The importance of effective infection control compliance has been evidenced in recent HealthLeaders articles about staff games for hand hygiene and online videos.
Another tactic some hospitals take is to monitor infection control through "mystery shoppers" who secretly note the behavior of employees.
The advantage of mystery shoppers, at least in the infection control world, is that they capture typical compliance rather than reactionary conduct, says Gayle Lovato, MS, RN, an infection preventionist at Inova Loudoun Hospital in Leesburg, VA.
For example, it's nearly impossible for infection control professionals to accurately observe hand hygiene practices during rounds. "People tend to run screaming to the closest sink when they see us," says Lovato, whose hospital uses mystery shoppers.
Medical centers can use secret shoppers to track a variety of infection control concerns, including steps to thwart urinary tract infections, proper use of gloves and masks, and observing isolation precautions.
Who you can recruit
Inova's mystery shopper program for hand hygiene uses infection control trainers to perform the surveillance. There is one trainer per unit, and he or she monitors staff compliance with hand hygiene regulations and then documents the findings on a standardized report form. Each trainer performs an average 10 observations a month, says Lovato.
To entice volunteers, Inova offers a step increase for secret shoppers. This gives staff members a small incremental pay increase, similar to what they would get for participating on a hospital committee, says Lovato.
Every month, Inova issues a report card that lists the compliance rates for each unit. "The observations are not scientific, they're random, but overall I think they give us a pretty good snapshot," says Lovato.
The hospital uses these hand hygiene figures to spot trends and see where problem areas exist. For example, if a particular unit has a high incidence of noncompliance, Lovato looks for opportunities to perform staff education or to improve systems issues, such as making alcohol-based hand sanitizer more readily available.
Widespread appeal to clandestine scrutiny
Mystery shopping has increased rapidly in hospitals in recent years, mainly from the perspective of sending in actual or stand-in patients to assess the quality of customer and clinical service in a medical facility.
Although many healthcare organizations are measuring patient satisfaction, their data don't always pinpoint the experiences behind the scores. Mystery shoppers fill in the fine details and help hospitals understand how patients feel about their experiences, apart from how they feel about their medical treatment.
There are a number of barriers to overcome before starting a mystery shopper program, says Brian Hudson, MT (ASCP), CIC, an infection preventionist at Cleveland Regional Medical Center in Shelby, NC.
Cleveland Regional also users secret shoppers to monitor handwashing. His biggest challenge has been recruiting people to take the job. "Nobody wants to be thought of as a rat," he says. "It's viewed as tattling."
Lovato says, however, there is no reason for staff members to view the job as a negative. Shoppers should know that they perform an important service by protecting patient safety. Offering an incentive, such as the additional pay step, is one way of overcoming an individual's unwillingness to take the position, she says.
It's important to let shoppers know they're appreciated to encourage participation. Lovato meets with the mystery shoppers monthly, sometimes at a catered breakfast meeting.
"We try to make it a fun role," she says. "We bring in speakers. Sometimes drug reps will do a presentation on infectious diseases or issues." The facility also hosts a holiday party for mystery shoppers and thanks them for their work in the hospital's internal newsletter.