care. Programs like that described is one the prime example. I don't care if it is only two "fake" visits a year, that is two too many. During those fake visits, means a real patient may potentially have to wait or may not be seen is it that fair to the real patients? Sure ER should ever mindful of the type of care, delivery of care, and yes they are in a customer business.. as well I am sure the demeanor of the staff will not be the same as to a patient that really needs to be there. We should not be encouraging non-emergency illnesses and injuries to seek treatment in the ER.

Now, with your whole one day whopping experience, they got to experience a slow day.. wow! Like ER Doc described, your experience was probably "unusual". I am sure if you were to re-visit them the other 360 or 364 days of the year and at different shifts it would be totally different.

This is typical, like management; people judging things they do not really have a clue about... It is the the same as people judging EMS personnel should be busy all shift long non-stop. That you really don't need ALS personnel on all calls, since < 10 % require ALS.

One should be ever mindful of how to improve things but do it with some forethought and reasoning. The funny thing is after most management receive the report card it and the suggestions on how to "fix it" They will only find out they should increase staff members, have less patient to staff ratio, deter "non-emergency patients' .. and then management will describe they have no "financial means for that"; of course the costs of these "satisfaction" programs would had helped pay for the off set.

R/r 911

[Timmy]

Guys lets face it, I bet an overwhelming majority of hospitals all over the world have these very same problems. There will always be nursing shortages, more patients, not enough money, increased work load, hypochondriacs ect ect ect but in reality there’s not much we can do about it. This problem has faced health care systems for many years and still nothing has been done about it and I’m sure nothing will be done about it in the future. Sure it’s hard on us and hard on the patients but we must learn to deal with it.

Take my local hospital, a rural acute care 19, 5 surgical and 3 ED beds. Day shift has 5 nurses, afternoon 3 nurses and night 2 nurses. Friday is surgical day so they have extra staff on. Now when I was on clinical placement it was madness. 5 nurses to run 19 beds and ED. Yeah sure it was stressful but we copped, patient care was never questioned, I know it’s different to the big trauma centers and everything but we need to make do with what we’ve got and I’m sure if it was a massive problem then more people would carry on about it and possibly something may be done.

If hospitals want to send in fake patents or what ever who am I to stand in there way.

The next question we should ask is, they’ve got there data, would they actually make any changes to the ED or just sit there and talk about making things better like they normally do??

But I do agree, kind of a dumb idea.

[Cookie]

$7000 to $10,000 cost!!! And Hospitals cutting everywhere they can, yet they can afford this expense. Really Really Stupid.

I have a deep hatred of mystery shoppers of any kind any where.

[Dustdevil]

Ha! I was a mystery shopper for Home Depot one summer in college. Good times!

Dude, if their patients are only having to wait 40 or 50 minutes, they're obviously not coming to the hospitals in Dallas - Fort Worth! Two to four hours is about average here. And that is AFTER you've been triaged and put in a room! :?

And then you only get to see some PA who doesn't know jack and just sends everybody home with ibuprofen. :roll:

[Just Plain Ruff]

i agree D- 5 visits a year is not that much but it's a huge deal to the old man who has pneumonia and has to sit out in the waiting room for hours so this "mystery" shopper can be seen for a fake illness.

Or the guy from an MVA who has to sit on the EMS Stretcher for an hour or more waiting for a bed but he could have been on a bed and his c-spine cleared by the MD and he coudl have gotten off the board.

Or the, well you fill in the blanks.

If I was sick and had to wait for a bed in the ER because a mystery shpper with a fake illness is in the bed that could have been mine I would be really pissed but then again how would I ever find out.

I'm still concerned about Hipaa and privacy issues here but I may be concerned over nothing though.

I agree that we need to keep an eye on quality but this has been mentioned before - Press Gainey surveys

I was a QI person at a small hospital for our ER. Medic too but I took on the role of QI and I compiled the press gainey reports and gave printouts to all the ED Staff and also the ER physicians.

After one or two survey cycles and pointing out the discrepancies I noticed as did the staff an improvement in patient satisfaction in several areas. Confidence in the physicians care, confidence in the staff care. What didn't change over the two years that I did this QI project were dissatisfaction on waiting times in the waiting room, times it took for lab to get back and the time it took to get to a room when admitted.

Unfortunately those 3 dissatisfiers will NEVER change - as these are universally the major dissatisfiers in the industry. But what I did notice is that the staff made a concerted effort to address those times and delays and inform the patients. Satisfaction increased because patients were more informed and they were more open to long waits.

It also helps if you do comfort measures for patients such as have a TV in the room, fresh magazines and coffee/tea and soda machines in either the waiting room or in a central area in the ED treatment area. Families and patients who are allowed liquids become much more jovial and happy when their needs are met. Be sure to have warm blankets and such.

This is how to improve satisfaction in the ER and not mystery shoppers in my opinion.

[DwayneEMTP]

Now, with your whole one day whopping experience, they got to experience a slow day.. wow! Like ER Doc described, your experience was probably "unusual". I am sure if you were to re-visit them the other 360 or 364 days of the year and at different shifts it would be totally different.

This is typical, like management; people judging things they do not really have a clue about... It is the the same as people judging EMS personnel should be busy all shift long non-stop. That you really don't need ALS personnel on all calls, since < 10 % require ALS.

After my basic rotation, I probably spent 200-300 hours in this ER with terminal relatives in the next 18 months...so it got to feel pretty homey. Even so, I tried to make it clear that I felt there was a good chance I didn't understand all that was happening. Looking into someone else's world is kind of like looking into someone else's relationship, things are seldom how they appear. It wasn't my intention to judge, just put out something that I didn't understand so those smarter than I am could explain it. Sorry if I got you shaken up Rid.

ERDoc, thanks for your response! It's truly is heartening to know that that is not the norm...You mention the Admin having to bend over backwards based on customer responses. Would you not perhaps benifit by having a professional evaluation based on rational, health care based, criteria (assuming that is what happens here) instead of a bunch of uneducated (medically, hospital operation) patients that have been angered by a long wait? As stated before, I haven't worked EMS or the ER with the exception of a few hours, so I have no idea what the answer is...I'm just interested in the question.

I do see the resouce issue though. Murphy's Law would seem to dictate that these visits would happen at the worst possible time...

Thanks for your thoughts...

Dwayne

EDIT: Yikes Ruff...somehow I jumped right over most of your post...Thanks for the great and thorough response...it makes a lot of sense!