the voice of your customers - mercy medical center...• in order to determine what our customers...

Copyright 2008 Nebraska Hospital Association and Business Excellence Group, Inc. All rights reserved

The Voice of your Customers

Listening to your Patients, Doctors and Staff

Video #2

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Personal Introductions• This is the 2nd of 6 videos produced by the Nebraska Hospital Association for the support

of Quality initiatives in any health care environment in Nebraska. The content was developed by the Business Excellence Group, Inc. an organization with over 15 years of experience supporting medical care clients in deploying Quality programs.

• The Business Excellence Group, Inc focuses on implementing service quality programs that drive validated benefits – customer related and financially auditable. They work with clients at their level of organizational maturity to evolve quality into everyone‘s DNA.

• This presentation is given by Annette Stanton, Director, Health Care and Human Services Quality Practice. Annette is a Master Black Belt in Six Sigma methodology with 20+ years of experience in finance and quality functions for Fortune 500 companies and in hospital and health care settings, integrating the financial benefits of quality in each of her organizations.

Patricia Tyre, PresidentBusiness Excellence Group, [email protected]

Annette StantonPractice DirectorBusiness Excellence Group. IncAStanton @businessexcelllencegp.com

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So, what have we learned so far:• In video #1, we looked at your health care setting and

realized that there was some opportunity to make improvements.

• We asked you to start small. Look to achieve some Quick Hits for success and bring the good news to the staff.

• We also understood how important it was to think about making changes sustainable.

• But the most important part was to make a positive change for the patient and/or the “customer”

• In this video, we will tune in to the voice of our customer – and hone in on what they are really saying.

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Introduction to Video #2 – Listening to the Voice of your CustomerPatients, doctors and some of the staff may be complaining

and its not about their physical pain. Indeed, they can direct you to which improvement to work on and how far away you are from good quality in your service delivery. In this video we focus on:o An easy tool to look at your process from a very broad

perspective, and theno Drill down to the critical issues that mean “quality” for

your hospital staff, your medical professionals and the patients themselves.

o Using techniques covered in this video, you will certainly be able to listen to the voice of your customers

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In Video #1, we built a Charter, a description of the problem and how we will tackle it

Project Charter

Business Case

Problem Statement

Scope-In Scope-Out

Methodology & Milestones

Goal Statement

Roles & Responsibilities

Project Idea

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Then we create a high level diagram of the process

Project Charter Process SIPOC

Business Case

Problem Statement

Scope-In Scope-Out


Goal Statement


Project idea Process Idea

Supplier

Input

1 2 3 4 5

Output

Customer

Process

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A collection of activities that take one or more kinds of Input (such as information, data or other materials) and creates Output such as products, services or reports that are of valueto the Customer, Patient, or Medical staff.

Definition of a process

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A picture is worth a thousand words…

Creating a graphical display is important – a picture allows your team to grasp concepts immediately

We have a tan house with yellow finish, it has a brown roof, the house has a 2-car garage,

the garage is closed, the weather is nice, there are no signs of a fire department, there

is no police, there are plants in front of the house, the family has 2 children, the older

child is wearing a hat, the smaller child is an infant, the dog is medium size, it has a long

tail.What is the problem here?

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A picture is worth a thousand words…

Graphical displays are multi-lingual. They communicate issues quickly and without ambiguity.

The house is tan with yellow finish, it has a brown roof, the house has a 2-car garage, the garage is closed, the weather is nice, there is no signs of a fire department, there is no police, there are plants in front of the house, the family has 2 children, the older child is wearing a hat, the smaller child is an infant, the dog is medium size, it has a long tail.What is the problem here?

THE HOUSE IS ON FIRE !! Producing a picture allows the team to understand the problem

quickly and accurately

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The graphic display of the major steps of a process. A SIPOC lists the suppliers, inputs, process steps,

outputs, and customers that constitute the process.

Start your project by creating a SIPOC for you process

Definition of a SIPOC (pronounced Sigh – Poc)

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What are the benefits of a SIPOC?

• Visualization enables the team to “see” the whole process.

• Simplifies complex issues immediately

• Enables the team to reach agreement on key components of the process.

• Allows team to understand where metrics may be considered.

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Potential SIPOC vocabulary

Supplier: Provider of inputs to your process.Input: Materials, resources and data required to execute a

process – the stimulus of the process.Process: A collection of activities that takes one or more kinds of

input and creates output that is recognized by the patient, doctor or medical staff.

Output: The service(s) that result from the process. Customer: Receiver of the outputs of your process — internal or

external.Requirements: A specific characteristic of the output that will

determine the extent to which customer/patient or other medical staff satisfaction is achieved.

Boundary: The limits of a particular process – where it starts and stops.

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Process Map

Process Requirements Customer Requirements

Boundary

The SIPOC chart

Start End

SIPOC graphically displays Suppliers, Inputs, actual Process steps andOutputs in relation to Customers.

Suppliers Inputs Process Outputs Customers

S I P O C

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Step 1: Define the Boundaries of the Process.

Building a SIPOC

Start End

Process Boundaries

The boundaries of the process should align with the scope of your project.


S I P O C

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Building SIPOC

Step 2: Identify Suppliers and Inputs.

Supplier is any person or organization (external or internal) that provides Inputs (products, guidelines or service) needed by the

process to produce the desired output. Inputs are needed to stimulate the Process.

• Processes can have multiple Inputs• And processes can have a single Input with multiple Suppliers.


S I P O C

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Building SIPOC (cont.)

Step 3: Identify Outputs.

Output is what is generated from the process.

It can be a service that the customer wants. It is most often what we are trying to improve.


S I P O C

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Step 4: Identify Customers.

Important elements to define your Customers:• Who is the customer: internal or external or both?• How many customers actually exist?• Are there natural customer segments?

The project team should agree on the identification of Customers.


S I P O C

Building SIPOC (cont.)

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• Patient Scheduling• Patient Registers• Patient Entry to Diagnostic

Imaging• Patient Prepares for Exam• Tech Performs Exam• Patient Exits• Radiologist Reviews Images• Communicate Results• Re-exam if needed• Patient Billing Process


Patient Patient Demographic

IT Department

Supplies

Digital Image

Radiologist

Physician

Patient

Accounts Receivable Coordinator

Supply Vendor

Imaging Equipment

Vendor

Imaging Equipment

Mammography Imaging

The SIPOC drives Voice of Customer collection covered later in the video and provides transparency into the actual work done in the delivery of the mammography process.

The Suppliers are people and/or groups that impact the process in some way.

The Inputs are tangible objects that are passed into and used during the process.

The Process is displayed as a diagram, often including swim lanes to designate responsibility for process steps.

The Outputs are tangible objects that are created during or passed through the process.

The Customers are the people and/or groups that are affected by or benefit from the process.

SIPOC example – the Mammography UnitThe SIPOC (Suppliers, Inputs, Process, Outputs, Customers) provides an end to end view of a

process including both internal and external customers

Charge Sheet

Radiologist Report

TranscriptionistDocumentation

Registration Computer

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Finally, we will address some of the tools needed to listen to the customer – but who are your “customers”?

Project Charter Customer CTQ’SProcess SIPOC

Business Case

Problem Statement

Scope-In Scope-Out


Goal Statement


Project idea Voice of the CustomerProcess Idea

Supplier

Input

1 2 3 4 5

Output

Customer

Process

Critical to Quality Characteristics

InterviewsSurveys

Focus GroupsOther

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To listen to the customer you need to know two things: the VOC and CTQ

VOC = Voice of Customer

• In order to determine what our customers want, we must gather Voice of the Customer data, using appropriate tools.

• The VOC information is then translated into specific and measurable CTQs around which the project is focused.

• CTQs: critical and measurable customer performance requirements our services.

CTQ = Critical to Quality

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Identify Customers

Voice of theCustomer (VOC)

Determine CTQs

• Review potentially existing VOC data.

• Decide what to collect and how — select appropriate VOC tools.

• Prepare VOC data collection plan (when, who, what and how).

• Collect data.

• Affinitize all collected VOC customer data.

• Translate VOC to specific needs.

• Define CTQs for specific needs.

• Prioritize CTQs• Contain problem if

necessary.

Three steps will get you from your VOC to your CTQs

• List customers • Define the customer

segments.• Narrow list.

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Customer

InternalMedical Staff, Administrative staff,

Clinical Staff, Housekeeping

ExternalPatients, Patient’s Families,

Regulatory agencies, Insurance Companies

Who is your customer?

Customer is the recipient of the services generated by your processes

Step #1: Identify Customers

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Look for segmentation in your customers

Economic• Frequency of use• Self pay or insured• Part time/full time• Type of service

Descriptive• Geographic• Demographic• Ethnic

Attitudinal• Price• Value• Service

Revenue

Geographic

Price / ServiceMonth

# o

f cu

stom

ers

Price Service

You may be able to group customers based on similarities:

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Step #2: Collect VOC

Steps to determine CTQs

Identify Customers


Determine CTQs



• Prepare VOC data collection plan (when, who, what and how)

• Collect data.




• Prioritize CTQs.• Contain problem if

necessary.

• List customers up.• Define the customer


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1. Reactive SystemsInformation comes to you whether you take action or not.

2. Proactive SystemsYou need to put effort into gathering the information.

Basic VOC systems

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Types of Voices (Reactive)

Analyze existing customer information

• Complaints• Compliments• Service preferences• Missed appointments

/cancellations• Market share changes• Patient attritions/

defections/acquisitions.

• Patient referrals• Feedback of new hires• Agency inspection details• Service hot lines• Technical support calls• Others in your hospital

Research if your Customers are already providing any feedback on your services.

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• Market research reports• Independent Studies• Completed customer surveys or evaluations• Industry reports • Available literature• Competitor assessments• Internal (other departments within the hospital)

Review other sources of available data

Research other potential sources for Customer feedback.

Additional sources of relevant customer/industry information are likely available:

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Three of the most common methods for gathering Proactive Customer data:

Interviews

Focus Groups

Surveys

Methods for gathering proactive data

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Interviews

Benefits:• Interviewer can ask more open-ended questions and dive deeper into

specific topics to better understand customer’s perspective.• Potential to increase good will with targeted customer groups by

showing an interest in understanding their particular needs and wants.• Flexible enough to conduct in the beginning, middle or end of the project.Drawbacks:• Time consuming to conduct.• Difficult to consolidate and measure responses.• Difficult to reach to larger number of customers,

smaller sample size.• Can be costly.

Collect specific customer’s point of view on service, product or service attributes, and performance indicators/measures.

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Interviews (cont.)

Uses:• Interviews are useful at several points during the process of

gathering customer needs.– At the beginning: To learn what is important to customers, which

supports the development of hypothesis about customer needs.– In the middle: To clarify points or to better understand why a

particular issue is important to customers.– At the end: To clarify findings, to get ideas

and suggestions, to test ideas with customers.

Collect specific customer’s point of view on service, or service attributes, and performance indicators/ measures.

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Focus groups

Benefits:• Discussion format encourages open exchange of ideas and issues that may

not occur in one-on-one surveys and interviews.• Potential to increase good will with targeted customer groups by showing an

interest in understanding their particular needs and wants.• Facilitator can steer the direction of discussions to focus on selected topic.

Drawbacks:• Small size of focus groups limit the

number of customers that an organizationcan effectively reach.

• Costly.• Time consuming.• Variability of data quality and volume.

Generally consist of a group of people plus a group facilitator.

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Focus groups (cont.)

Uses:• To identify and define customer needs.• To gain insight into the prioritization of needs.• To test concepts and get feedback.• Sometimes used as a Next Step after customer interviews or a

preliminary step in a survey process.

A group facilitator uncovers the feelings, attitudes and biases towards a service or treatment.

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Surveys

Benefits:• Structured and consistent data collection method• Ability to gather specific information on customer’s needs and wants• Ability to customize survey to specific customer groups• Ability to segment and prioritize customer groups• Relatively efficient and cost effective.

Drawbacks:• Low response rates• Limited ability to obtain open-ended responses• Response bias.

When designed and applied properly, surveys provide power insight into the customer’s perspective.

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Surveys (cont.)

Uses:• To efficiently gather a considerable amount of information

from a large population.• To measure “as is” conditions and drivers.• To measure change and causality.

When designed and applied properly, surveys provide power insight into the customer’s perspective.

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Telephone interviews to identify baseline issues and opinions.

Focus groups to obtain deeper understanding or feedback from a selected customer group.

Survey to verify or obtain detailed data and quantify responses.

Tools can be used together:

Determine VOC strategy

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Choosing the right methodConsider these factors:• Number of people on your team that will participate in VOC collection• Number of customers or segments you identified to interview• Location• Time available• Number of questions that you want to ask• Costs and budget• Type of data you are expecting to collect• Systems or tools available.

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No information Interview/Focus group Customer wants and needs (general ideas, unprioritized, not clarified, all qualitative)

Input Research Method Output - What You Get

Known preliminary customer wants and needs

Interview/Focus group Customer wants and needs (clarified, more specific, preliminary prioritization)Customer input to list of competitors, best-in-class

Qualitative, prioritized customer wants and needs

SurveyFace-to-faceWritten–mailTelephoneElectronic

Qualified prioritized customer wants and needs Competitor comparative information

Determine method from what you already know from your customer

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But do you ever get more data from your customers than you can handle -

…..Affinitize it !!!

When customer feel passionate about a topic, they want you to know and they may give you a lot of information. How to you cope? How do you organize the Voice of the customer into manageable topics you can act on.

Create an Affinity Diagram !

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Affinity diagramWhy use it?• Allows a team to collectively generate a large number of ideas/issues

and then organize and summarize natural groupings.What does it do?• Encourages creativity by everyone on the team.• Breaks down communication barriers.• Allows breakthroughs to emerge naturally.• Encourages “ownership” of results that emerge from the discussions.• Overcomes “team paralysis” which is brought on by an overwhelming

arrays of options and lack of consensus.• Helps everyone to grasp large and complex issues.• Assists in finding patterns in mountains of data.• Organizes ideas, issues and opinions.

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Creating an affinity diagram1. Gather ideas from interview transcripts, surveys, etc.2. Transfer verbatim quotes on to index cards or self-stick notes and

arrange them randomly.

Tip: use variety of statements: neutral as well as positive, negative, and solution oriented questions.

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Title

Creating an affinity diagram (cont.)3. Group the cards to find the “affinity” (similarity).4. Label the groups of cards.

Look for natural groupings.

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No Wait Time

Short Time to Locate Patient

Record

Clinical Provider Readily Available

Nice Decor

Clean

Close Parking

Convenient Location

Simple Forms

Already has myinformation

KnowledgeableReps

Professional

Make Me FeelComfortable

Patient DuringProcess

Professional

Keeps a quiet tone

Private Location

Comfortable SettingTimely Friendly ConfidentialEasy

Talk ToOne Person

Polite

Few patients visible

Registration Staff Readily

Available

Spacious

Idea/Need Statement Group Title

5. Draw the diagram.

Creating an affinity diagram (cont.)

Secure Data

Provide Information One Time

Wheel Chair Accessible

Comfortable Seating

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Step #3: Translate collected VOC into CTQs

Steps to determine CTQs

Identify Customers


Determine CTQs



• Prepare VOC data collection plan (when, who, what and how).

• Collect data.




• Prioritize CTQs• Contain problem if

necessary.

• List customers up.• Define the customer


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Customer information — data types

Examples:

Quantitative Data

Qualitative Data

Measurable and number oriented descriptors.

Statements of needs, wants and problems.

• “I’m tired of having to tell the hospital my address each time I visit. They know my address. They sent me a bill last week.”

• “The survey shows 47% of customers rate our registration timeas ‘fair’ or ‘poor’. ”

• “There were five people waiting in-line for the registration staff”.• “The phone must have rung six times before I got an answer.”• “I’m not that satisfied with your service.”

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First Level -Drivers

Second Level –Customer Needs

I want a good

experience at my out-

patient clinic

Timeliness

Confidential

Less than 5 minutes to be greeted by clinical provider

Less than 4 minutes with registration staff

# of people who saw me registering

# of people who could hear my conversation

Translating VOC to CTQ – CTQ tree

Customer wants

Park less than 100 yards away Valet Parking Wait Time

Easy

CTQ tree converts Qualitative Data into Quantitative Data. It takes general needs from VOC responses and drills down into measurable requirements that you can manage

Answer Only Three Questions

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CTQ Tree

Translating VOC into CTQs

VOC

Easy RegistrationConfidentiality

Delivery

Friendliness

TimelyTimely

Needs Statement developed

CTQ Elements defined

Characteristics/ Drivers

I want …

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Guidelines for needs statements

• Must be written from customer's perspective.• Write the need, not the solution.• Write the need in complete sentences• Use measurable terms.• Avoid words like “should” or “could be”• Be concise.• Validate the need with the customer.

Accurate translation of VOC statements is critical to understand the customer’s perspective.

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GoodCustomerService

Confidential

No other person hears or sees patient Information 100% of the timePatient feels data is secure (100% of time)

# staff or other customers who can hear/seeregistration details (zero)

Easy Patient asked questions(< 3 questions)

Patient communicates info (1 time)

Short waitTime from entry to contact with clinical provider (<10 min)Time to schedule (< 4 minutes)

Need Drivers CTQs

Get something measurable, these will be the minimum and maximum parameters your customers can accept

Level understanding what the customers want:

General Detailed

Hard to measure Easy to measure

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Video #2 – it’s all about the customer

• We have now learned as much as we can about the wants and needs of the customer.

• We have taken subjective phrases and translated them to quantitative requirements to be assured we can measure when the customer will be happy.

• We know our process and we have pulled it into major pieces.

• Now we can look at each piece – assess the variation and get a clear picture of how bad (or good) the process really is.

• We will discuss measuring and analysis in Video #3

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Thank you

All rights reserved: 2008 Business Excellence Group, Inc in conjunction with the Nebraska Hospital Association. Any reproduction of the slides used must receive permission from Business Excellence Group, Inc. Contact Monica Seeland at the Nebraska Hospital Association at 402-742-8152 or Business Excellence Group, Inc at 319-822-7011 or 914-319-1382 or for additional support or questions.

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