AMA Report (3) Secret Shopper “Patients”
The subject 3 Secret Shopper "Patients" is one of a series of 8 Reports of the Council of Ethical and Judicial Affairs (CEJA) of the American Medical Association. These reports have not yet been adopted as AMA policy; they will be discussed and debated in June 2008. If they receive the support of the majority of the delegates from the state and specialty societies, they will become policy. Anyone, including the general public, can provide testimony on CEJA reports either in person at the meeting or by writing to firstname.lastname@example.org.
I am presenting each Report as a separate thread on this blog. By clicking on the link above, you can gain access to the specific wording of the Reports, 1 through 6 are to be Amendments to the Constitution and Bylaws of the American Medical Association. Reports 7 and 8 are for Informational purposes. Why should the public be interested in these reports? They are part of the ethics of the system of medicine in the United States and may be reflected elsewhere in the world. Through the practice of medicine by all physicians, the rules presented in these reports can be applied to and may affect all patients. You may write directly your comments to CEJA at the e-mail address above and, of course, you are certainly welcome to post your comments on this particular Report here.
Have you any idea what is a “Secret Shopper ‘Patient’? Actually, to demonstrate how ignorant I have been about such matters (and probably I am not the only physician to say this), I had no idea that such a “patient” could be part of my patient population until I read this Report. The Report explains:
Secret shopper “patients” are modeled on quality improvement tools developed in nonclinical service domains. The secret shopper industry has been used for decades to evaluate practices in the retail and hotel industries, primarily in the area of customer service. As of 2004 the health care industry was responsible for just 2% of all secret shopper revenue, although this represented a twofold increase over the preceding year.
They are individuals hired to act as patients to monitor service quality. The activities of a secret shopper “patient” will vary depending on what type of feedback is desired. Secret shoppers have been used to evaluate most of the steps of the patient experience, from the ease of making an appointment over the phone, to the environment and flow of patients in the waiting room, to the encounter with the physician. Secret shoppers usually record general observations and may use a checklist to record whether pre-identified service criteria are met.
There are ethical issues that are related to the use of such “patients”. The Report describes the following:
…ethical concerns can arise when secret shoppers are sent into practice settings, especially when they may interact or interfere with the care of bona fide patients or are used specifically to assess clinical skills. Some examples of ethical unease include concern that the use of secret shoppers wastes scarce health care resources, is a deceptive practice, raises privacy issues,and is not well validated as a methodology for assessing clinical performance.
Their presence in hospital emergency rooms could delay and interfere with the treatment of critically ill patients.
The Report sets forth the following recommendations:
Physicians have an ethical responsibility to engage in activities that contribute to continual improvements in patient care. One method for promoting such quality improvement is through the use of secret shopper “patients” who have been appropriately trained to provide feedback about physician performance in the clinical setting. A sound secret shopper program should include the following elements:
(1) All relevant parties, especially those to whom secret shoppers will be making unannounced visits, should be notified that this mechanism is being implemented in their practice setting.
(2) The information collected by secret shoppers should be used only to identify areas of improvement and not as a basis for punitive actions. Third parties should not have access to information collected by secret shoppers that includes personally identifying data.
(3) Feedback from secret shopper “patients” should not be relied on as the sole source of data for evaluating clinical performance.
(4) The use of secret shopper “patients” should not be implemented in a manner that adversely affects access to medical care by legitimate patients. For example, the need for urgent care (such as in the emergency department setting) must always take precedence over secret shopper “patients.”
So what do you think about a “patient” who enters a doctor’s office or clinic or hospital emergency room at the request of some party who wants information about how patients are managed there? Do you think that by following the recommendations presented, the results will be a fair compromise concerning further utilization of these “patients”? ..Maurice.