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Ready Yet For Your Fake Patients?

July 21, 2008
by Mark Hagland
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As a number of mainstream media journalists are beginning to catch onto the trend, those reporters are writing stories about a recent trend that CIOs should be following carefully—the use of “fake patients” to stir quality and service assessments in healthcare.

As The Ann Arbor News reported earlier this month, Saint Joseph Mercy Health System in that market is “one of a growing number of healthcare providers turning to a method of quality control more common to the retail industry—so-called secret shoppers who act like customers so the business owner can rate its customer service.” In the purely clinical context, these people are known as “mystery patients.”

The difference between those patients who in previous iterations were used primarily to help clinicians improve their diagnostic skills and the individuals whom the Saint Joseph Mercy System folks are using is that these new people are being used primarily to help assess the speed and quality of service. For example, initial “fake patient” runs helped Saint Joseph Mercy executives determine the fact that admitting clerks at St. Joseph Mercy Hospital in Superior Township did better in person than over the phone in handling the mystery patients. As a result, executives there created a phone courtesy class now taken by every new clerk.

Interestingly, as the Ann Arbor News story notes, a similar program undertaken at the University of Michigan, also in the Ann Arbor area, several years ago, was discontinued after no specific problems were identified, and some staff expressed discontent over the practice.

Physicians and organized medicine have also been increasingly critical of the practice. The Ann Arbor News story quoted a colorectal surgeon who said, “I think it is a horrendously bad idea. This is a marketing thing. It’s not how you evaluate medical care.”

Actually, Doctor, consumers and purchasers are increasingly voting with their feet, with consumers shifting to hospitals and physician groups that have committed to—and achieved—better service quality, especially around wait times. I myself left one personal physician for another, after a horrendous experience with waiting and indifference (what busy modern person has three-and-a-half hours they can devote in any one day to useless sitting around?).

So whether or not your hospital or health system chooses to use “fake patients” to get a sense of what’s really going on service-wise in your organization, or whether it choose some other strategy or combination of strategies in this area, you as a CIO should be out on the front lines, championing service quality, and helping to strategize around whatever IT-based and other tools might be appropriate to help achieve and maintain higher service quality levels. You owe it to your organization to be a leader in this area.

And, in this context, you might find interesting the feature article that my colleague, Associate Editor Kate Huvane, is working on for the October issue. She’s looking at patient-service kiosks and how they fit into broader patient services strategies. Stay tuned, and stay engaged.



Ethics? That's a really interesting way to approach this.

The approach of using 'fake patients' and subsequently publishing the results is probably best seen as an attempt to "inspect in quality," an approach discredited by Deming a half century ago. The hunt for 'bad apples' distracts from addressing the process improvement opportunity. That's either ignorant or ethically immoral.

Today, we might try to label the 'fake patients' initiative as "transparency." Without combining it with a larger program to use proven methods to improve "patient throughput" (there are many successful initiatives in many care settings), measurement using fake patients is defocusing and misleading.

Anthony's framing this in terms of fake patients and real ones is terrific, because, if the goal is measurement, leading to the transparency necessary to real improvement, then the approach could (perhaps should) be one of observing the flow of real patients. Combined with looking at those results on control charts, factoring in context (appropriateness of staffing and skill levels), and involving the "workers" is the only ethical way, and the only proven way to address new problems.

I ended that paragraph with "new" problems for a reason. Whenever we're faced with a problem like quality and service assessment in healthcare, we often have a choice to make. Do we 'invent' a solution or 'discover' a solution. Inventing in this case is creating a measurement approach, fake patients, and creating or hypothesizing a solution. We generally like invention. It's fun and feels important.

The alternative is discovery. If the problem, it's measurements and options to deal with it are well known (i.e. not "new"), then we should turn to the internet, to experienced minds, to benchmarked measurements and benchmarked management solutions to the problem.

In contrast to invention, 'discovery' is always better-faster-cheaper, when dealing with a problem. Predicaments and Wicked Problems are another story for another day! The discovery approach quickly invalidates the use of fake patients.

Is it immoral to knowingly use an invalid approach? Publish a comment!

what are your thoughts on the ethical implications of this for example, what if a physican has to take time with a "fake patient" to the detriment of a real one? We always hear about understaffing, wouldn't this exacerbate the problem?