David Kerr: The mystery shopper

David KerrWorking in supermarkets over the summer holidays can be an education for many an aspiring medical student as, to quote Henry James (and the News of the World newspaper), “all human life is there.” In the supermarket aisles the best and worst aspects of humanity are often laid bare while the checkout assistant struggles to be helpful and efficient at all times. Supermarket bosses perceive the tills to be the epicentre of customer service – every shopper has a choice and the store needs to encourage return visits. One commonly used assessment tool for checkout performance is the mystery shopper. Their role is to assess the attitude and effectiveness of the checkout till operator while the checkout assistant is unaware that an examination is taking place. Mystery shoppers almost made a surprise appearance in healthcare last week.

In the US, the Obama administration’s changes in health care law are expected to grant 30 million previously uninsured Americans coverage for healthcare. As a result these newly insured Americans are presumably going to seek out primary care physicians, further exacerbating the already growing problem of a shortage of such physicians in the US. However, having coverage is not the same as being able to access care – a recent survey by the Massachusetts Medical Society found that about half of family doctors and general physicians were not accepting new patients. In response, the US government planned to employ “mystery shoppers” to try to arrange appointments with more than 4000 doctors – 465 in each of nine states. The mystery shoppers were supposed to pose as patients, call doctors’ offices and request appointments to see how difficult it is for people to get care when they need it. Apparently the aim was to try to discover whether doctors were accepting patients with private insurance while turning away those in government health programmes that paid lower reimbursement rates.

After a robust defence of the idea the whole project was “put on indefinite hold” two days following an article in the New York Times. Doctors and Republican politicians were unanimous in describing the idea “wasting taxpayer dollars to snoop into the care physicians are providing their patients.” The US Department of Health and Human Services had decided that “now is not the time to move forward with this research project,” although it denied that politics had played any role in the decision.

In the UK perhaps the “mystery shopper” idea may catch on after all. In my own area of interest, diabetes, many patients with the condition do not have access to important technologies (such as insulin pump therapy) that could benefit them. Some patients may not even know that these technologies exist as they are never discussed with their primary care or diabetes teams. Mystery shoppers could be trained to ask healthcare teams leading questions to assess commitment to offering these technologies.

Others may agree with the Republican Senators who describe the whole idea of having mystery shoppers in health care as “big brother-ish.” Meanwhile, at the supermarket till, mystery shopping continues, poor performance results in a summons for a managerial dressing down. Good performers are given gold stars, which can be exchanged for vouchers – which can only be used in the same supermarket!

David Kerr is the managing editor of the Journal of Diabetes Science and Technology.