Dr. El

Posing as customers, “secret shoppers” deliver the inside scoop to management about their experiences with various service providers. They can be invaluable to management in all kinds of situations, including long-term care, though there are special challenges there.

Secret shoppers are perhaps best known for retail settings. But they’re also used in hospital settings. A controversial recent New York Times article noted how faux patients arrive in emergency departments with contrived symptoms that allow them to observe the proceedings. The information provided is used to alter procedures and enhance training with the goal of improving customer satisfaction. 

According to the article, “Undercover in a Hospital Bed,” personal details that explain poor customer service ratings can leave hospital executives “spellbound.” In one example, a secret shopper reported that staff members were dismissive of patient concerns and squabbled among themselves. Poor teamwork made her doubt the quality of the care she was receiving. 

The findings inspired the hospital to create and train employees on new norms of staff behavior, including staying off cell phones and learning more about the lives of the people presenting for care. Obvious long-term care parallels can be assumed, but there’s more.


There were a wide variety of comments on the New York Times piece. Hospital insiders affirmed the necessity and benefit of this stealth approach. Others deplored the waste of resources used on the deception. A few pointed to statistics indicating that what customers might consider good service could actually result in poorer clinical care. (Think: I’m so happy they gave me that opioid I wanted.) 

Workers fumed that their own opinions weren’t solicited. They were also concerned about superficial fixes such as pushing employees to plaster smiles on their faces without investigating and correcting the reasons that they weren’t smiling in the first place.

My take is that while workers have valuable information regarding the patient experience, they’re not always in a position to reveal it and management isn’t generally receptive to worker commentary. If the leadership team uses the information gleaned from the brief deception of a secret shopper to make underlying changes that positively impact patients and employees, then the strategy is a valuable tool.

Application to LTC

Those interested in the idea will note, however, that it’s easier to pose as a hospital patient than it is to be a mock nursing home resident. Skilled nursing residents tend to be much older, have visible impairments and to be admitted after a hard-to-fake hospital stay. 

While LTC facilities might not be able to gather information as easily from sham residents, SNF leaders who want to illuminate the important, human details behind dry customer service statistics might find these ideas useful:

  • Call the nursing home and ask for information. Does the call go through immediately or does it take several attempts? How long does it take to reach someone who can answer questions? Are staff members helpful and pleasant? This exercise can provide an idea of the initial presentation of a facility to potential residents and their families and reveal what it’s like for them to reach a loved one on an ongoing basis.
  • Schedule a tour. Have someone from a sister facility observe the home with fresh eyes.
  • Peruse your website, which functions as your 24/7 customer representative. Is it appealing and welcoming or impersonal and formulaic? Does it answer the types of questions adult children might have about the facility? Do the links click through? Is it up-to-date? 
  • Hire a trained shopper “temp” to gather some intel as a staff member, posing, for example, as a fill-in file clerk on the unit or as a resident “transporter” who moves from floor to floor. 
  • Take the complaints at the resident council meetings seriously. Read between the lines for clues regarding resident dissatisfaction. “Long waits for the call bell to be answered” could mean problems such as insufficient staffing, workers intentionally ignoring alarms or a lack of training. “No hot water” might be indicative of poor communication between departments, the need for a new boiler, or general problems with the maintenance department. 
  • Ask your consulting psychologists. We are the proverbial “flies on the wall,” overhearing conversations at the nursing stations and listening to the perspectives of residents and their families, with psychological training that allows us to integrate our observations. If requested, we might help formulate a treatment plan for the facility.
  • Ask your residents and employees — if you’re prepared to get an earful and to act upon what you hear with a judicious, planned approach. 

Even leaders who regularly walk the floors of their facilities know that the interactions between workers and their charges are different when senior managers aren’t observing. 

Discovering details of the day-to-day experiences of residents, families and staff can offer valuable insights that improve care quality, increase satisfaction and make a facility a better place to live and work. 

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Bronze Medalist for Best Blog in the American Society of Business Publication Editors national competition and a Gold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements and/or content writing, visit her award-winning website at MyBetterNursingHome.com.