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Undercover 'shopping' to evaluate lab services.

Wonder what goes on at your outpatient labs when you're not there? This clever adaptation from the retail world can help you ferret out foul play and affirm first-rate employees.

ABOUT TWO WEEKS before Christmas, a patient, who required a preemployment drug test, offered a phlebotomist at one of our outpatient centers $100 to substitute her urine for the patient's. The patient told the phlebotomist that he really needed the job for which he was applying in order to give his wife and children a decent Christmas, but he was afraid his drug test would be positive. He was willing to pay almost anything for clean urine.

The phlebotomist refused and later reported the incident to her supervisor. When we talked about the incident the next day, we decided two things: 1) The phlebotomist who turned down the $100 so close to Christmas was to be commended, and 2) We needed to devise a way to find out if this sort of thing was happening at our other nine outpatient locations.

The more we talked, the more we realized we had no way of monitoring adequately all 10 locations and their employees for such activities or for some of the behaviors that had been reported on patient comment cards. Was one of our phlebotomists really rude to patients? Were there really blood spots on the wall? Did the phlebotomist really wear baggy pants and thongs?

For years department stores, supermarkets, discount stores, and even banks have used undercover "shoppers" or customers to observe and evaluate their facilities and employees without the workers being aware. The shoppers check for cleanliness, friendliness, attractively arranged merchandise, and service. Why couldn't we use the same concept to monitor our outpatient locations?

We agreed on a 6-step process that was implemented immediately. First, we had to determine what image we wanted our labs to project. Second, we designed an evaluation form around the elements necessary to create the image we desired. Third, we selected and trained our shoppers. Fourth, we informed all of our employees of the program and implemented it. Fifth, we developed a system for evaluating results. And finally, we developed mechanisms for providing employees with feedback.

* Selecting an image. What image did our laboratory want to convey through our outpatient centers? Since we are an independent laboratory, patients' only knowledge of us is what they experience at our outpatient locations. We wanted patients to regard us as a professional organization that cares for each and every one of them; we wanted them to feel they were entering a clean, neat facility with fast, friendly service. And we wanted them to think our employees were the best!

* Developing the form. With those thoughts in mind, we designed our "Shopper Report TABULAR DATA OMITTED Form". Using a 1-5 rating system, the form aids shoppers in evaluating various aspects of the outpatient labs. For example, one item on the form asks shoppers whether a blueing agent was used in the toilet bowls of the lab they are inspecting. This is important because some patients coming to the lab for drug screens are not above substituting toilet water for their urine specimen.

* Choosing and training shoppers. To start, we established four false accounts. We printed request forms with the four false names on them and addresses that belonged to some of the members of the committee designing the program. The first shoppers we selected were friends and family members ranging in age from 18 to 70. We met with all of the volunteer shoppers and reviewed the checklist item by item, explaining what to look for. We selected the outpatient centers to which they would go based on comments from patients and physicians.

Each shopper received $15 upon mailing in their evaluation form. As an added incentive, we decided to allow shoppers to choose the test they would like to have done. If, for example, a shopper was applying for a new job and needed to have a drug screen performed, the shopper could have it done as part of the shopping program free of charge. Shoppers who had no test preference were assigned a test selected by the committee.

* Going shopping. With the shoppers trained and ready to go, we informed our employees about the program. We showed them the form and explained each item. We wanted employees to view the program as an opportunity to recognize positive aspects of our outpatient centers as well as to correct flaws. The forms would not be used for disciplinary purposes but for learning how we, as a team, could be better. The employees accepted the program quite well and were eager for its start.

And so it began. We collected the previous months' patient comment cards and selected locations and areas about which we were concerned. Twenty-five shopper visits were logged during the first month at 10 outpatient centers by nine shoppers.

* Evaluating results. At the end of the month, shopper report forms were grouped by location and a final score was determined by averaging the grades for each item on the checklist. Most of the encounters were positive. The data seemed reliable and, for the most part, was what we expected. Our smallest outpatient center, for example, is a tiny room with no lobby or waiting area except a public hallway. Not surprisingly, it received "ones" on most of the appearance items, but "fives" on most of the aspects pertaining to personnel.

One of our newest locations is directly across the street from the University Medical Center. Parking is at a premium for blocks in all directions. Again, not surprisingly, parking for this location received quite a few "one" ratings.

What was surprising was when the system helped us to discover that an employee we thought was friendly and professional was making a completely different impression on patients.

* Employee feedback. Employees at each location were shown the summary for their site and asked for their suggestions on how to make the scores higher. In all cases, when employees were mentioned by name on a form as having been outstanding, the employees were recognized by their supervisor and the laboratory manager. If a problem was identified with an employee, we worked with that employee to improve the particular rating. In the case of the "surprise" employee, for example, we worked with her on how she greeted and conversed with patients. Over the next several months, the numbers on the shopper reports for that center and that employee increased to "fours" and "fives."

We are now well into our third year with our shopper program. We have between 22 and 30 shoppers at any given time; each participates in two encounters per month, and we change shoppers every other month.

Along the way, we have had to set up a few new false accounts since some shoppers were "discovered" by employees, but overall, the program has turned out to be one of the best means of evaluation we have. We know we can't find and fix everything, but it doesn't hurt to try.

Edwards is laboratory manager and Edmunds is phlebotomy service manager at Associated Pathologists Laboratories, Las Vegas, Nev.
COPYRIGHT 1993 Nelson Publishing
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Author:Edwards, JoAnne; Edmunds, Richard
Publication:Medical Laboratory Observer
Date:Jun 1, 1993
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