Health Care Mystery Shopping – National Hospice Provider Case Study

National Hospice Provider Case Study

A hospice client with 17 locations nationwide recently implemented new scripting standards for their phone intake operators and after-hours on-call nurses. To measure levels of staff compliance to the revised standards, the hospice client contracted Verify HealthCare to:

  • Gauge effectiveness of recent intake process changes
  • Benchmark current performance of intake operators and on-call referral nurses by conducting mystery shopper phone inquiries to all locations
  • Make recommendations for improvement based upon data gathered during the calls

Methodology of Mystery Shopper Phone Audit

  1. Identified client standards of performance and best practices for handling incoming calls
  2. Identified the locations to be shopped
  3. Built the client’s web-based Dashboard and user access profiles
  4. Developed two separate shopper scenario “Scorecards” (General Inquiry & Intake Referral)
  5. Created call scenarios and shopper “patient” profiles
  6. Scheduled and performed the shops, during both a.m. and p.m. time frames
  7. Scored and published all shops, complete with audio recordings, to the client Dashboard
  8. Analyzed intake operators’ and on-call nurses’ Scorecards and presented results to client


The one word to explain our findings: Variable. Our audit found high performers, low performers and everything in-between.

Positive Findings

  • Phone lines, including those of the answering service, were answered promptly
  • There were minimal hold times
  • Our shoppers were always able to reach someone in a timely manner
  • Intakes used clear, understandable voice tones
  • Intakes were responsive and, overall, very knowledgeable about services offered
  • Prompt callbacks were made by on-call nurses
  • A 19% overall improvement in intake referral call performance compared to the initial benchmarking project

Missed Opportunities

  • Standardization / consistency – intakes’ answers to caller questions, as well as relayed messages, were sometimes varied, incomplete, or inaccurate
  • Lack of compassion – intakes and nurses did not verbalize compassion for callers inquiring about a terminally ill loved one
  • Client information collection – critical questions were often not asked to qualify needs and to initiate the next step, including those related to appointment setting
  • Intakes did not solicit appointments in 66% of all calls made, diminishing potential opportunities to acquire new patients


  1. Implement verbatim scripting to improve call response consistency
  2. Reinforce the client’s brand by training intakes how to explain the differences between their hospice services and the competition’s
  3. Schedule regular education sessions to drive home the importance of standardization and knowledge of the brand
  4. Re-shop to measure level of improvement
  5. Incentivize the shopper project by rewarding high performers


The client implemented our recommendations and re-trained the intake staff. Eight months after the initial benchmarking project, the client scheduled a 2nd round of shopper audits. With benchmark results in hand, the client has seen steady improvement in the way calls are being handled. Leadership now has a system in place to measure the quality and effectiveness of the training intervention performed.

As a lean, six-sigma client, mystery shopping on a semi-annual basis has become integral to its continuous quality improvement efforts. Analysis of data collected during the calls has also been a key ingredient, as direct audio quotes from intakes during conversations with callers were used to accurately measure compliance to established best practices.

Case Study – Healthcare Specialty Clinic

Healthcare Specialty Clinic Case Study

Time Frame: Phone Shopping Audit from March – August 2014

A healthcare specialty clinic client in Texas opened their first two clinics in 2010, and today they have over 50 locations across America. The client came to us with concerns that the rapid expansion was diluting their ability to effectively train front desk coordinators and monitor their phone reception and scheduling procedures. Newly opened locations were falling behind in appointment setting, which is crucial to franchise growth, profitability, and stability.

Verify HealthCare was retained to conduct a series of telephone audits to assess clinic coordinators’ handling of phone reception and scheduling duties. Multiple new and prospective patient profiles and scripted scenarios were created to mystery shop pre-designated locations. Conversations between coordinators and shoppers were recorded, and shoppers “scored” the calls utilizing established client standards.

Upon completion of the initial round of shop calls, we discovered that coordinators failed to consistently follow key phone reception standards. While most coordinators answered phones promptly and politely and with proper scripting, 28% of them did not ask callers how they heard about the clinic, which is an important sales and marketing metric.

In reference to dealing with caller’s questions and call flow, our shopper’s found that coordinators also failed to identify caller needs and properly lead the conversation to establish rapport and encourage new business.

Scheduling appointments is the primary role of the coordinator as defined in the job description. Our audit ultimately revealed that nearly 40% of coordinators did not solicit an appointment.

Result: The client has taken data from the shopper scorecards and is re-training coordinators to address audit findings and meet organizational standards. Verify HealthCare will measure effectiveness of the re-training with additional shops at a later date.

Make Quality Pay – Reward the Error Finders!

Four Possible Responses to Errors

An error can be defined as a roadblock to quality, and there are four actions that can take place around every error:

1) Management corrects an error it happens to find;
2) Customers/patients find it, or experience it, and are dissatisfied or even hurt;
3) No one discovers or acknowledges it, and it continues to be a problem;
4) Employees identify virtually all errors, and they are resolved so that customers and patients experience only the best in products and services offered.

Did you identify the response that is preferable and best reflects your organization’s goals for continuous quality improvement and risk management?

Are your employees encouraged to identify errors, or are they, through fear or apathy, more concerned with ignoring or covering errors up?

Identify the Errors

Most errors have multiple or domino effects; a problem in one area almost always causes problems in one or more other areas. And when employees are frustrated by errors, they slowly lose their pride and, in turn, their energies. Apathy sets in and performance standards are ignored or even scorned. What we have, in other words, is a perfect setting for more errors!

It is critical that employees and managers themselves become involved in the error identification process. Only then can they see first hand the damage that errors create. That’s much more effective than having management try to make the point through communication alone.

Reward the Error Finders

Consider developing an error identification program which is designed to be an informational and awareness tool that fosters understanding. In fact, why not make it a part of every employee’s orientation, training, and re-training process?

Any employee (or team) that identifies an error which detracts from the quality mission has his/her name placed with other error identifiers in a box. At the end of the month, an award is given to the best error identifier.

Remember, an integral part of high conformance is reward and recognition. Why not try eliminating the singling out of individual employees and instead base rewards on a work-unit or team basis, such that all members win if the team wins?

Eliminate the Causes of Errors

Errors are not solved by simply identifying them. They’re solved by reviewing and writing standards and requiring compliance. Identifying the error is only half the battle. Done properly, the root cause process of tracking down and eliminating errors becomes a game, after which it becomes a way of life for the employees and the organization.

Imagine the power in an organization in which every employee believes in the process of eliminating errors and their causes, at every level, and assumes the responsibility to do so as an integral part of their basic job!

There’s Gold in that Data! – Data Analysis and ROI – How to Get the Most Out of Your Secret Shopping Audit

At some point during every client presentation or initial conference call the following questions inevitably come up: “Well this all sounds great but, what’s the return on investment? What are our expected outcomes? Your service isn’t free.”

Let’s answer these questions in reverse.

No, our service is not free. It is also not a fast food shop to see if the cashier offers you the latest burger of the month. We are auditing your health care organization. This takes a tremendous amount of preparation, organization and training. Knowing and evaluating your specific organizational systems and processes and ordering a cheeseburger are two very different services. Please don’t confuse the two in reference to pricing and/or scope. While we have adopted the measurement tools of the hospitality industry our health care audits are hospitality shops on steroids. Yes, they are from the same family. No, they are nothing alike in reference to depth and breadth. Are all your siblings the same?

What are our expected outcomes? That is up to you and what you do with the data assembled from our shopping audit. If we analyze the data with goals and objectives in mind, we can pinpoint areas of concern that will take organizational interventions to address. With analysis, we can illuminate best practices to be disseminated throughout the organization.

Without any kind of deep data analysis you will have a treasure chest of data with no key.

Which dovetails right into “so what’s my ROI?” Return on investment depends on commitment and follow thru. In today’s world if you can’t solve a problem without a pill or Smartphone app (you’ve got the flu, there’s an app for that!) people tend not to be interested. But if you have the commitment from the top down with resources to boot, the sky is the limit. Trainings, interventions and process re-engineering are generally the outcomes of a mystery shop. The quality of the shop then is directly tied to the quality of the changes implemented post-shop.

When we re-shop after changes are implemented we can then measure for return on investment. So if a client wants to know what their return on investment will be after a mystery shop of their facility the answer is, “That all depends on you.”

A quality audit can elucidate the best and worst of your organization, but unless the data is acted upon, ROI will be MIA.

Russell Brand is the senior consultant and co-founder at Verify HealthCare. Verify HealthCare is a mystery shopping and consulting firm dedicated to the health care industry. Contact Russell at moc.e1508475642racht1508475642laehy1508475642firev1508475642@lles1508475642suR1508475642 for more info.

You Can’t Change the Rules in the Middle of the Game? Or Can You?

Have you ever heard a 6 year-old make up rules to a game? Whether it’s hockey in the driveway or a board game in the toy room, my little girls are changing the rules constantly.

“Dad, you can’t score whenever you want to, it’s against the rules.”

“Since when?” I asked.

“Since 5 seconds ago when Jules and I started losing,” my oldest retorted.

“But that’s not in the rules.  The rules say I can score as much as I want. That’s the point of hockey.”

“Well now we changed the rules,” my oldest said very matter-of-factly.

“But you just can’t change the rules in the middle of a game, that’s crazy?!”

My pleas were met with blank looks on two young, sweet faces.

“Ok, no scoring for me,” I say somewhat defeated.

“Great, we are going to beat you silly Daddy-O,” the youngest announces.

And the game went on. I lost 5-0. (Turns out you can’t score more than 5 goals either).

Now, imagine that instead of changing the rules in a driveway hockey game with two adolescents, we are talking about changing the rules in the way healthcare is delivered (HCAHPS) and insured (Affordable Care Act) for the entire population of the United States. That’s a spicy meatball!

Today healthcare systems find themselves in a brand new environment where money can be withheld, even if the outcome for the patient is positive but found their interpersonal connections with staff less than positive. The ACA has turned parts of the healthcare insurance industry upside down with new regulations being rolled out on a seemingly monthly basis.

When will all this change stop? How can organizations be expected to function optimally in such a fluid environment? Who can possibly succeed in an industry where the rules and benchmarks are constantly in flux?

You can, by being prepared and flexible. Both the HCAHPS and ACA laws were announced with enough time for organizations to take stock of systems, processes and products and begin to shape them towards the future healthcare landscape. Those that invested in understanding their organization and were able to plan accordingly are managing this new regulatory environment. Those that are just now reacting to the “new” rules are finding themselves and their organizations behind the eight-ball and scrambling to adapt.

In conclusion, if your organization is reacting to governmental regulation instead of planning for it, you’ll find yourself in a quagmire of issues that will put your organization at considerable risk. Reaching for solutions ad hoc instead of implementing strategic changes will give your more prepared competitors the advantage.

So to answer the question first posed in this post is, “Yes,” you can change the rules in the middle of a game. Is it fair to change the rules in the middle of the game? That would depend on your own perspective. In 41 years living in this world I can attest to one thing, change is constant. Just ask the organization formerly known as Kodak how new ways of doing things can disrupt an industry. Adapt to the environment and thrive or resist the change and become irrelevant. The choice is yours.

Who Can Speak for the Patient? Great article looking at process and systems.

By systematizing my approach, I’m confident that I’ll always remember the many different steps involved in treating a patient with cardiac arrest. I’ll be more prepared to start tube feedings or begin to wean the patient off the ventilator when the time is right.

But despite my checks and balances, I had almost allowed the wrong person to make crucial decisions for this vulnerable patient. And I had nearly excluded a wife from her rightful place on her husband’s team. Missing this crucial piece of information would have caused far more suffering and damage than any miscalibration of a ventilator.

I realized then that I needed another checklist, one that puts patients, and not just their organs, in the center. It would account for the human needs that we weren’t always taught to prioritize – .Dr.Jessica Nutick Zitter, NYT, June 14, 2014.


This article shows the need to constantly review your organizations systems and processes to assure that whatever is truly important will be addressed every time.  Copy and paste the link below to read the entire article.


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Another Article Highlighting the Value of the Family P.O.V.

“Dr. Gerald Hickson launched the innovative program at Vanderbilt University Hospital after seeing wife’s post-operation care” – Claudia Kalb, Yahoo news, 7/21/2014

We are beginning to see more and more the validity and quality of data that a patient’s family can provide on something as simple, but unbelievably important as hand washing. The doctor watching his wife’s post operative care was the impetus to real change for Vanderbilt University Hospital.


Link Here:–vanderbilt-s-hand-washing-initiative-172312795.html

Great Article on Emapthy in HealthCare via HBR

“This Appreciative Inquiry approach can be accomplished through educational sessions – for example, Brigham and Women’s Hospital put on a session called “Love Stories: Deconstructing and Learning From Successful Doctor-Patient Relationships,” in which a highly respected physician and one of his patients were interviewed (in the When Harry Met Sally-style) about what made their relationship successful.”  Thomas H. Lee, MD,, 7/17/14.

Not only is this a great article citing the need for a “sympathy epidemic” in the health care industry but also cites one of my favorite organizational training styles, The Appreciative Inquiry!    Appreciative Inquiry is an organizational development tool that looks at best practices in an organization and expands on them instead of looking at what is going wrong in an organization and trying to correct it.  Take a look and leave a comment.

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Be Brave, Look in the Mirror.

About 6 years ago I realized that having the lush locks of my 20’s wasn’t going to last into my late 30’s. I saw myself in the mirror and saw right through to my scalp. Yup. It was time to shave it all. I bought a good pair of clippers and took it all off the next day.

For a while I had “phantom hair” that I would shake free of water after taking a shower. It took a while to get used to the new looking me. You don’t realize how defining a feature that hair is, until it’s gone. To be honest, I don’t miss it and really like the current version of myself. And shockingly, most people in my life don’t remember me with hair. Even my wife (whom I met in 6th grade) likes my chrome dome.

To get to this point though, I had to look in mirror to see what was going on and who I wanted to be. Did I want to be a guy with a comb over or bald and beautiful?  The choice seemed obvious. Mirrors don’t lie.

Every time we greet a new client I always commend them on the courage it takes to have a third party come in and audit their organization (bald head and all) and decide what is working and build upon it, and what is not and change it.

Understanding where you are as an organization is integral to future success. Looking in the mirror takes guts and a willingness to grow. Opening yourself to an outside agency is difficult sometimes, but necessary. Without objectivity, the reflection you see may be distorted with inter-office politics and biases. The reflection we give to clients is unbiased and unfiltered.

Take a look at your organization, and when necessary buy a pair of good clippers and cut off what’s not working. You will be happy you did. I promise.

Be brave, look in the mirror.

Great Article About Value of Patient and Family Viewpoint

“Patients and their families are a potential gold mine of information,” Mr. Hatlie said. “They see things that busy health care workers don’t see. Doctors are in and out. Nurses are in and out. But relatives are there continuously with the patient. They often know how to fix problems that cause errors.” NYT, 9/22/12, New Systems for Patients to Report Medical Mistakes.

While this article is 2 years old it certainly validates our methodology.  We know that volumes of quality data can be derived from the patients and their families.  This is the point of view we provide at Verify HealthCare.

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