Understanding patient experience and what influences decision-making is a strategic priority across the healthcare industry. But getting inside the heads of consumers can’t be achieved solely with surveys. Using qualitative research including ethnography or observational research is incredibly revealing. Our mystery shopping work is one form of ethnographic research that collects facts and feelings in real time along the patient journey. It’s a form of qualitative research where our trained observers immerse themselves in a healthcare experience and report back on their findings based on what they’ve observed and felt providing richer insights than a survey could provide alone.
This research is specifically designed to help healthcare leaders understand what is impacting patient experiences and whether or not they will return for care or recommend the organization. By detailing the step-by-step experiences, complete with facts and feelings, mystery shopping reveals the truth about what patients encounter in your organization.
There is a saying that complaint is a gift. In theory that is true, but not everyone is thrilled when our observations reveal problems. In fact, more than once we’ve gotten pushback on a mystery patient’s experience. During a recent report, one physician said, “Well, that’s an n of one. Is that statistically significant?”
When that happens, my response is always the same: “Is your mom’s opinion statistically significant?” The answer, of course, is no. But then I ask a follow up question: “Does she matter?”
Of course she does—and so do the individual opinions and insights of your patients. Each one of them. If a problem shows up during a snapshot of your daily operations, it’s highly likely that it isn’t a singular event.
The Phenomenon of Selective Belief
Here’s what I’ve observed time and again: When the data paints a positive picture of an organization, everybody believes it. The methodology is sound. The findings are valid. The insights are actionable.
But when the news is bad? Suddenly, everyone’s an expert in research methodology. They punch holes in the validity and reliability of the tool. They question the sample size. They dismiss the findings because “that’s just one person’s experience.”
This happened recently with a group of physicians. Our mystery shopper had what appeared to be the perfect emergency room experience. She was greeted properly. She was seen in a timely fashion. Everything was explained clearly. The doctor was professional and competent.
Her recommendation? “Would not recommend.”
The physicians were incredulous. “This is bogus data,” they told me.
Then I shared what the mystery shopper observed while she was in the waiting room. An elderly woman was crying out in the waiting room and obviously confused. Her caregiver was trying to calm her when a man in a lab coat, wearing a hospital badge, came from behind the counter, looked at an elderly, confused woman who was crying out, and said to the caregiver , “Give that b@%!h a cigarette so she’ll shut the f@&% up.”
Yes, our mystery shopper had a positive personal experience. But what she observed about how others were treated? Absolutely unacceptable.
Healthcare is Individual
In healthcare, n’s of one matter. Each patient is an individual with individual needs, individual concerns, individual perspectives. Each of those perspectives could be the difference between a repeat patient and staunch advocate for your healthcare organization—or a lost patient and negative word of mouth.
And through these individual experiences, everything matters. Everything. Including what you witness about how others are treated.
We recently completed a study for a client trying to understand why patients weren’t returning. The staff was friendly and nice. That wasn’t the problem. The problem was they weren’t helpful.
One example: An elderly, arthritic patient who needed help getting dressed again after her exam. The staff left her walker on the other side of the room. Nobody stopped to think, “Who is this human? What does she need before I walk out of the room?”
The Doctor Who Got It
I was doing shadow coaching with a physician who asked me to round with him—someone I’d consider a poster child for patient experience.
During rounds, we saw a 32-year-old woman scheduled for emergency surgery. He took her surgical history which included three cesarean sections, the last one six months previously.
He moved on with the rest of her history.
When we stepped out of the room, I asked him, “What do you think is going on in her life right now that she has to have this emergency surgery?”
He looked at me, puzzled.
“When she gave you her surgical history,” I said, “she told you she’s had three cesareans. The last one was six months ago. The outcome of a cesarean is typically a baby. So, according to her history and assuming she had viable births, she has a three-year-old, a two-year-old, and an infant at home.”
I asked if he had kids. He did—three of them.
“What would happen if your wife was hospitalized today?,” I asked.
“Oh my God,” he said. “It would be chaos.”
Exactly. He realized what he overlooked. He could have gotten defensive. He could have said, “That’s not my job. That’s what social workers are for.”
But instead, he said, “I’m going right back in there.” And he told me that this was the most impactful and important feedback he’d ever received.
That’s the difference between someone who dismisses qualitative insights as “an n of one” and someone who understands that every patient is an n of one.
The Question That Changes Everything
This is why I encourage every healthcare organization to ask one simple question at every admission: “What is the most important thing to you while you’re in our care?”
If you listen—truly listen—you might find out they’re worried about their dog at home. Their kids. Their job. Their finances. That they want to be healed in order to attend their daughter’s wedding. The things that keep them up at night while they’re lying in a hospital bed, trying to heal.
These aren’t “soft” concerns. They’re human concerns. And in healthcare, human concerns are everything.
So the next time someone dismisses qualitative research because “it’s just an n of one,” ask them this: “Is your mom statistically significant?” She might not be. But I can guarantee you that she matters.
