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JULY 23, 2008
Can Undercover Patients Improve Quality?
Very few things impact us more than the quality of our health care services, which is why I was intrigued by this news story about hospitals using “undercover patients” to judge doctors’ performances. In fact, the American Medical Association recently considered endorsing this practice. The debate generated some heated discussion - just check out the comments left on New York Times blogger Tara Parker Pope’s post on the subject.
Now I am as much a privacy freak as the next person, but something deep inside me applauded this sneaky approach to quality control. Of course, many doctors don’t like it, but there are exceptions. Dr. Frank J. Weinstock responded to Parker Pope’s post:
As a physician, the concept of “secret shoppers” should start with us. Unfortunately, not enough physicians take the time to observe their own reception areas or the reception areas at the hospital or listen to the way their staffs speak to patients in the office and on the phone. If so, there would be many changes. We should have nothing to fear from secret shoppers if we pay attention to our offices ourselves.
The practice of using “mystery shoppers” is already commonplace in the retail and food industries. (Just beware of scams asking you to pay to become one).
When quality is such a key measurement for consumers, how far should a company go to ensure it’s meeting its customers needs? I don’t want to live in a Big Brother world, but if we are each doing our jobs as we should, does it matter if someone is looking over our shoulder?
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One of the problems with hospital and nursing home inspections is they depend on the paperwork to verify that patients and residents are getting good care. The facilities pay nurses to make sure the paperwork is perfect, thereby ensuring a good inspection.
To really inspect a health facility, they should have decoy patients or residents to actually experience and observe what goes on in that facility on a day to day basis. Or else have an inspector be hired as a staff nurse and work there for a few weeks to see what is really happening.
We are facing a huge increase in the need for quality in nursing home care. It strikes me that for the past almost eight years, our federal government has been run by an administration that has little regard for running good government. With private equity groups like the Carlyle Group taking-over facilities like Manor Care, nursing home care has gotten worse.
The desire for profit margins translates into less staffing at nursing homes, less training for the staff that they do have, less food (or a lower quality of food) for the residents, and less management and oversight. A conflict arises between saving dollars and providing good care.
There would be a much higher level of care given to patients if adequate staffing were provided. However, Administrators benefit from the amount of profit generated by the nursing home they manage, usually paid annual bonuses based on bed-count. They must choose between increasing the profit margins of their individual facilities or supplying more support staff for the care of residents.
Another way residents don’t receive the care they need because of profit concerns, ranges from which ambulance service the nursing home calls, to whether or not a patient even goes to the hospital after a fall or other calamity.
Even nursing home abuse may occur because of the desire for profit. Caregivers who work in nursing homes are often stretched beyond their ability. They try to do the best job that they can, but the lack of additional support restricts what they can do to help patients.
You’ll never catch these discrepancies with facility inspections depending on paperwork to verify patients and residents are getting good care. Self-reported and audited paperwork (data reported by the facilities themselves and no oversight agency verifies audits to ensure that it is even true).
Posted by: Gregory D. Pawelski | October 15, 2008 at 2:45 PM
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