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The Prizes and Perils of Designing Processes for your Customers

The Prizes and Perils of Designing Processes for Your Customers

Sometimes it takes a personal experience to remind yourself of how important it is to understand the customer journey and experience when designing or improving processes, as Rich Seddon experienced recently.

Putting your customers at the core of your process design is a key enabler to generating positive customer sentiment, and failing to do so can be damaging.  Last summer, I had surgery on my spine for a damaged disc in my neck.  Working in process improvement, I often find it impossible to leave the day job behind and so found myself observing process efficiency and effectiveness at every stage of my treatment.  Afterwards I reflected on what I’d experienced from a customer and process design point of view.

Process design – a story of 3 phases​

In the first phase, the customer was king AND the process operated with obvious efficiency.  In the second phase, chaos broke out as processes failed, and in the third phase well intentioned process “improvement” had led to the purpose of the process being forgotten, and as a consequence the customer, or patient in this case, being left behind.

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Phase One: It all started so well​

Usually with private healthcare in the UK, if you need treatment or diagnosis you have to make an appointment with your NHS GP first, but with the strains on GP’s resources this is no mean feat in itself.  Once you manage to see your GP, you have to request they write a letter of referral.  Yes, a letter, remember those?  Then, once you receive the letter, the onus is on you to contact the insurer to request an appointment with the appropriate specialist.  At this stage, hopefully, someone else contacts you to make the appointment.  A rather cumbersome and wasteful process.

My healthcare insurer has recently introduced an online GP service and in doing so has managed to achieve that rarest of things; a more efficient internal process as well excellent customer service.

The booking process was flawless.  Using an app on my iPad, I was able to make an appointment for a video consultation with a private GP within 24 hours and at no extra cost.  The consultation took place at my desk and what’s more, the GP was able to refer me straightaway.  I was informed that within 2 hours I would be contacted to book an appointment with a surgeon for further investigation.

To say I was sceptical about this process is an understatement, but sure enough, just under 2 hours later my phone rang and a suitable appointment was arranged at a private hospital.  I was delighted with how well this process had been both designed and executed.  I extolled the virtues of the experience and the insurer to anyone who would listen.  In short, I became an unpaid advocate: every CEO’s dream.

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Phase Two: The handover

I was now largely in the hands of the hospital rather than the insurer, and the contrast could not be more stark.  The initial diagnosis and consultations all proceeded without any issue.  My surgery was booked and the pre-op clinic confirmed.

Then it all started going wrong.  My expectations had been set so high thanks to the wonderful experience in phase one, that I had progressed very rapidly along the Kano Model of customer satisfaction.  I now expected to be delighted at every stage!

The pre-op clinic experience was dire.  Patients were organised using a dysfunctional paper-based process, clinical staff were stressed, and there were not enough seats for the number of patients waiting.  The paper system wasn’t executed in the order in which patients arrived resulting in arguments amongst the patients and the staff.  To make matters worse, I had to tell the nurse what I was there for as my paperwork didn’t state it, and then my details were recorded on the wrong patient’s notes.

I was left concerned and my positive sentiments had evaporated.  I was now a ‘former’ advocate, angry with the insurer as the ultimate service provider, even though it was the hospital that had failed.

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Phase 3: The surgery and after

Disappointed and alarmed by the pre-op clinic experience, I didn’t know what to expect from the in-patient experience.  Initially, I was pleasantly surprised.  The check-in process was seamless and it was immediately obvious that a process improvement team had been at work in this area.  A porter appeared in less than a minute to escort me to my room, he explained the facilities clearly and to a well-honed brief.  He was immediately followed by a nurse and then a physiotherapist in rapid succession.

Within 25 minutes I was fully labelled, all forms were complete and I was equipped with the ubiquitous hospital gown and a pair of fetching compression stockings.  Fast, efficient and little waiting or waste.

Having woken up in the recovery area after the operation I was then transferred.  As I was being moved I could see signs hanging from the ceiling that read ‘Intensive Care’.  I queried why I was being moved to this area, was there a problem? “Just standard practice” came the response.

At no point had anyone mentioned intensive care.  I’m not medically trained so it surprised me.  My expectations hadn’t been managed during this process, I was simply being processed.  The customer of the process had been forgotten, with the design being geared around efficiency of the transaction itself.

Matters got worse as I repeatedly asked if my operation had been a success.

All I was told was “your consultant will talk you through it”.  However, I was the last on the operating list and the consultant had gone home for the night.  So there I was, the customer of a process that on the surface was efficient, unexpectedly in intensive care with no insight into the success of my operation – unhappy does not do justice to how I was feeling.  It was not until 24 hours after I had gone to surgery that my consultant appeared and informed me that all was well.  Too late, I’d transitioned, I was now a critic.

Some process design conclusions​

So, what lessons are there here for those involved in process design and improvement?

1. Effective, customer focussed process improvement can create a valuable asset in the customer as an advocate of your product or services, as I experienced in Phase 1.

2. Customer expectations are rapidly accelerated; customers can delight in experiencing excellence but they very soon expect it at every stage, as demonstrated in phase 2 of my story.

3. Process improvement can be efficient but it also needs to be effective; customer needs, wants, and expectations must be at the heart of process design or they will be dissatisfied, no matter how efficient your service or product is delivered, as I saw in phase 3 of my experience.

4. Process Improvement teams beware; unless the customer experience is understood and standardised, your work can be damaging – it is conceivably worse to go from experiencing excellence to the polar opposite as a customer than simply be satisfied throughout.

So what now?

With my neck fully recovered, would I recommend my insurer’s service provision?  This is a tricky one.  I recognize that the steps they were responsible for were fantastic, however, my overall experience and therefore my sentiment, was negative.  I found the process as a whole so traumatic that no matter how good they were up front, the experience provided by one of their selected hospitals was of such a poor standard that I hold them responsible.  This may be unfair, but I was the customer and customers are rarely fair!

This is a salutary lesson for those of us who work in process improvement and very much supports the theory that customers need to be central to all process redesigns.  Furthermore, this experience emphasises that suppliers of services need to work together to ensure the collective experience is consistent, standardised, and then incrementally improved as a whole and not in isolation.

Do this, and you stand a much better chance of retaining and growing your customer advocates!


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