Using unannounced standardised patients to obtain data on quality of care in low-income and middle-income countries: key challenges and opportunities

Wiseman, V; Lagarde, M; Kovacs, R; Wulandari, LPL; Powell-Jackson, T; King, J; Goodman, C; Hanson, K; Miller, R; Xu, D; Liverani, M; Yeung, S; Hompashe, D; Khan, M; Burger, R; Christian, CS; Blaauw, D

Journal article

Using unannounced standardised patients to obtain data on quality of care in low-income and middle-income countries: key challenges and opportunities

Abstract:: Standardised patients (SPs)—also called patient actors, simulated patients or mystery clients—have a long history in medical education in high-income countries.1–5 They are now increasingly being used in low-income and middle-income countries (LMICs) to measure quality of care in a variety of clinical and retail (drug shop/pharmacy) settings. SPs are healthy people, or people with stable conditions, extensively trained to consistently simulate the medical history, physical symptoms and emotional characteristics of a real patient to multiple healthcare providers, and subsequently to report details of those interactions. The SP approach has been referred to as the ‘gold standard’ for capturing actual provider behaviour in the healthcare setting.6 7 In a paper published in BMJ Global Health, Kwan et al discussed the different types of research questions that can be addressed using SPs, and the various methodological and analytical issues to consider.8 In a recent complementary paper, King et al provide a step-by-step ‘how to’ guide for planning and implementing an SP study.9 The two papers, and the detailed field manual provided by Kwan et al in their appendix, combine to make a valuable set of resources for researchers using the SP method. In this commentary, members of the Standardised Patients Working Group, comprising economists, epidemiologists and social scientists across nine universities and global health institutions, elaborate on five key methodological and ethical issues raised in the two papers, and discuss how these can be assessed. A key concern about SPs is that they are not real patients and therefore provider responses to SPs may not be valid. Researchers using this method in LMICs go to considerable effort to train SPs to act as real patients. SPs receive coaching to build their understanding of the background story and presentation, including the body language of ill individuals10—see the …

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

Wiseman, V., Lagarde, M., Kovacs, R., Wulandari, L. P. L., Powell-Jackson, T., King, J., Goodman, C., Hanson, K., Miller, R., Xu, D., Liverani, M., Yeung, S., Hompashe, D., Khan, M., Burger, R., Christian, C. S., & Blaauw, D. (2019). Using unannounced standardised patients to obtain data on quality of care in low-income and middle-income countries: key challenges and opportunities. BMJ Global Health, 4(5), e001908–e001908.

MLA Style

Wiseman, V, et al. “Using Unannounced Standardised Patients to Obtain Data on Quality of Care in Low-Income and Middle-Income Countries: Key Challenges and Opportunities.” BMJ Global Health, vol. 4, no. 5, 2019, pp. e001908–e001908.

Chicago Style

Wiseman, V, M Lagarde, R Kovacs, et al. 2019. “Using Unannounced Standardised Patients to Obtain Data on Quality of Care in Low-Income and Middle-Income Countries: Key Challenges and Opportunities.” BMJ Global Health 4 (5): e001908–e001908.
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