experience mapping for destination programs

8/14/2019 Experience Mapping for Destination Programs

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Building a Destination Marketing Program from the Inside Out

Service as a Differentiator


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Agenda

Advertising versus Advocacy

Experience Mapping

Our Skin Cancer Program Applications

Questions


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Satisfaction = Profits

Fornell, Mithas, Morgeson III, & Krishnan, Journal of Marketing, 2006

There is a positive

correlation betweencorporate performanceand satisfaction


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Even Starbucks Gets Back to Basics

Closes approximately 600underperforming company-owned stores

with a goal of enabling our

organization to focus itsefforts on locations where wecan more effectively improve

the customer experience.

Howard Schultz, Chairman,

President, CEO (7/1/2008)


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Loyalty and Satisfaction Stem from Experiences

Customer loyalty ismore a result of howcustomers feel about

the overall experiencethey receive from youthan what they

rationally think aboutyour individualproducts and services


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But We Need a Game Plan

Leonard Berry, Ph.D., Texas A&M University,

Professor of Marketing, Gelb Affiliate

Author, Discovering the Soul of Serviceand

Management Lessons from Mayo Clinic

Organizations that simply tweak

design elements or focus on thecustomer experience in isolatedparts of their business will bedisappointed in the results.


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Volume and Experience

To increase patient volume

You need patients and

physicians who becomeadvocates

Because they are

enthusiastic about anexceptional experience


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The Critical Role of Touchpoints

A Touchpoint is theinteraction between anorganization and itscustomers

It is the means by whicha customer realizes thepromise of your brand

And expectations aremanaged


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Touchpoint Types


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Experience Management

What is the current

experience?

How can we make

this experience

exceptional?

How will we deliver a

consistent

experience?

Are we meeting

expectations?

Strategic

Questions

Touchpoint inventory

Staff interviews

Patient interviews

Physician interviews

Operations/ business

processes review

Resources/technology

review

Rollout plan

Customer satisfaction

Touchpoint performance

Employee commitment

Operational performance

improvement

Activities Experience creationworkshop

Implementation planning

Deliverables Touchpoint priority

Day in the Life

Ideal experience map

Touchpoint guidelines

Touchpoint performance

dashboard

Experience dashboard

Organizational excellence

dashboard

Implementation strategy

Understand Design Implement Monitor

Understand

Design

Implement

Monitor


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Benefits of Experience Mapping

Reviews the total experience, including: Expectations prior to the first encounter with the organization

Multiple activities (e.g., parking, check-in, exams, follow-up)

Multiple touchpoints (e.g., materials, conversations, website)

Recognizes changes in attitudes, if any, through each stage

Goes beyond mystery shopping:

By engaging actual patients and their stories, results provide rich insights beyondaudit statistics

Taps into the emotional needs of patients, particularly those with life-changing

events like cancer Increases face validity for staff responsible for making changes

Does not tax medical resources

Includes actual comments (via digital audio files and verbatim comment) toimprove staff empathy


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photo

Skin Cancer Program Patient Experience Map

Key Touchpoints

Primary Experience Stewards

Referring physician Referring

physicians Clerks

Nurses

Nurses

Volunteers/Parkingattendant

Front line staff

members

Physicians

Nurses/Staff Environment

Physician

Nurses Referring

physicians

Ideal Experience Elements

Doctor knows

best

Everything is

smooth

Theyre

expecting me

I feel like their

only patient

Your support

doesnt end

Need Scheduling Arrival Visit End of Visit

photo photo photo photo


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Background

University of Michigan patients access diagnostic, treatment andsurveillance services for Melanoma, Non-Melanoma, and Merkel cellcarcinoma conditions through your world-renowned program

Gelb was retained to derive insights from staff, patient, and referring

physician interviews to lead a process to improve customer empathy todocument the current patient experience, propose a framework fordestination marketing, and provide a set of standards to improve thecustomer journey in other parts of the organization

Our approach examined the customer journey holistically, engaging staff,patients/family members, and referring physicians to:

Define key steps and touchpoints in the patient/physician experience

Assess the performance of those touchpoints

Describe the functional and emotional benefits patients seek

Identify opportunities for alignment and improvement


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Interviews

In-clinic interviews provide visualcues for recall

Interviews with family/support

system reveal unique roles andneeds

By interviewing a large number of

patients, a composite view of thetotal patient experience is attained


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Participants

Over the course of two weeks, Gelb conducted in-depth interviewswith:

50 patients

29 Mohs

12 Melanoma

4 Melanoma & Mohs

4 Merkel cell carcinoma

1 Merkel cell carcinoma and Melanoma

21 referring physicians

54 faculty and staff members who were interviewed individually and in

small groups

These interviews were conducted with the support and assistance ofthe skin cancer program administrative team


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Discussion Areas

Decision criteria

Involvement versus Influence

Expectations

Sources of anxiety

Areas of praise

Experience conclusion

Summary


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Phase Performance Summary

Need

Patients understand that U-M is top-notch, but are intimidated by itssize. More information about the programs services and how its

different from local services could allay fears and reservations.

Scheduling

Patients are highly satisfied with the ease of this process but havedifficulty understanding the need for the consultation. Yet, patients findthe personal attention and organization of this experience reassuring.

Arrival

While the packet helps patients to know what to expect, the wholeprocess of getting to the clinic is still stressful for patients. Their anxietyis high, particularly among older patients. Close parking and friendlygreetings overcome many wayfinding issues.

Visit

The personal attention given by physicians and staff members exceeds

expectations. The timeliness, caring, and expertise of the skin cancerexperience outshine other healthcare experiences.

Follow-up

Education and outcomes provides patients with a sense ofempowerment. The collegial attitude expressed toward referringphysicians leaves patients with confidence in the healthcare system.

The Skin Cancer Program experience is one patients rave aboutSummary

19

High performance Moderate performance Low performance

Summary


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Key referral drivers rooted in reputation, service excellence

Outstanding communication and collaboration regarding their cases

U-M multidisciplinary approach improves quality of care, medical outcomes Consistently positive and efficient patient experiences

Physicians feel differently about other areas, particularly dermatology

Mohs-eligible patients sent to more convenient, but less satisfying local options

Most importantly, referring physicians feel part of the treatment team Patients told their physicians are familiar and made smart a choice in sending

Both parties eager to praise each other

Education is a role U-M fills ably

Dr. Johnsons reputation in medical outcomes, patient focus

Taking the time necessary to answer questions both from physicians andpatients

Physicians are concerned that growth could reduce access andcommunication

Emulate Mayo Clinics efficiency model Improve Web site to promote the program more effectively

Referring physicians are highly satisfied with communication, but areconcerned with consequences of growth

Summary

Summary


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Staff and faculty cite the high standards and patient care, level of service

integration, and positive medical outcomes as critical to success Staff within the skin cancer program feel valued and supported by a strong

leader

Indications that growth must be accompanied by staff and space increases

Some feel that program should be managed under one umbrella

Non-derm staff feel pressure to excel, but dont have resources and control

Separate Mohs/Melanoma clinics inhibit the staffs ability to work as a team

Conflicting priorities and schedules make interdepartmental coordination difficult

A lack of resources limits their ability to meet the demands of the skin cancerprogram

Specific opportunities for improvement

Web site: online forms, secure messaging, condition information, insurance

Improved information transfer with other services (e.g., surgery groups)

More clinical trials

VIP program

Skin cancer staff are proud to be part of a patient-centered program;others respect it, but find staff too demanding

Summary

Summary


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Phase Non-melanoma Melanoma

Need

Patients are worried about quality of life andfacial disfiguration. Nervous, but told by

physician their situation is not life-threatening or

can be treated locally.

Referring physicians often do not provide enoughinformation regarding diagnosis or treatment.

These patients are more likely to have discussed

the situation with someone who has the condition.

Younger patients have the highest levels of anxiety.

Scheduling

Mohs patients may wait longer for their consult

and surgery appointments, but are reassured

their condition is not critical.

Melanoma patients often get appointments

sooner due to the severity.

ArrivalUpon arrival at the Cancer Center patients are greeted warmly; sometimes by the same person they

spoke with over the phone.

Visit

Most finish in the same day. This is a source of

complete satisfaction. Complex cases require

additional services which are skillfully

coordinated.

Visits are coordinated with multiple physicians.

Patients dont see the behind-the-scenes work

required to make their experience a smooth one.

Follow-up

Typically, patients are sent back to their

physicians after their follow-up appointment.

Returning back home quickly endears them to

the program.

Sometimes require more follow-up with other U-M

services. This handoff is often clumsy as no one is

in charge of care. Many also encourage family

members to get screening appointments due to

the genetic link.

Patient handoffs are biggest difference, but not a source of dissatisfactionSummary

22


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A Framework for Action

Interactions are categorized

using the experience map

Each step/touchpoint hasexperience stewards who are

responsible for delivery

With an experience map,every steward can see the

relationship of their actions tothe rest of the journey


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CompetitionFacility Physicians Driving

Distance

NCI

designation

Airfare

(non-stop)

2007 US News

Ranking

(cancer)

University of Michigan 23 0 Miles CCC N/A 21

Beaumont Hospital No program listed


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Non-melanoma Market Profile

Overview: These patients are concerned about their cancer, but, with education,realize its not life-threatening. Motivated by convenience, timely appointments, andpositive cosmetic and medical outcomes

Descriptors:

More commonly older patients (>50 years old)

Depend on dermatologist for medical direction

Anxiety driven by uncertainty, cosmetic outcomes

Size:

Non-melanoma new cases/year 1,000,000 (NCI, US)

Competition:

Procedure available through multiple resources in community

6 active clinical trials within 200 miles of Ann Arbor

Mainly dermatology practices, a primary referral source for the entire program

19 ACMS certified Mohs surgeons in MI (ACMS website)


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Melanoma Market Profile

Overview: Anxious patients with a potentially life-threatening cancer diagnosis.Having a team approach is critical for accurate diagnosis and effective treatment.Early detection is the key to a cure.

Size:

Merkel cell 1,200 new cases per year (NCI)

Melanoma 60,000 new cases per year (NCI)

Descriptors:

Less than 5% are self-referred

Multidisciplinary very important

Many arrive at U-M without diagnosis

Anxiety driven by life-threatening nature of condition

Competition:

Numerous multidisciplinary programs within 250 miles

23 active clinical trials within 200 miles of Ann Arbor


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Messaging

Overcome perceptions as too big and bureaucratic

Leverage positive reputation and service excellence

Fight your disease, not red tape

FasterOrganized around patient to completeMohs treatment in one week;Appointments within a week forMelanoma with multi-disciplinary team

BetterLargest multidisciplinary team in the countryThis team of experts gives you the best chance for favorable medical outcomesBest trained: only two year fellowship in the countryReturns to your community physicianMedically-trained care coordinatorsNCI Comprehensive Cancer Center designation

99% success rate (Mohs) this is available for all doing Mohs

CheaperDetroit Metro airport: international hubTransportation ease


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Tactics Consumers

U-M Differencepatient stories

In one week, at one placeall my questions answered, treatment by a team of nationally-

recognized specialists, cancer eradicated or quality of life improved

Imagery

No buildings

Patient after pictures only (cant be scary)

Doctors/staff behind patients, busy executives

Improve online physician profiles

Care philosophy

Motivations why I care about patients

Showcase expertise

Figurehead: Dr. Tim the authority in skin cancer

U-M Indices: Sponsored Skin Cancer or UV Index

Set standards for early detection programs for melanoma


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Tactics - Referring Physicians

Build wider team of referring physicians in key markets

Destination program will not interfere with patient relationships and encourage return

Provides support of multidisciplinary teamsecond opinion (e.g., pathology)

U-M maintains contact when following their case

Branded physician tools

Skin self-exam

Patient education materials

U-M website for downloads

Skin Cancer Knowledge Transfer CME online or hosted on-site (make sure DOs can receive credit)

Conferences national/international venues, focus on melanoma

Newsletter - information about the latest technology, other physicians in program

Use these forums to build reputation of other program faculty (skin cancer, medical oncology,

plastic surgery, pathology, etc)

Include international outreach education


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The Patient-Centered Culture

MotivationX

Ability=

Behavior


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A case for change must be made to physician administrators

By focusing on the patient , the skin cancer program has successfully:

Decreased/minimized staff turnover

Improved staff empowerment and satisfaction

More service line revenue = better office space and amenities

Improve program-specific donations (e.g. Hannah Fisher fund-raising)

Potential claims:

Increase access to clinical trials (our searches dont support this)

Improved patient satisfaction (must separate this from dermatology) Improved faculty recruitment (not sure if youre losing to community, too)

Motivation


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Current enablers in the Skin Cancer program:

Mantra with a focus on the patient, not on the physician

Strong leadership

Scheduling templates

Direct access between front office and physicians

Interchangeable faculty and staff

Role players, not generalists (e.g., bench scientists versus clinicians)

Team driven innovation, physician driven implementation

Use of first names puts everyone (and their input) on the same level

Opportunities for improvement in Skin Cancer program:

Training of those not directly in the unit (support services like call center)

Not just near misses but patient moments

Monitoring system for patient experience

Tutorials on software tools Scheduling templates for other areas

Better use of online media photos from community physicians, website scheduling, etc

No voice mail in other departments; home phone numbers physicians?

Monitoring mechanisms (e.g., calls to Cancer Answer Line, referring physician satisfaction)

Succession planning the next Tim

Ability


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Consistent communication and support from senior leadership

The mantra

Reinforces clarity of purpose

Research does not come at the expense of the patient

Patient focus relentless and genuine Linking performance to pre-defined objectives

Holistic design of an exceptional functional and emotional patient experience

Empowerment

Collaborative problem solving Anticipating patient needs

Mutual respect

Community physicians are colleagues Dont knock the doc

Phone call post-op from physician/nurse to patients Consideration of ideas from those who are experience stewards

Behaviors

Adapted from APQC Best

Practice Benchmarking


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Interviews indicate that the current experience for melanoma patients is comparableto non-melanoma, but it seems to take more resources to manage

Satisfaction score differences between Mohs and Melanoma not statistically significant (small

sample sizes, but our interviews indicate the same)

The non-dermatology staff who serve melanoma and Mohs patients are caught in the

middle Arent dedicated to serve only skin cancer patients

Do not receive the same type of training regarding skin cancer conditions

Administrators may place restrictions on what can be changed

Cannot draw from a large pool of resources

Not included in Skin Cancer staff meetings

Nevertheless, expectations from the skin cancer program staff are high

Therefore, there needs to be a new collaborative mechanism established betweenskin cancer and others

First Stop: Melanoma


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Participants were divided into three groups:

Administration

Physicians and Nurses

Frontline Staff

Each group will be asked to identify opportunities toimprove the ideal patient experience

Creating Solutions


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Operational Output

As a result of the kick off meeting November 7, 2008 three groups,physicians, nurses, administrators, and front end staff each

highlighted barriers and developed solutions for issues.

Three distinct committees are being formed with subcommitteesattached to each:

The Steering Committee: A high level administrative committee. The purpose ofthis committee is to have a high level view of what the operational, clinical andbusiness barriers are to the programs and create steps to remove the barriersand ensure success.

The Clinical Enterprise Refinement Group: Comprised of several key physiciansand clinicians, will work to resolve the clinical issues pertaining to the program.

Business Enterprise Facilitation Group: Comprised of business service team.Will meet quarterly and oversee the business issues which relate to the program.


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Meeting the Demand

Creating a phone decision tree for all calls

Perfect the registration process to include a flag forthese patients in all systems which include registration,scheduling and billing and cash collections

Ensuring that a system is in place to monitor each andevery patient for quality assurance, lessons learned, andupgrades needed to the program


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Promotion

Consumer - print and radio ads attached

Purpose of this and search advertising efforts is to drivequalified(diagnosed) patients to our landing pageshttp://www.umskincancer.org/

Referring Physicians - sent dedicated Colleagues inCare newsletter, with personal letter attached from Dr.Johnson.
http://www.umskincancer.org/http://www.umskincancer.org/


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Results Q4 2008

Acquired 33 new patients

Conversion rate of 33% from phone inquiry to patient

Close to 60% of inquiries from outside of Michigan


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Making this Work for You

UMHS as a large, academic medical center, has all the same challenges of

decentralization, doctor/administrator personalities, and strategy/budgetcoordination as you do

We have larger plans for destination programs, and purposely choose thisone as a pilot to demonstrate to the nay-sayers that this can work

We're not creating new "centers of excellence" and all the organizationhurdles that presents, rather we're capitalizing on ones that already exist byadding the factor of customer service

This process output allows individuals to see the relationship of their actionsto the rest of the journey -- get out of our internally-created boxes

Need a physician champion like Dr. Tim Johnson

Thorough internal communications are key


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Questions


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John McKeever, [email protected]

800-846-4051 x22

Gelb Consulting Group, Inc.

1011 Highway 6 South, Suite 120Houston, TX 77077

281-759-3600

www.gelbconsulting.com

experience mapping for destination programs

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