SynthesisHealth policy and planning2019
How to do (or not to do) … using the standardized patient method to measure clinical quality of care in LMIC health facilities.
Synthesis in Health policy and planning, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
30 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- What is the relationship between hospital management practices and quality of care? A systematic review of the global evidence.Health policy and planning · 2025Pooled it
- Comparing the use of direct observation, standardized patients and exit interviews in low- and middle-income countries: a systematic review of methods of assessing quality of primary care.Health policy and planning · 2021Pooled it
- An evaluation of the Hawthorne effect in a clinical trial of trauma care in Ghana.World journal of surgery · 2024Trial
- Trial
- Assessing quality gaps in hypertensive disorders of pregnancy care in China: an unannounced standardised patient study protocol.BMJ open · 2026Article
- Access to cervical screening in Australian general practices: a cross-sectional study using a 'secret shopper' approach.Cancer causes & control : CCC · 2026Article
- Implementation and evaluation of a secret shopper methodology to examine access to prenatal care for patients with opioid use disorder.BMC pregnancy and childbirth · 2026Article
- Simulated Interviews, Real Results: A feasibility Study Implementing "Standardized Research Participants" cases in Qualitative Research Training with Older Adults.Research square · 2025Article
- Application of Large Language Models in Medical Training Evaluation-Using ChatGPT as a Standardized Patient: Multimetric Assessment.Journal of medical Internet research · 2025Article
- Comparing the Quality of Direct-to-Consumer Telemedicine Dominated and Delivered by Public and Private Sector Platforms in China: Standardized Patient Study.Journal of medical Internet research · 2024Article
- Review
- Management Practices and Quality of Care: Evidence from the Private Health Care Sector in Tanzania.Economic journal (London, England) · 2024Article
- Do private providers initiate anti-tuberculosis therapy on the basis of chest radiographs? A standardised patient study in urban India.The Lancet regional health. Southeast Asia · 2023Article
- Article
- Does increased provider effort improve quality of care? Evidence from a standardised patient study on correct and unnecessary treatment.BMC health services research · 2023Article
- Validation of the Adolescent Health Quality of Care (AHQOC) index for mystery client studies.PloS one · 2023Article
- Secret shopper studies: an unorthodox design that measures inequities in healthcare access.Archives of public health = Archives belges de sante publique · 2022Article
- Tuberculosis diagnosis and management in the public versus private sector: a standardised patients study in Mumbai, India.BMJ global health · 2022Article
- Investigating the relationship between consultation length and quality of tele-dermatology E-consults in China: a cross-sectional standardized patient study.BMC health services research · 2022Article
- Improving Data Surveillance Resilience Beyond COVID-19: Experiences of Primary heAlth Care quAlity Cohort In ChinA (ACACIA) Using Unannounced Standardized Patients.American journal of public health · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
Abstract
Standardized patients (SPs), i.e. mystery shoppers for healthcare providers, are increasingly used as a tool to measure quality of clinical care, particularly in low- and middle-income countries where medical record abstraction is unlikely to be feasible. The SP method allows care to be observed without the provider's knowledge, removing concerns about the Hawthorne effect, and means that providers can be directly compared against each other. However, their undercover nature means that there are methodological and ethical challenges beyond those found in normal fieldwork. We draw on a systematic review and our own experience of implementing such studies to discuss six key steps in designing and executing SP studies in healthcare facilities, which are more complex than those in retail settings. Researchers must carefully choose the symptoms or conditions the SPs will present in order to minimize potential harm to fieldworkers, reduce the risk of detection and ensure that there is a meaningful measure of clinical care. They must carefully define the types of outcomes to be documented, develop the study scripts and questionnaires, and adopt an appropriate sampling strategy. Particular attention is required to ethical considerations and to assessing detection by providers. Such studies require thorough planning, piloting and training, and a dedicated and engaged field team. With sufficient effort, SP studies can provide uniquely rich data, giving insights into how care is provided which is of great value to both researchers and policymakers.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.