A resident physician at Scott Air Force Base checks a patient's eyes in this file photo. Scott and at least six other Air Force bases have enlisted the help of mystery patients to evaluate the care they receive at medical centers. (Staff Sgt. Ryan Crane / Air Force)
When Col. Bret Burton took command of the 375th Medical Group at Scott Air Force Base, Illinois, he put customer satisfaction near the top of his priority list.
One order of business: A Mystery Patient program that would give patrons the chance to rate everything from how they were greeted by medical staff to whether providers answered their questions satisfactorily.
As many as 20 patients a week have provided feedback at Scott since the program’s launch in May 2013. Patient advocate Shawn Saunders recruits participants and takes volunteers, all of whom document their experience unbeknownst to clinic staff.
Once every three months, about a dozen mystery patients sit down with Burton and others to provide in-person feedback.
“We don’t just pick the ones we know are loving on us,” said Nick Cardozo, chief of quality services, who sits in on those meetings. “We make sure we have a mixed bag. We’ve had those folks who have had criticisms of what we do.”
The program recruits mystery patients from a cross-section of those the clinic serves: active duty, retired and dependents.
The program has paid off, Cardozo said. They’ve learned many clients weren’t getting a list of their medications on check-in and check-out and that providers weren’t always washing their hands in front of patients.
The latter led to an instruction sent out from the chief of medical staff. Now, patients report they see techs, nurses and doctors wash their hands about 97 percent of the time, Cardozo said.
“That’s an infection control measure,” he said. “We’ve got to make sure they can see it. If a tree falls in the woods, do you hear it?”
Burton learned that patients generally prefer hearing medical test results over the phone even in an age of email and text messaging.
“We really need to pay close attention and respect the fact these folks prefer to hear from us, and we need to be as timely as possible,” Cardozo said. “We’re doing our best to get to that telephone consult list as quickly as possible.”
Scott is one of at least a half-dozen Air Force medical groups with a mystery patient program, said Janice Ellison, program director for customer service at the Air Force Medical Operations Agency. Also onboard: Offutt Air Force Base, Nebraska; Joint Base McGuire-Dix-Lakehurst, New Jersey; Beale Air Force Base, California; Sheppard Air Force Base, Texas; Seymour Johnson Air Force Base, North Carolina; and Royal Air Force Menwith Hill, England.
Defense Department-mandated surveys have long measured satisfaction within the military health care system, but collated results can take months to get back, Ellison said. The Air Force medical agency developed the mystery patient program in 2012 as a way to gauge patients’ experiences in real time.
The program is voluntary, and commanders can tailor it to suit their needs, picking and choosing from a list of questions that run the gamut: How long did it take you to get an appointment? How long did you have to wait once you arrived at the clinic? How was parking and signage? Were you asked for your ID at the front counter? How did each person in the chain of care greet you?
“It’s whatever the facility deems they want to look at for that day, that month or for six months,” said Lt. Col. Stephanie McCue, branch chief of the clinical quality support branch for AFMOA. “It’s another tool that allows us to measure immediately anything we want to look at.”
And if a problem or issue arises, McCue said, clinics have the ability to address it on the spot.
“We know that when patients feel like you care, satisfaction goes up, customer buy-in goes up. Everything goes up — perception of quality of care. Once patients feel they can trust the service, they are more likely to come back and know we can resolve anything that comes up,” she said.
That’s what has happened at Scott, where the mystery patient program has come to stay, Cardozo said. Whether patients had a good experience or a bad one, “One hundred percent of the people we’ve had in our forums have thanked Col. Burton. They say, ‘It’s nice to know you want to hear from us, no matter what it is.’ It pays dividends.”
Not everyone who worked at the clinic was thrilled at the prospect at first, Cardozo said. “We had a lot of unhappy and skeptical people. They wanted to know: What is this going to look like? How can you do this? That has turned 180 degrees. They appreciate getting the feedback.”
Joe Park, a retired Air Force hospital service administrator, has been on both sides. He signed up to be a mystery patient after seeing a form about the program in the clinic. He and his wife, Joyce, a retired hospital commander, were both later invited to a forum hosted by Burton where, they said, there were just as many compliments as complaints.
“By having these programs — and I hate to sound corny — but it really brings [patients and medical staff] together,” Joe Park said. “I may not know I’m doing something to a patient they don’t like. Maybe I took too many times to take their blood. Maybe I think I’m doing a good job but they don’t. Same with appointments. If it takes you too long to get an appointment, you get upset. But maybe the doctor doesn’t know it took you a lot of time. People have a vehicle to say they didn’t like something.”■