An internationally recognized cancer institute asked that we investigate best practices in customer service across industries and create a framework that would help lay the groundwork for patient experience improvements across their hospital system. Their efforts are being driven by a desire to maintain their reputation for best-in-class cancer care and test their hypothesis that improvements in patient experience can positively affect health outcomes. Without a unified customer service strategy, siloed departments have been left to define and implement their own patient experience so it varies widely across the organization. Cultural orthodoxies prioritize science over service and senior leaders consider patient experience a “soft investment” with no measurable return. Other attributes of our client’s organization that required special consideration include their one-time patient commitment, high-risk environment, distributed service network, high stress and/or emotion demands on both patients and staff, strong organizational culture, and the need for both precision and hospitality.

The complexity of the healthcare context makes it difficult to directly translate commercial customer service models to a cancer patient’s experience. We found existing frameworks to be too hierarchical for an organization with a non-linear reporting structure and too abstract to be actionable at this stage. For these reasons, we designed a customer service framework to respond to the unique challenges our client is facing. In order to design an innovative yet actionable approach to customer service for our clients, we lead a series of exercises to identify stakeholders, examine existing orthodoxies and define their criteria for a successful customer service framework. We interviewed Directors who shared the various customer service philosophies and approaches that they have implemented within their respective divisions. We then ventured into both primary and secondary analogous research, identifying organizations that shared one or more attribute with our client’s organization. We interviewed staff members of 23 of those organizations which we considered to best in their respective class. Many of these companies were outside of the healthcare industry and our client appreciated that we were able to contribute learnings from unexpected sources. We synthesized this research into rich case studies, including quotes, stories and philosophies that characterized each organization’s customer service approach – paying special attention to training systems, organizational structure, culture, metrics and incentives. These case studies served as stimulus for analysis and were included in our deliverable.

We created a custom customer service framework to structure conversations around patient experience improvements and unify the organization's efforts towards a common goal. As a companion to the framework, we created a playbook of customer service tactics to illustrate how our client might begin to implement each of the framework components. We provided both near-term and long-term starter concepts, as well as a brief explanation of how the client is positioned to excel in each area, what challenges the organization may face, and references to further research into relevant behavioral science principles.

Defining customer service within a healthcare context

Whether it is intentional or not, service experiences speak volumes about an organization’s values. In today’s consumer-driven economy, we are all service experts in our own right– we recognize good and bad service immediately. We make choices based on this information, such as whether you will return to the business or recommend it to others. Technology enables us to easily broadcast evaluations of our experiences on social media and learn from the opinions of others. In response to consumer expectations, many organizations now recognize the impact of service quality on their bottom line. Some even see customer service as an opportunity to differentiate themselves or gain a competitive edge. However, consistently producing an effective end-user service experience at scale requires an extensive underlying support system.

The healthcare industry has traditionally not been held to the same level of customer service standards. The idea of patients as “customers” or hospitals as “corporations” conflict with our notions of healthcare as an industry that creates more than just monetary value. However we must recognize that healthcare systems are evaluated based on many of the same metrics as commercial and retail businesses. The industry is also in of a period of consolidation and increased competition, since patients have access to more information and greater control in selecting their providers. Decisions around health are often extremely personal and emotional and thus not always rational. It is no longer sufficient for healthcare organizations to compete on science alone, so there is a growing focus on patient perceptions of service quality. We have also seen birth of terms like “patient-centered care” and “patient experience” to describe elements of healthcare services outside of the treatment itself.

We define “patient experience” as a patient’s perception of their interactions with a service. Whereas “customer service” is the strategy, systems and structures intended to enable these experiences and promote desired outcomes. This distinction is important in the context of our work because a single customer service system can produce a variety of customer or patient experiences. Each customer has a unique set of needs and preferences so they may perceive the same service differently. In addition, large organizations often serve many different functions across divisions, so a single customer interacting with different parts of an organization may have a different experience. An organization’s customer service strategy, system and structure enables and informs every possible customer experience. In this sense, patient experience is similar to Aspen trees. An individual standing in front of a grove of Aspens sees many individual trees of the same type. However, Aspens actually grow from and share a singular parent root-system. While each tree grows in its own pattern of branches and occupies its own space, the grove as a whole operates from a single foundation.

Responding to unique organizational attributes and challenges

We were asked by an internationally recognized cancer institute to investigate best practices in customer service across industries and create a framework that would help lay the groundwork for patient experience improvements across their hospital system. Their efforts are being driven by a desire to maintain their reputation for best-in-class cancer care and test their hypothesis that improvements in patient experience can positively affect health outcomes. Service design has deep roots within commercial and retail industries so there are a number of customer service frameworks currently available. However these existing frameworks were not an effective tool for approaching patient experience improvements due to the unique attributes of our client’s organization and the context in which they operate. We found existing frameworks to be too hierarchical for an organization with a non-linear reporting structure. They are also too abstract to be actionable at this stage and the complexity of the healthcare context makes it difficult to directly translate commercial customer service models to a cancer patient’s experience.

For these reasons, we designed a customer service framework to respond to the unique challenges our client is facing. Without a unified customer service strategy, siloed departments have been left to define and implement their own patient experience so it varies widely across the organization. Cultural orthodoxies prioritize science over service and senior leaders consider patient experience a “soft investment” with no measurable return. In turn, some hospital staff view customer service as a “nurse’s job,” or “nice to have.” Other attributes of our client’s organization that required special consideration include a high-risk environment with a distributed service network, high stress and/or emotion demands on both patients and staff, strong organizational culture, the need for precision and hospitality, and a one-time patient commitment.

Finding insight in broad-based analogous research

In order to design an innovative yet actionable approach to customer service for our clients, we first needed to understand the context of their organization. We lead a series of discovery exercises to identify stakeholders, examine existing orthodoxies and define their criteria for a successful customer service framework. We then lead a series of interviews with Directors who shared various customer service philosophies and approaches that they have implemented within their respective divisions. In order to create a foundation for our research, we also sought out customer service bright spots within our client's organization, which served as concrete examples of best in class service and instilled a sense of pride.

Based on the this context, we ventured into both primary and secondary analogous research. We identified organizations across industries that shared one or more attribute with our client’s organization and interviewed staff members of 23 of those organizations which we considered to best in their respective class. Many of these companies were outside of the healthcare industry and our client appreciated that we were able to contribute learnings from unexpected sources. For example, we spoke with a funeral home who shared best practices of serving and educating customers at a very emotional time, as well as navigating family dynamics. We then synthesized this research into rich case studies, including quotes, stories and philosophies that characterized each organization’s customer service approach– paying special attention to training systems, organizational structure, culture, metrics and incentives. These case studies served as stimulus for analysis, engaging our client in analysis so as to leverage their institutional and subject matter expertise.

We stayed in close communication with our client throughout our process, which was key to the success of our solution. Each week, we sent a brief report, including actions we had taken, things we learned and our plans moving forward. We began sketching rough frameworks based on our research from the very beginning, which helped to illustrate the evolution in our thinking and ensure a successful final solution for our client.

Framing actionable service system improvement

We created a custom customer service framework to structure conversations around patient experience improvements and unify the hospital's tactics towards a common goal. As a companion to the framework, we designed a playbook of customer service tactics to illustrate how our client can begin to implement components. Each piece of the framework contains near term and long term starter concepts as well as a brief explanation of how the client is positioned to excel in this area and what challenges the organization may face. Also included are jumping-off points for pursuing further research into behavioral science principles to better understand how to design for these spaces. We’ve also highlighted the case studies which are most relevant.

Developing customer service strategy

It all starts with strategy, of which a large part is the overarching philosophy. This philosophy would be the “north star” to clarify the organization’s customer service mission. In order to be effective, the customer service philosophy should next be translated to more actionable principles. Collective identity and values rounds out the strategy wheel and would reinforce the customer service philosophy.

Empowering best-in-class customer service

Through a robust network of support and tools, customer service strategy becomes concrete. This includes tools on the ground like open scripts for patient interactions, but also more structural elements like facilitating conversations between staff. In order to reinforce the support and tools and monitor their effectiveness, the client should collect timely patient feedback and place an emphasis on customer service evaluation and recognition. To round out the delivery wheel, oversight and accountability helps to ensure alignment with the overarching strategy and provide a sense of progress.

Gaining knowledge for continuous refinement

In order to strengthen the strategy and approach to customer service, the framework calls for both formal and informal channels of information flowing between the two wheels.

Engaging all levels of the organization

The framework can cascade to be utilized differently on each level of the organization. At the organizational level, we have senior leadership who drive and define the overall vision for the hospital. At the strategic group level, we have and guiding tools to make sure that management is supporting their team to provide the best service. At the individual level, we see it being personalized by hospital staff and the generation of insight that will influence systemic changes.