Mystery shopping has taught me more about the patient experience than just about anything else. One of the most revealing things is what patients and visitors overhear from hallways, waiting rooms and exam rooms. They constantly hear things that they shouldn’t; and that applies to clinics as well as hospitals.
One of the Disney principles is the “onstage and offstage” concept. Using that metaphor, the biggest problems exist because staff and physicians are not conscious of “stage.” The stage isn’t just when they are conversing directly with an individual. The stage is everything that a patient or visitor can see, hear, smell and touch – even when the curtain is closed.
Imagine that you have a cast of actors on stage. The curtain is closed and the auditorium is dark. The audience is sitting silently, each person anticipating the start of the show. From behind the curtain you hear voices arguing, gossiping, talking about specific members of the audience, or what they plan to do after the performance. The actors discuss their lousy working conditions and how much they hate their jobs. You’d be appalled. Even when the curtain opens and the show begins, it would be difficult to forget everything you just experienced, regardless of the beautiful set, perfectly orchestrated musical score and talented actors.
We observe “back stage” behavior in a significant percentage of our mystery shops. And they have a huge impact on the patient perception of the whole organization. A few recent examples include:
- A front office person hangs up the phone and says to her colleague, “<First and last name> is on his way in for <treatment>. When he gets here, you take him. I’m not going to deal with his crap today.”
- Everyone in the waiting room got his name and reason for the office visit. They are now wondering how staff talks about them.
- A family inside a patient’s room hears two physicians arguing about the care of their loved one. “If we do it your way, we could lose her.”
- This sent the family into panic.
- A nurse calls her supervisor into a patient room. In front of the patient and roommate she points out an issue and says, “This is unsafe patient care.”
- The issue isn’t that she pointed out a problem. The issue is that she said it in front of two patients who will now question the rest of their care.
- A scheduler calls a patient on the phone and can be heard saying, “Is this <first and last name>? We have your test results for <condition> here and they’re not good. Dr. <name> would like to see you right away.”
- The people overhearing this call are now privy to someone else’s personal information, and questioning how well their confidential information is protected.
I wish I could say that these are isolated incidents. They aren’t.
I cannot stress enough the importance of monitoring what can be heard in waiting rooms, hallways and inside exam rooms and patient rooms. The issue isn’t just about HIPPA violations. It’s about how each comment impacts the patients’ perceptions of the whole organization. So listen up! What you don’t know can, and does, hurt you.