Monday, February 09, 2009

How was your visit?

A couple of years ago, I wrote about our use of mystery shoppers to evaluate how well we provide service in our ambulatory clinics. (You can also read more about it in this Boston Globe story by Liz Kowalczyk.)

Now, we are going the next step, not only conducting surveys of patients about their experiences in our clinics, but posting the survey results in those very same clinics. A portion of the survey is shown above. You will see three particular questions highlighted (just here, not on the actual survey). Those are the ones about which we receive the most complaints.

You also see above a mock-up of the kind of poster that will be prominently displayed in each waiting room, showing the performance results of that clinic for all to see. We believe this is part of "putting ourselves under the microscope." We have aspirations, not only to have an incredibly safe hospital, but also to rank highest in patient satisfaction in the country. We believe that you cannot achieve aspirations like this unless you hold yourself accountable by being transparent with regard to your progress.

I'd love to get comments from others out there, whether in hospitals or other businesses, as to whether you have tried this and what you have learned from it.

P.S. The mystery shoppers are still at work. We never stop learning from them.


Anonymous said...

My firm performs mystery shopper services for health care providers ( as well as publishes satisfaction data publicly ( We've found that consumers trust organizations more when they engage in these activities and are more willing to overlook some inconveniences. It is as if the act humanizes the organization and makes consumers/patients more sympathetic.

Congrats on your brave work!

Barbara improving hospitals' bottom lines.

Christian Sinclair said...

Great idea. I always love surveys that actually include seeing how your results fit in as part of the bigger whole. It seems like the least you could for the survey participant for the time and valuable information they are giving you.

Any discussion about the possibility of influencing the questionnaire (inducing bias) by providing this feedback? Just curious. (i.e. Here is what other people have replied...what are you going to put down?)

Anonymous said...

Very admirable. I believe we all want to have "good grades". Posting them should help motivate. There is a thread on this topic in the Press Ganey Forum.
One small point to consider: Press Ganey discourages communications that encourage patients to give a specific answer. Your draft poster suggests you want patients to answer "Very Good". Interestingly, CMS forbids this kind of "encouragement" with HCAHPS.

Anonymous said...


We did discuss it, and we concluded that the influence could go in both directions. So ,in the face of uncertainty, full speed ahead!


Ditto. We don't think we are encouraging one answer over another. Does it look otherwise to you?

Anonymous said...

The left side of the middle box says "We hope our improved communication with you at today's visit will encourage you to respond "very good" when surveyed."
That's not blatant but I think it sends the message that you would like a specific answer.
It's a small point.
By the way, I'm going to propose your idea to my department.

Anonymous said...

Ah, thanks!

Ileana said...


Whenever I get this kind of surveys, I keep thinking: but this is not what you should be asking me. This is because each of us has a different experience and it's difficult to ask the right questions for each person's experience. And when you try to do it, it ends up being a multiple pages survey that is so boring to fill in.

I just got a lengthy survey from the theater asking me all sorts of irrelevant questions for me (about bathrooms, dining experience, etc.) I had the choice of answering N/A to 90% of the questions, picking up the 3 in the middle, or being guilted into selecting the 5 (because they mentioned to comment if not 5).

I would ask four questions: were you happy with the physician, were you happy with the staff, were you happy with the facility, and overall impression, and then encourage the patient to comment at length on each of these. Or, if you do it online, allow them to only go into the details they want. Maybe some people have time to go through surveys, some of us don't.

What people want to say is what was outstanding and what pissed them off. And this can differ a lot from person to person.

Of course this is more expensive in terms of staff that need to interpret the data, but you can still do your graphs and you will find out precious info... kind of mystery shoppers multiplied.

Anonymous said...

Thank you Gregg et al for your thoughts regarding our comment, "we hope our improved communications with you today..." in that you thought it may be somewhat leading. We gave that great thought and as Paul mentions, the response could go either way. Additionally, our staff in the clinic(s) "own" this responsibility to inform our patients about any delays, and we felt that if we stated something as outward and strong as "we hope our improved communication will encourage you...," then we had better produce such improved communication! Thank you again for taking the time to comment. Best, Jayne Sheehan, svp

Danny said...
This comment has been removed by the author.
jayne said...

Dear Gregg,

Well, i gave your comments some more thought and, at bidmc we pride ourselves on being nimble, so i have decided, based on your thoughts, to change our comment to read the following: "We hope that our improved communication at today's visit is "very good." In that way, i still feel we communicate with our staff that they need to live up to our own expectation of better communication and they "own" the accountability there, and, at the same time it is not as "leading" as you mention. Thanks again for your thoughts, j

Anonymous said...


Well, I was holding my tongue, but I like your wording in your 2:38 post much better than your original wording, which did sound kind of blatant to me. Good for you rethinking and being honest about rethinking - the attitude that will serve your patients best.

nonlocal MD

Anonymous said...

I've gotten a form like that from Health Care Associates. I also got one from the Brigham which wasn't really applicable. I was in a therapy group run by two residents, and I got a survey asking me questions about my visit on such and such a date, including the ease with which I had scheduled the appointment.

Well, I didn't schedule the appointment. We met at the same time every week.