Medical DevicesPsychiatric Facilities Encouraged To Use "Mystery-Patients" To Improve Services
Mental health services could be improved by
planting trained consumers pretending to be patients, or "mystery patients," to identify
problems, according to a commentary in the July 2009 issue of Psychiatric Services, a
journal of the American Psychiatric Association.
The concept is similar to the long-standing practice of using "mystery shoppers" in retail
stores for market research. Pseudo-patients have also been used for some time in general
medicine to improve services.
Arthur Lazarus, M.D., M.B.A., author of the recommendations, is the senior director of
clinical research for AstraZeneca Pharmaceuticals, past-president of the American
Association of Psychiatric Administrators, and an authority on healthcare practice and
administration.
Medical mystery patient programs are typically geared to identify problems in the
delivery of health services-not to assess the quality of medical care. The types of
functions they can help assess and improve include telephone etiquette and wait times,
interpersonal skills and efficiency of office staff and clinicians, and adherence to policies,
Dr. Lazarus said. Some programs have been used to identify staff training needs and to
reward superior employees.
"Although there is little empirical evidence for beneficial outcomes of mystery shopping
in mental health settings, there is reason to believe that positive results can be achieved as
they have been in general medicine," argues Dr. Lazarus. In particular, notes Lazarus,
people with mental illnesses "who may be unassertive or easily intimidated or may lack
the capacity to advocate for change, medical mystery shopping may be an ideal method
to improve the quality of psychiatric services."
Lazarus points out that this method has proved to be "highly valuable, if controversial" in
improving patient satisfaction and standards of care. Prime targets in mental health would
include state psychiatric hospitals, U.S. Department of Veterans Affairs hospitals,
community mental health centers, and mental health services in primary care.
The method is not without objections and obstacles, including staff resistance to mystery
patients for ethical reasons, use of res by mystery patients that are needed by real
patients, and the potential for third parties to get patient-identifying information. Dr.
Lazarus argues these obstacles can be overcome with proper design and planning.
Use of mystery patients must be implemented carefully to be effective. For example, it
requires staff buy-in and staff awareness up front that pseudo-patients will be used. The
intent of the effort needs to be clear - receiving constructive feedback and improving
services, not conducting a "sting" on employees.
While questions remain about the use of medical mystery patients in mental health care,
Dr. Lazarus contends that in a climate of increased competition for medical services,
psychiatric facilities should be looking for ways to improve.
American Psychiatric Association