Some hospitals are deploying "secret shoppers" to get a better understanding of patient experience in their facilities, and sometimes the findings can be eye-opening, Tim Lahey, a physician whose hospital used secret shoppers, writes for the New York Times' "Well."

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What secret shoppers do

Secret shoppers are people who pose as patients using a pseudonym and symptoms of an illness that either can't be diagnosed or immediately ruled out, Lahey writes. For instance, they might describe a psychiatric condition or an intermittent heart arrhythmia.

Then, while being cared for at the hospital, the secret shoppers will evaluate different aspects of the patient experience, such as how compassionately they're treated, whether nurses wash their hands, or whether doctors listen, Lahey writes. Their findings are then shared with hospital executives.

While these shoppers expose themselves to some risk, including blood draws, IVs, and potentially even X-rays, they decline more invasive treatments by saying they have a scheduling conflict or some urgent family matter to attend to, according to Lahey.

What secret shoppers find—and how hospitals respond

Reports from secret shoppers have had noticeable effects on hospitals, Lahey writes. For example, a few years ago, Randy Peterson, at the time president and CEO of Stormont Vail Health in Topeka, Kansas, hired Etch Strategies, a consulting company that provides secret shoppers, to figure out why his hospital had average patient satisfaction scores despite having high clinical quality metrics.

The secret shopper found that caregivers were often dismissive of patients and didn't interact well with one another, sometimes bad-mouthing other employees within the patient's earshot. "They didn't feel like a team," the secret shopper said, "and that made me doubt the quality of my care."

Peterson said he and the hospital's leadership team were "spellbound" by the secret shopper's report, and quickly implemented a plan to improve the patient experience. For example, the hospital began to encourage staff members to greet people in the hallways rather than looking down at their phones while they walked.

"Keep your eyes up. Socialize with patients instead of talking about patients. Tune into the social determinants of health. Everyone has a story," Peterson said.

Another secret shopper from Etch Strategies went to an ED in rural New York dressed in sweatpants and a graphic T-shirt. The shopper also hadn't showered for three days and told the ED's desk clerk that she didn't have any health insurance.

The shopper said she noticed a significant difference between the treatment she received in disguise and the treatment she has received having health insurance and being dressed professionally. "From the second I walked in, people were very short with me," the shopper said. "There was no eye contact. People didn't even introduce themselves!"

Elsewhere in the medical industry, secret shoppers have been used to highlight access to care issues, Lahey writes. For instance, one 2016 study had secret shoppers contact 743 primary care practices in California and found that over 70% of the callers were unable to make an appointment with the clinician they had originally contacted.

Another study found that more than one-third of secret shoppers seeking treatment for opioid use disorder were denied an appointment.

Steve Leffler, an ED physician and interim president of the University of Vermont Medical Center, said he's seen secret shoppers spur difficult culture changes by showing providers what it feels like to be a patient.

Leffler said secret shoppers are "a mirror for all of us" and can help remind providers the importance of making a human connection with every patient (Lahey, "Well," New York Times, 7/16).