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Customer Strategist Journal
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A Healthy Dose of Customer Strategy

In Healthcare the "Customer" Has Many Faces

There are multiple customer communities of interest loosely and in some cases intimately intertwined in every industry. Each community has its own interests and each intersection of communities--whether collaborative, confused, or in conflict--produces opportunities. This is particularly true in healthcare. Doctors, nurses, medical specialists, hospital administration, technical services (medical and infrastructure), pharmacists, suppliers, referring MDs, insurance carriers, Medicare/Medicaid, regulators and legislatures, patients and their families, even medical schools and universities are all present in this complex and vital industrial network. It's a recipe for competing priorities and a loss of customer focus.

Service providers must understand each of the healthcare community's perspectives and priorities in order to get attention and provide a valuable service. Once the perspectives and priorities are understood, visions can be developed, resources can be marshaled, processes defined, measures established, and the customer experiences, as well as economics, can be optimized. Organizations that understand the perspectives of these players enhance their ability to work with any group in this network while working for any other group. Ultimately, this gestalt leads to improvements in customer experience and business outcomes.

A unique community
Healthcare is perhaps unique in that it is the most "hands on" industry of the 10 recognized industrial sectors. Products are not simply created and shipped, like washing machines, software, or potato chips. The end customer base (patients) is literally seen and touched by the industry. As a result, the philosophy of customer care resonates with all health professionals, and they will act in accordance with it. In fact, extensive experience in the healthcare industry has shown that clearly, repeatedly, and sometimes forcefully stated customer needs can unite or reunite departments across routine organizational agendas.

Still, in healthcare it can be difficult to prioritize or balance meeting the expectations or requirements of the various customer groups entwined in a relationship or set of interactions, activities, or processes that are sometimes at odds.

One powerful example is how the interests of patients and medical providers (MPs), such as doctors and nurses, and those of insurance carriers (ICs) can compete. Patients want expedient and effective medical care, as well as a straightforward claims process. The MPs are primarily interested in patient care and how the results of the care they provide impact each patient. Insurance carriers are driven by their vision of efficient medical care. That vision is supported by complex negotiated rate contracts, coded diagnoses, and the treatment preapproval process. ICs and MPs typically can act rapidly in emergency medical situations, e.g. the emergency room. However, the next level of urgency, acute care, can put these groups in conflict. For instance, certain types of brain tumors can double in volume in as few as seven days and thus can kill in a matter of days. ICs usually want five business days to review a patient's data and decide what procedures they will approve. However, doctors need far more timely follow-up in these cases. The patient may not have symptoms like fevers or external bleeding and may be only mildly discomforted, yet immediate surgical relief is the patient's only hope.

Another example is within a hospital community, where various subgroups such as medical engineering and IT, pharmacists, and MPs must work together. In theory, they're united behind the concept of superior customer service. In practice, however, collaboration can be challenging among a set of groups each with different vocabularies and priorities. 

A scenario most patients have encountered that links all of these groups is administering medications. The chain runs like this: Doctors prescribe medications; the prescription is submitted to the pharmacy via an electronic record maintained by IT. The pharmacist prepares the dosage and a technician loads it onto a robot cart provided by medical engineering. The cart navigates a path through the hospital, appearing at patient rooms on schedule, prompting nursing to match patient to medication and add the meds to a patient's IV or otherwise deliver the medicine. All these interactions require the medical engineering systems to accept and report back to IT patient record systems.

A vendor selling equipment, technologies, or other supplies that are part of this process must understand the needs and interplay of each group, as well as the gravity of each step being performed correctly and in a timely manner. Gaining a deep understanding of each group and how its role impacts the overall process can help a vendor gain an edge.

Reaching an understanding
Acquiring that insight is no easy task. To understand the perspectives and priorities of these sometimes collaborative, sometimes competing groups it's necessary to gather detailed data that can then be transformed into actionable information. This means listening to feedback, comments, and suggestions from the various customer groups; reading internal and industry-based studies and findings; watching specific systems in action; and using personal experience to draw relevant, tailored conclusions.

This will allow those selling within the healthcare industry to not only better serve each set of customers, but also to help each group assist each of the others--which could serve as a powerful relationship builder between the seller and the customer groups it serves. One reason: Across an interacting healthcare community, consensus is usually the rule, each group acknowledging the others' needs and priorities and not wishing to negatively impact their peers.

Consequently, once a seller has digested the insights learned from the customer groups it serves, as well as from those that are influencers, and when the recommendations acknowledge and balance all the interests of the various communities--demonstrating a strong likelihood of making the work environment better and improving patient outcomes--that seller can likely expect acceptance and support to proceed.

However, simply balancing the interests of these entities isn't enough. We have to review this consensus-supported recommendation against its impact on the end user by asking: Will this improve the patient's experience? How? Will it reflect well on the company in those all important referral networks? Will the recommendation positively impact the patient throughput? How will we sustain service levels if the number of customers jumps? How will we impact the service providers, from clerical to medical?

One example: scheduling a visit at a clinic. Referring doctors, pharmacists, and patients like to receive quick service, with few holds, few transfers, and no voicemail exits. Doctors stop referring patients to clinics that don't process calls expeditiously. Front-office personnel do not like to remain after hours to empty jammed voicemail boxes and call patients back at night.

The customer experience at a clinic can deteriorate because scheduling visits is actually quite complex. Here's a sample: Front-office personnel have to assess the patient: New or returning? Known diagnosis or diagnosis needed? What are the signs and symptoms? How urgent is the need? Which doctor should handle the case? Is the most suitable doctor accepting overbooked appointments? What are her rules for overbooking? Which doctor is available during the patient's timeframe? Will the doctors work after hours? Which insurance carrier is involved? What does that carrier cover? Are authorizations needed?

Clinics tend to develop phone trees and voice mail systems over time, tailored to organic processes and past events. Over time these trees become more difficult for patients to navigate and have underutilized branches, too many exits to voicemail, and other warts. In a busy clinic the front-office staff receives some training and then gets a lot of on the job training. They pin, tape, or staple answers to their daily needs on boards, desktops, and computer monitors. Different service reps know different things, so side bar conversations take place as patients wait.

A seller that doesn't take the time to understand all these nuances can easily offer a product or service that makes matters worse. By understanding the collected needs and priorities of each group involved, a seller can design a solution that not only enhances clinic throughput and staff morale, but also delights patients. This interest and understanding is what will build trust, cement long-term customer relationships, and increase sales.

A prescription for success
To gain a full understanding of a problem and develop a strategic solution--one that solves the needs of multiple communities and delights the customers--sellers in the healthcare industry have to get back to the basics of customer insight. They must follow the universal business methodology of data collection, analysis, drawing and testing hypotheses, drafting and thought testing solution concepts, selling solution designs to stakeholders, doing detailed designs, developing a project plan and business case, and working through implementation. Concurrent with the detailed solution design, they need to develop relevant success metrics and data collection methodology to prove the efficacy of the solution and provide feedback for tuning the new business processes that result.

Ultimately, patients want to assume the best of all the players in the healthcare industry; they expect exemplary care followed by an efficient administrative billing process that interacts reliably with their insurance carrier.

Fortunately, the primary players in healthcare started from a customer experience perspective. Cogently appealing to that perspective in the face of competing interests will provide the push to make improvements in the system. All industry players recognize that a steady flow of patients is necessary for their businesses to thrive. A superior customer experience is the key ingredient.