the voice of your customers - mercy medical center to quality characteristics interviews surveys...
TRANSCRIPT
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
1
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
2
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.
3
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
4
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
5
Then we create a high level diagram of the process
Project Charter Process SIPOC
Business Case
Problem Statement
Scope-In Scope-Out
Methodology & Milestones
Goal Statement
Roles & Responsibilities
Project idea Process Idea
Supplier
Input
1 2 3 4 5
Output
Customer
Process
6
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
7
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?
8
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
9
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)
10
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.
11
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.
12
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
13
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.
Suppliers Inputs Process Outputs Customers
S I P O C
14
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.
Suppliers Inputs Process Outputs Customers
S I P O C
15
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.
Suppliers Inputs Process Outputs Customers
S I P O C
16
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.
Suppliers Inputs Process Outputs Customers
S I P O C
Building SIPOC (cont.)
17
• 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
Suppliers Inputs Process Outputs Customers
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
18
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
Methodology & Milestones
Goal Statement
Roles & Responsibilities
Project idea Voice of the CustomerProcess Idea
Supplier
Input
1 2 3 4 5
Output
Customer
Process
Critical to Quality Characteristics
InterviewsSurveys
Focus GroupsOther
19
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
20
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.
21
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
22
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:
23
Step #2: Collect VOC
Steps to determine CTQs
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.
• List customers up.• Define the customer
segments.• Narrow list.
24
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
25
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.
26
• 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:
27
Three of the most common methods for gathering Proactive Customer data:
Interviews
Focus Groups
Surveys
Methods for gathering proactive data
28
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.
29
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.
30
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.
31
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.
32
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.
33
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.
34
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
35
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.
36
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
37
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 !
38
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.
39
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.
40
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.
41
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
42
Step #3: Translate collected VOC into CTQs
Steps to determine CTQs
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.
• List customers up.• Define the customer
segments.• Narrow list.
43
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.”
44
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
45
CTQ Tree
Translating VOC into CTQs
VOC
Easy RegistrationConfidentiality
Delivery
Friendliness
TimelyTimely
Needs Statement developed
CTQ Elements defined
Characteristics/ Drivers
I want …
46
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.
47
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
48
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
49
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.