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Mystery shopper redux

July 6, 2009
by Terry L. Stawar, Ed.D.
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In the July 2009 issue of Psychiatric Services, Arthur Lazarus, MD, suggested that mental health services could be improved by planting trained consumers pretending to be patients in facilities to identify problems. 

Almost 20 years ago, I remember Kathy Walls, PhD, who was CEO of the CMHC in Jacksonville, Florida presenting a program at the Florida Council for Community Mental Health’s annual conference on a Mystery Shopper Approach to Evaluating Mental Health Programs. Dr. Walls trained a small group of volunteers to be “mystery shoppers” and then ran them through her various programs. Staff were notified that such shoppers would be coming through the program and I seem to remember that staff frequently misidentified real patients as mystery shoppers. 

She also devised a fairly elaborate debriefing process that might be described as a focus group approach today. Since the program had some elements of deception, the morality of such an approach was much debated at the time. Using consumers as planted patients might alleviate some of the deception involved when volunteers were used. 

In any event I don’t recall that this approach caught on, although many centers before and since have run ringers through their crisis telephone services and their front desks to assess responses. Perhaps Dr. Walls was just ahead of her time. 

In an ugly twist on this approach there have been some centers that have planted private detectives in programs where wrong doing was suspected.

I have also known a few residential and inpatient programs that required any staff member working in the program, to spend a few nights first, as a patient in the program, to better understand the consumer’s perspective.

I am not sure how widespread such practices are today.



It might help increase emphathy. I think working in an inpatient/residential unit over time can lead to some decree of desenstization. For first time inpatients, the whole experience may be one of the most traumatic things that has ever happen to the patient or the patient's family, while it may become more or less routine to the staff. I think we also don't always realize how impersonal, scarey, and even dehumanizing hospitialization can be at times.

I also recently found out that Dr. Wall even gave a version of her Shopper's presentation to the National Council back in 1981.

Kathleen E. Wall, Ph.D. March 1981 The "Shopper" Evaluation of Mental Health Services: finding out what our clients already know, National Council for Community Mental Health, Dallas, Texas.

Do you think having staff spend a few nights in patients' shoes is effective?

Terry Stawar

President/CEO (LifeSpring, Inc.)

Terry Stawar


Terry L. Stawar, EdD, is President and CEO of LifeSpring Health Systems, a community behavioral...

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