The cloak and dagger world of mystery shopping

Get an objective view of your practice’s service

When you have more than 100 clinics and 1,000 physicians to oversee, it’s hard to know whether the service each clinic provides to patients is adequate. Just ask Randy Hutchison, administrative director for Penn State Geisinger Health System in Danville, PA, the third largest physician group in the country. He is in charge of customer service and performance enhancement for the group and decided that he wanted a concrete measurement of his clinics’ telephone performance.

"We want an entire culture of service," Hutchison explains. "Everyone may think they are polite, but everyone has a different definition of polite. So we have to create standards, and to do that, we need specific information on our performance."

Hutchison selected 24 clinics for a pilot program, which includes mystery shopping, to enhance service. In the last few months, those locations have gone through a baseline survey, training, and follow-up.

The first round of mystery shopping provided some interesting results, he says. For instance, one clinic greeted callers with "good morning" only 20% of the time.

Once the results were in and disseminated, Hutchison started a complete training program for all of the clinics that includes specific goals for them to meet — such as greeting callers every time with the appropriate salutation for the time of day. "Having this kind of specific standard isn’t just important to our performance with patients, but also to our staff," Hutchison adds. (For information on other types of surveys, see stories, pp. 35-37.)

A key indicator of performance

Many would argue that how your receptionist answers the phone is the least important aspect of your practice. But Preston Ribnick, MS, president of Professional Resources — a South Wellfleet, MA-based medical consultancy — strongly disagrees. "It is a bellwether of performance," he says. "If they can’t do that well, what else can’t they do right?"

Ribnick, whose firm has done telephone mystery shopping for over 6,000 practices around the country, compares it to the airline industry. "Before deregulation, there was no urgency to leave on time. But then the government started reporting those figures. Overnight, there were changes."

Medicine is going through similar alterations, Ribnick says. "Capitation means that more has to happen over the phone — triaging, answering questions. There is a high premium on phone performance." (For a telephone performance checklist, see box, above.)

For about $200 per report, Ribnick and his team conduct a series of calls over a three week period. (For a list of the topics covered by the calls, see survey form, p. 31.) Standard questions on the physicians and their qualifications and availability of appointments are asked. "We look at medical salesmanship — are they willing to look for new clients? Even if the practice is full, there is a way to communicate that without being rude."

Office staff should be able to answer questions about the physicians’ education, training, and where they are on staff — or at least demonstrate a willingness to find out the answers and get back to the caller, he says.

After conducting the calls and providing a report, Ribnick can also provide remediation for the practice — including scripted answers to certain questions that the staff can practice and have on hand.

For most practices, getting the baseline performance is the most important aspect of the program, says Cathy Casali, executive director of Rhode Island Primary Care, a 95-physician IPA based in Warwick. "We have a lot of sites with two or three physicians around the state. Mystery shopping is a way to get a handle on the strengths and weaknesses of each."

Like Hutchison, Casali says it is important to set a standard for telephone performance. "There is a high turnover, particular in primary care practices. As great as your training program was three years ago, it may have been taught to people who are no longer at your practice."

Get staff commitment

Getting buy-in for a mystery shopping program isn’t easy. Hutchison says staff at his clinics complained before the first round. "They thought it was sneaky," he recalls. "They wanted to know ahead of time it was going to happen."

On the lighter side, the second round went off without a hitch, and the staff members not only didn’t complain but said they could tell which callers were the mystery shoppers. According to Hutchison, their guesses were always wrong.

Ribnick says one way around the griping is to tell staff that the program is a way to discover successful methods and to celebrate those positives. "If you emphasize the desire to build on strengths, then it’s easier to see the monitoring as a positive thing."

Once staff accept the program and you start the process, Casali says you have to be willing to act on the information you get. "It’s more than a piece of paper," she says. "This is the root of quality assurance. You have to be accountable to your clients, and in medicine, they are your patients. This is a way to start that process."

Ribnick agrees. "You are getting this independent information about your practice. You have to make sure that everyone in the practice sees it. These are tools to use; this is a starting point to develop your skills. If you get the information, use it."