Behavioral Healthcare

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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.

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, said Arthur Lazarus, M.D., M.B.A., author of the recommendations, 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. 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, 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.”

Dr. 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 resources 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. 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.

Source: American Psychiatric Association, June 29, 2009