Service Design for Government
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customer experience improvement program

Bouncing Back from a Failing Grade in Customer Experience

As kids head back to school this fall, many will hear a familiar lecture reminding them of that last report card before summer and encouraging them to start off this school year on the right foot, creating good habits from Day 1. Nextgov’s Frank Konkel had a similar message for government in his recent interview with Forrester’s Rick Parrish. Forrester Research’s 2016 Customer Experience (CX) Index indicates that federal government agencies were collectively rated has having the worst customer experiences compared with 300+ consumer brands that included underperforming cable TV providers, internet service providers, and airlines. Furthermore, these poor ratings occurred despite the White House’s emphasis on improving customer experience over the past five years.

But the message is not all bleak – Konkel also noted a few bright spots, notably where agencies have demonstrated marked improvements in their CX Index demonstrating “money and resources currently being spent at those organizations is shifting customer perceptions.”

So, as we head back to school, we offer three habits that to focus on to improve customer experience grades in government throughout the year ahead.

Building Good CX Habits

Follow the Outcomes.  The business case for customer experience is about improving the performance of government services. High performing services — whether provided by government or commercially — are measured on how well they help their customers achieve a desired outcome. Just like we scoff at automating bad processes that deliver the wrong output faster, customer experience is another means towards the end of delivering a better customer outcome. Agencies need first be aware of what outcomes their customers are trying to achieve before they build the service to assist them.

Customer Satisfaction Customer Experience.  As Parrish notes, that while many agencies conduct traditional customer satisfaction surveys, they need to better track their customer behavior. Measuring only satisfaction at certain touch points (e.g., directing them to the correct phone number, correcting a problem in an online form, or responding to a phone call within the estimated response window) is insufficient because it does not inform the service provider whether their action contributed to the outcome. Understanding the decisions that customers make throughout their journey, whether to continue or abandon the service, is the key to better performance.  We need to create services where customers continually opt-in to the next step of the journey. This happens when services solve real problems, provide a customer experience that is consistent with American values, and meet customers’ expectations for aspects such as ease of use, availability, reliability, and security.

The Incentives for Better Government Just Aren’t There. One commenter to Konkel’s article noted that government is not incentivized to change because it lacks competition for its services; Government has a monopoly. Essentially this implies that customers have little choice of whether or not to do business with the government. After all, where else can you go for services like food stamps, airport security, or a subsidized home loan? Though this may be a dominant perception within and about government, it is also the most ripe for disruption.  Just as with commercial services, customers perceive a cost of using government services, even when they are being offered for “free”.

Am I sacrificing my privacy by giving up this information?

Who is really going to notice if I don’t pay my taxes?

This isn’t worth it, we will just get by without

It won’t harm anyone if I bypass this security measure

I had to take time off work to stand in this line to vote

These are all examples of customer sentiments measuring the opportunity cost of their alternatives and trying to figure out if its worth it.  When government understands its customers and the value of those other opportunities, it will clearly see the need to deliver a competitive customer experience.

Our team at Technical Assent works with government Program Managers to develop these habits from the start – building services that drive customer outcomes and position government services as the preferred alternative. We have found over and over again that government agencies who focus on their customers first, deliver higher performing services at better value for the taxpayer.

amazon is a leader of customer-driven strategy

To Find a Differentiator for Long-Term Success, Look to Amazon’s Customer Obsession

By John DiLuna and Jonathan Miller

For anyone who has ever studied Amazon or its founder, Jeff Bezos, one thing is absolutely clear: the customer is king.  Amazon’s focus on customer experience success was a founding principle for Amazon and remains deeply embedded in the company culture today.

After last week’s record earnings report, we wanted to see for ourselves where customer experience was integrated into Amazon’s operating model – not just as a corporate talking point but where it was really driving business decisions.  We studied 20 years of shareholder letters for evidence about the role that customer experience plays in the long-term financial success of the company.  What we discovered was an intrinsic interaction between customer experience and long-term financial thinking that acts as a catalyst for future financial success.  We identified three general principles that we hope will be helpful for organizations hoping to mirror Amazon’s customer experience momentum.

Obsessing over customer experience is the long game

Amazon unleashed something powerful by placing customer experience success at the core of their business strategy.  In addition, Amazon has always had a perspective of long-term success rather than short-term profits.  Bezos has highlighted this perspective in his shareholder letters since the first letter in 1996.  In his 2008 letter, he explicitly connects this concept to the customer:

“Long-term orientation interacts well with customer obsession. If we can identify a customer need and if we can further develop conviction that the need is meaningful and durable, our approach permits us to work patiently for multiple years to deliver a solution.”  

By investing in the long-term satisfaction of customers, Amazon has created a relationship which drives lifetime customers.  Early in Amazon’s life, the team identified three key things their customers valued in a retail experience: price, selection, and convenience.  Since then, everything Amazon does focuses on lowering prices, improving selection, and maximizing convenience.

In the early days when Amazon was solely an online bookstore, their business decision to present new books side-by-side on a web page with used versions of the same items was initially criticized, but it makes perfect sense when viewed through their customer-centric lens.  By creating this new environment of new and used books intermingled, they provided access for a wider audience of customers to be reached through price, selection, and convenience. It is the same for Amazon’s current experiments with drone delivery and same-day shipping.  Antagonists are unsure as to the current feasibility of these services because they have never been done to this extent for customers, but Amazon, true to providing the type of service their customers value most, is pursuing both for one reason: convenience. From the 1998 shareholder letter:

“We must be committed to constant improvement, experimentation, and innovation in every initiative. We love to be pioneers, it’s in the DNA of the company, and it’s a good thing, too, because we’ll need that pioneering spirit to succeed.”

Through the bull and bear markets of the last two decades, Amazon has remained steadfast in its commitment to provide exceptional customer experience.  This unwavering resolve to innovate around customers is a unifying force that helps the company push through the lean years when others may crumble or change course at the cost of their customers.

Use data to work backwards from customers and build customer experience success

When the entire workforce believes in customer experience success as the primary growth driver for your business, then it only makes sense that corporate strategy, business initiatives, and day-to-day operations fall in line.  This is the way it works at Amazon.  In many ways, this unified, corporate-wide belief simplifies governance and decision-making because culture provides a consistent framework to gauge the potential impact of new ideas.

Baked into the Amazon culture is the predisposition to work from the outside-in as well as to validate those decisions with data.  Bezos highlights that just about every important decision can be made through data. From the 2005 shareholder letter:

“There is a right answer or a wrong answer, a better answer or a worse answer, and math tells us which is which.”

Starting with the desired customer outcome, quantitative methods help sort through alternatives and establish priorities around what should be done first. We see this exhibited in the analysis Amazon conducts prior to making any foundational decision, which confirms that the solution drives the intended customer behavior and is financially viable.

Amazon has remained steadfast in their decision making process by holding uniquely to their core values of building solutions based on their customers. How Amazon makes these types of decisions is highlighted in the 2005 shareholder letter:

“To shorten delivery times and reduce outbound transportation costs, we analyze prospective locations based on proximity to customers, transportation hubs, and existing facilities. Quantitative analysis improves the customer’s experience and our cost structure.”

By methodically approaching expansion locations, Amazon highlights the need to be there for their customers while at the same time improving their own cost model.  Understand that the mindset Amazon uses embodies exceptional customer experience, an approach that leads to a repeatable pattern of customer driven decisions.

Customers benefit from improved service infrastructure

Continuous improvement is the third principle Amazon consistently emphasizes to create an exceptional customer experience.  When Jeff Bezos says “continuous improvement,” he is not referring to the catchphrase that is commonly used in business marketing materials.  His version of continuous improvement is fundamentally connected to customer experience and essential to Amazon’s business model.

Bezos explains this concept as driving the cost structure-price loop.  Quite simply, by continually lowering the cost structure of the business, Amazon can maintain downward pressure on prices.  Amazon’s customers like low prices, which keeps them coming back to the site.  The growing demand of potential buyers is attractive to sellers who actively seek to offer more selection. Amazon’s customers like more selection, which not only retains current users but fosters new ones and keeps them coming back to the site day after day, fueling the growth of the company.

In the Amazon model, driving the cost structure-price loop to continuously improve the underlying service infrastructure is both good business and a boon to their customers.  By systematically eliminating waste and scaling the value of their assets across the enterprise, Amazon also gets better at delivering new capability faster.  By focusing these efficiency efforts squarely on the needs of their customers, Amazon is better able to translate latent customer demand into real solutions and differentiate themselves from competitors.  Amazon has scaled this business for their long-term profitability through selection. In the 2003 shareholder letter Bezos explains:

“Increased volumes take time to materialize, and price reductions almost always hurt current results. In the long term, however, relentlessly driving the “price-cost structure loop” will leave us with a stronger, more valuable business.”

Every business system has some amount of waste, process variation, or inefficiency.  For customers of an online retailer, waste can be seen in the form of hold times, extra mouse clicks, confusing checkout options, or cumbersome return policies – the list can go on.  Waste results in effort a customer must expend in order to complete their order; and the more effort a customer has to exert, the less likely they are to come back a second time.  Amazon pushes to reduce customer effort; their One-Click ordering feature is the epitome of simplicity, automating a complex order and logistics process into a single mouse click allowing customers to receive satisfaction immediately.  Amazon’s continuous improvement initiatives reduce customer effort by improving the people, processes, and technology which have a direct and measurable impact on customer experience.

Final Thoughts

Bezos captures these three principles of customer experience success as foundations of “Operational Excellence.” Focusing on customer experience first provides a consistent framework for making strategically-aligned business decisions and a perfect filter for removing non-value add goods and services (things your organization does that customers generally don’t really care about).  Through the disciplined, data-driven application of these principles, Amazon increases asset velocity, revenue, and margin across the business.

And Amazon is proving that the model works.  Just last week, after nearly 20 years as a publicly traded company, Amazon announced Q1 earnings that shattered market expectations and raised stock prices by 12%.  Here at Technical Assent, being a company that values customer experience as an engine of growth, we couldn’t help cheering as they reached this benchmark of success. Indeed, the customer is king.

From Amazon’s 1998 shareholder letter:

“We intend to build the world’s most customer-centric company…Our customers tell us that they choose Amazon.com and tell their friends about us because of the selection, ease-of-use, low prices, and service that we deliver.”

Disney is a leader of customer experience

Crowds vs. Price: Lean Economics for Disney Tickets

Yesterday, the Wall Street Journal published an article about The Walt Disney Company considering a change to demand-based ticket pricing for Disneyland and Disney World. Rather than eventually out-pricing middle class families by continuing to raise overall prices, this change could help alleviate the resorts’ unmagical overcrowding through lower priced tickets during off-peak days.

According to author Ben Fritz, Disney will be surveying previous visitors this week to gauge their reactions to different variable-pricing options.  Though I have not visited either resort in the past few years and will not be among the surveyed, I find the situation intriguing.

Chris Bobbitt, Technical Assent Vice President, commented that this is a good example of Lean management and economics working in tandem.  Disney is an organization that understands its capacity to deliver the experience that it wants, what it costs to do that, what the limits are, and trying to manage demand around that capacity.

Beyond the basic survey questions, I would be curious to know how the behavior of visitors changes on the slow days, or how people might use the park differently, such as use of restaurants and rides.  Further, it would be interesting to see the profiles of the types of people who would take advantage of demand-based pricing.  Are they people who live within driving distance of the resort?  People who don’t have school-aged children?  People who pull kids out of school for an annual trip to California or Florida?

There have been several high-profile cases in the news lately of backlash against service businesses that have use demand-based pricing (e.g., Uber) and one important consideration is those who have access to the service on a pricing model other than pure supply-demand pricing (e.g., senior tickets at the movies, educator discounts).

From a personal perspective as one of the many who does not live within day-trip distance of one of the resorts, going to Disneyland or Disney World involves the choice of dealing with the infuriating crowds during times when my children are not in school or pulling my children out of school during non-peak times.  A more affordable ticket is certainly more incentive to make the latter decision and in consideration of this, I think it would be fantastic if this child-oriented company would provide a special service on non-peak days such as education events, science experiments at the parks, or homework hour with Mickey.

Photo of the Department of Veterans Affairs building in Washington D.C. MyVA is a customer-experience focused government service strategy.

Is MyVA the Future of Government Service Strategy?

Since its release this week, I have been absorbing and digesting the MyVA Integrated Plan published by the Department of Veterans Affairs. For those who haven’t seen it yet, it is the government service strategy for the transformation of VA to become more veteran-driven and ensure the veteran experience is predictable, consistent, and easy.

The MyVA Task Force has accomplished a lot since it was chartered just last year and the document does a nice job of bringing together all of the moving parts in an organization as big as VA. Here are a few highlights that stood out to me as evidence of progress:

VA took a look in the mirror

Using Secretary McDonald’s model for a high performing organization, the MyVA Task Force assessed the current state of the organization – successful outcomes and blemishes included. They looked at the operations, budget, and political environment in the context of their strategy to really understand the constraints they need work within going forward. This upfront transparency will go along way in communicating honestly with VA stakeholders.

VA is translating their government service strategy vision into action

The Plan translates VA’s customer-centric vision into action through five priorities,  Veteran Experience, Employee Experience, Support Service Excellence, Performance Improvement, and Strategic Partnerships. Each priority is supported by several initiatives focused on improving specific aspects of VA – this provides a clear thread between their vision and the actions being taken.

VA is holding themselves accountable

In the Plan, they highlight specific, measurable target outcomes. They talk explicitly about what changes to look for – a single customer-facing website, expanded training and leadership development for employees, and vastly improved internal support services – as evidence of change.

There is one statement, however, that rubbed me the wrong way. It comes in the final paragraph:

“If we do our jobs well, Veterans won’t think much about what we’ve done or how we’ve done it. They will just know they’re receiving some of the best health care anywhere in the world. They’ll know it didn’t take too long to apply for and receive their deserved benefits. They’ll enjoy the home we helped them to finance. Their lives will be richer because of educational opportunities and community connections VA helped to create. And their families will know they’ve been given the utmost respect and final honors when laid to rest.”

VA is selling themselves short, especially with the first sentence. Perhaps as they begin achieving success, the MyVA team will readjust their aim with their government service strategy so that Veterans will ultimately look to VA as the preferred service provider for healthcare, benefits, and memorial services. They will see the service quality they receive as honoring their decision to serve in the armed forces. And they will see all 300,000+ VA employees as advocates in their corner as they transition into civilian life.

Decades from now, I hope we look back and see this initial effort at VA as transformational for government writ
large. As VA learns, adapts, and succeeds, it will become the framework for how we design, implement, and manage government services in the future. Government agencies will look to customer experience as a way to ground their organizational strategies, engage their employees, and better accomplish their mission.

seeing through the noise to discover government's service portfolio

To Improve Your Team’s Performance, Start with Experience

In our view of the world, Customer Experience is the starting point for improving the performance of services. Adjust the angle of your head slightly and the concepts, tools, and methods being used to design better services can also be applied to improving business functions, programs, and operating units. Positioning yourself as a service provider immediately transforms why, what, and how you go about your work.

Here are three ideas to get you started.

Find Your Customers

Services only exist when there is a customer so the first step is to seek out the customer – the people who receive the benefit of the service. It seems like a simple enough concept, until it’s not… in a simple consumer service transaction, the customer is the person who pays for the service.  As transactions become more complex, the term customer can be confused with words like “stakeholder,” “management,” “buyer,’ or “oversight committee.” The ultimate goal here is to deliver services that provide real value to customers – the people who receive the benefit of the service – despite all other distractions.

See Services Where Others See “Business as Usual”

Take a look at the image below; 3D stereograph posters like this were once littered across shopping malls. They enticed shoppers to stop and look; separating by-passers into those who could “see” and those would keep walking because they tried before and it wouldn’t work. I fall into the latter category, but the idea is that you stare at the image deep enough and long enough and a second image will appear out of the clutter – usually a sailboat or a pod of jumping dolphins.

In many cases, looking for services in established organizations can be very similar to seeing the sailboat. It takes some practice at first, but once you get it, it is even harder to unsee it. Government Agencies and Businesses are functionally organized around the work being done, like Operations, Marketing, Finance, and IT. Service Designers must be able to see through these structures and pick out the services that are delivering real value to customers, i.e. outcomes. These are easy to find when a customer buys something – the transaction itself serves as the indicator that there was an exchange of value. It gets more challenging as we dive into the inner workings of organizations – the monthly budget analysis, the provisioning of services for a new customer, or the installation of a new network drop. Each can also be viewed as a service even though no money changes hands. When seeking out services in your organization, look for these 5 attributes:

  1. Intangible – in a pure service, the “thing” of value that is produced is intangible. We often “productize” these things – a dashboard, a report, a legal brief – but the real value is what went into delivering these in the first place.
  2. Inventory – There is none. In a service, the exchange of value happens at the point in time where it is transferred to the customer. The value is perishable in the moment that the service provider transfers their expertise, experience, or insight to their customer.
  3. Inseparable – Just like you cannot have a service without a customer, it is equally impossible to separate the service from the service provider.
  4. Inconsistent – Services are subject to variable demand and are provided on an as-needed basis.
  5. Involvement – There is a certain intimacy involved between the customer and provider where both have the opportunity to influence and customize the outcomes.

Practice applying these filters in your organization and you will quickly see your service portfolios emerge and how well they perform.

Follow the Customer Journey

With both the services and customers accounted for, the next step is to follow the customer journey – the series of decisions and actions that a customer makes from the time they first become aware of your service to the point where they retire it.

As a service designer, taking responsibility for a customer journey may seem overwhelming at first as it will likely the organizational structure. Customer journeys don’t necessarily align with siloed business functions; customers easily move from installation to a technical help desk call to a billing question and expect a consistent service experience throughout. This customer journey exercise often highlights gaps in existing technologies, employee knowledge, and processes in systems that have multiple owners.

Embrace the opportunity to work cross-functionally; the focus on improving customer experience is an invitation to put on your “big hat” and find opportunities to better integrate services that deliver more of the outcomes that matter most to your customer in the ways that are most relevant to them.

 

 

 

team-based approach to building a service culture

3 Ways to Grow a Service-Oriented Team

People working in government and nonprofits often refer to a personal calling to serve the public good. Their sense of purpose can be a source of energy for their peers and their customers cannot help but feel their enthusiasm for the mission. But even the most passionate public servant has an occasional bad day – it is human nature and most people are willing to give us a pass when we stressed or distracted.

Unfortunately, the service itself doesn’t get the same courtesy. Customers expect service quality to be maintained and the experience to be consistent despite the occasional system outage, process glitch, or failure of personality. Services have to systematically overcome these variables to consistently provide a relevant customer experience. As a service provider, here are three ways to develop a service-oriented mindset:

  1. Find the Services, Find the Customers. The first step of a services mindset begins with the customers; identify what problem you solve for them and how they interact with your team to solve that problem. Both the solution and the interactions are part of your service portfolio. Some of these services are easily recognizable – like a haircut or table service at a restaurant – but some can be tricky. Business support functions like the Finance Department, Human Relations, and the CIO’s office can also be viewed through a services lens. Unlike consumer services, internal customers don’t typically pay with money but they do pay with their time. Scheduling a meeting to discuss next year’s budget, providing a brown bag session to present the impact of new hiring policy, or waiting for a call back from a technical expert are all examples of services that contribute to an internal customer experience.
  2. Optimize Services Around Customer Needs. Once the services have been named, engage customers to better understand what is important to them – do they care more about accuracy or speed in the weekly report, are the templates provided helpful in crafting new job descriptions, what was the impact of the last system outage on their productivity. This initial feedback can go a long way, but look for opportunities to formally measure the performance of your services against these attributes. In a consumer service, service quality is captured in a contract document called Service Level Agreement; while it may not make sense in your organization to take it this far, it is worthwhile to communicate to your customers that your performance objectives are focused on the things they care about.
  3. Build Service into the Culture. Shifting culture is never easy, but there are several things that leaders can do to change the tone of the conversation with their employees. First, involve them in the process we have outlined above, encouraging them to think about the services they personally provide and those they contribute to on the team. Expose them to new ideas and techniques for how to approach a customer conversation with empathy or how to constructively accept feedback. Teach them how to measure their service portfolio against customer performance attributes. Model the behavior yourself; emphasizing that the customer is always in the forefront of your mind. When pitching a new project, include the expected customer impact in your scope statement. When being briefed on an issue, first ask about the impact to the customer and how the customer is being taken care of in the interim before digging into the details of the problem. Each of these small actions can have a big impact when repeated consistently.

These relatively simple exercises will take some time up front but can have an immediate impact. We are currently mentoring a Support Department Head of a medium-sized organization responsible for IT services, acquisition and contracting, and human relations. While a little nervous about exposing some of her team’s shortcomings at first, she has found her customers are receptive to offering feedback and employees are energized about the opportunity to think more explicitly about serving customer needs.

exploring what

Services “As a Service”

Delivering capability “As A Service” has significant potential to impact the service sector but has minimal adoption outside of the Technology industry. We explore the relevant themes (minus the IT jargon) to see the broader impact of an “As a Service” model and discover how this focus enables a shift from doing work to delivering outcomes.

Way back in 2008, it seemed everyone in the tech sector was rushing to coin the next great cloud computing offering – Software As A Service (SaaS), Infrastructure As A Service (IaaS), Platform As A Service (PaaS), Everything As A Service (XaaS). As the term has evolved, something delivered “As a Service” has come to mean something very specific; different from just saying “We deliver X,Y, or Z services”. Delivering software services could mean any number of things related to the design, operations, and management of software but delivering “Software As A Service” describes a service model that has a distinct value proposition.

Introducing Lawn Care as a Service (LCAAS)

This relatively simple concept can make a significant impact on a customer, the service provider, and even the industry. Let’s use Lawn Care to illustrate the broader application of the “As a Service” concept. If a customer purchases “Lawn Care Services” in the traditional sense, he expects to negotiate with his service provider about how often the grass should be mowed. The service provider expects to meet her obligation by cutting according to the prescribed schedule. In this type of arrangement, if the lawn dies, the service provider has little, if any, ownership of the problem as long as she cuts the grass according to the schedule everyone agreed on. Likewise, other competitors in the market have trouble distinguishing themselves beyond price.

But there is a new entrant looking to disrupt the market and begins to offer “Lawn Care As a Service“; she resets her customers performance expectations and provides an entirely unique experience. Instead of discussing which day of the week to mow, she tells her customer he should expect to pull into his driveway every day and be greeted by a healthy lawn. In addition to cutting the the grass to an appropriate height, she also includes complementary services that contribute to maintaining a vibrant green color, minimizing the presence of weeds or the infestation of certain pests. These included services may include watering, fertilizing, bug control; they are turned on or off as needed in order to produce the outcome for the customer.

The customer pays for the outcome of the service (healthy grass and curb appeal) within specified performance parameters. As long as that outcome is met, he doesn’t need to think about how many people were onsite cutting the lawn, whether they used a weed whacker or a push mower, or whether the chemical formulation for the fertilizer was better suited to Spring or Summer. The parameters create mutually agreeable tolerances which both customer and provider are comfortable with. They may help reduce the customers’ risk or give the service provider some freedom to optimize her operations. In this example they may require the service provider to warrant that all people who visit his home are covered under her insurance policy and wear appropriate safety equipment or that the watering schedule will adhere to the county’s water conservation guidelines. And in exchange for this added peace of mind, the customer is willing to pay a premium.

An “As a Service” model provides a platform for service innovation

Oriented towards an “As a Service” model, providers can more accurately describe a portfolio of capabilities in terms of the problem it solves (utility), the terms & conditions of its performance (warranty), its costs, and its value. Services are thought of as modular and self-contained units of capability and have everything they need to produce a specified outcome and communicate with its peers in the value chain. These have significant impact to the business of services in the following ways:

Optimize the Business Model. As service providers think about delivering their capability “As a Service”, they recognize the core services needed for their business model to thrive. Likewise, they identify those services that could be potentially provided by a partner or specialist. They key in on overlapping capabilities, redundancies, and even logical gaps in how their service portfolio is being delivered today. Alternatives can be evaluated strategically in terms of how they impact the competitive position of the business in the market.

Fine Tuned Performance Control. Because of the way the services are segmented and described in the first place, service providers have an immediate understanding of the mechanics, the interactions, and the contribution to the bottom line of each service at the time of launch. Services assembled in this way provide agility and responsiveness that corresponds with changes in customer demand.

Business Insight. Services are defined in terms of both their value and cost structure, so business leaders have immediate understanding of the expected contribution to the organization’s bottom line. They can create an entirely new capability by linking services together in new and interesting ways and have an understanding of its expected financial performance.

Platform for Innovation. Finally, “As A Service” provides a tremendous new platform for differentiation and competitive advantage. As service offerings become more and more commoditized, understanding and designing services around a unique customer experience can be a source of pure innovation. The “As a Service” model forces providers to think in customer terms, design the services that best suit existing and prospective customers, and clearly communicate the customer outcomes fulfilled by the services.

improving patient experience is key to improving healthcare

3 Ways to Improve Healthcare Outcomes by Following the Patient Experience

Consider all the touchpoints between a patient and a hospital for a single doctor visit – scheduling the appointment, receiving an appointment reminder, navigating endless hallways, filling out forms and waiting, maybe more waiting, seeing the nurse – then the doctor – then the nurse, then stopping at pharmacy, billing, and insurance. Healthcare professionals and patients likely view these experiences quite differently – what the hospital may view as an efficient workflow to maintain consistent quality of care for hundreds of patients, patients may process as redundant, glitchy, or even careless.

The medical community has long been committed to patient outcomes as the primary metric for measuring quality of care. Patient Experience, however, includes interactions with medical and non-medical staff; all the processes, policies, and business rules; and the digital media and mobile technology they encounter along the way. These concepts of Outcomes & Experience are not mutually exclusive; however the question remains as to the extent to which patient experience can directly influence patient outcomes. Here are three examples of the direct impact of a patient-centered approach.

Improve Satisfaction by 20%. In the highly interactive exchanges among the medical staff and patient, most medical professionals will do anything to make a patient’s stay as comfortable as possible. The challenge for the medical institution becomes how to maintain that same perception of care as the patient moves through the more business-oriented functions of the organization.

Increase Employee Engagement by 20-30%. Patients are keenly sensitive to discontinuity in their experience and have an innate sense for when organizations deliver stove-piped services. When seeking out opportunities to improve, Patient Experience provides a unique vantage point to create a dialogue among stove-piped departments about how to make things better. It offers a lens by which to view the convergence of talent, tools, and technology (regardless of who owns the asset) as they come together at a specific touchpoint to add value for a patient.

Lower Cost to Serve by 15-20%. Despite their intrinsic value, the two points above may be insufficient to convince Administrators to invest in improving the patient experience. This approach makes several strategic and economic contributions – understanding the Patient Experience helps us understand what is really important to patients and, equally, what is not. This enables targeted investments that are tied to business outcomes such as efficient service delivery, workforce productivity, and a more competitive cost structure.

customer experience in government

For the People…Government as a Service Business (Part 2 of 2)

This is the second of a 2-part article.  You may want to start with Part 1 located here

Government is a Service Business

Service is a means of delivering value to customers by facilitating the outcomes customers want to achieve without the ownership of specific cost and risks. When we purchase something “as a service,” we want to directly experience the outcome or benefit without having to worry about the know-how, systems, and processes it takes to deliver it.

To say that government is a services provider is to say that government delivers value to the governed (that is you and me) by facilitating outcomes the governed want to achieve without the ownership of specific costs and risks of undertaking to achieve these outcomes individually or even in small groups. Take National Defense as an example of a government-provided service. Most people will agree that a nation has a much better chance of withstanding a foreign aggressor if it maintains an army than if the people were to rely on the tenacity of individuals or the valiant efforts of small militias. Other examples include the construction of roads and canals, the conduct of diplomacy and foreign affairs, and general enforcement of the laws of the land.

The 5 Government Services

In fact, everything government does can be categorized as one of five types of services.

  • National Services are government services to the nation as a whole, without intent to benefit one group, region, or industry more than another, including regulation that affects more than one industry. National services are the purest sense of government services and we associate them with the missions of the Department of Defense, the Congress, the Federal Trade Commission, and the Environmental Protection Agency.
  • Citizen Services are provided directly to members of the public or individuals. Examples include Veterans Benefits, Social Security, Federal Student Aid, Pensions, and the DMV.
  • Industry Services are provided for the benefit of specific industries either as a whole or to firms directly, including industry-specific regulation. Examples include the Federal Aviation Administration’s air traffic control, the Federal Deposit Insurance Corporation, the Securities and Exchange Commission, and much of the Department of Agriculture.
  • Regional Services are provided to or for the benefit of discrete geographic areas. This includes parts or all of multiple States. Examples are the Tennessee Valley Authority and the Appalachian Regional Commission.
  • Intra-governmental Services are provided to other parts of the government. The work of the General Services Administration is the quintessential example of this type of service. Internal or Shared service providers with departments and agencies such as human resources, acquisition or procurement, information technology, and finance are also forms of intra-governmental services.

Call to Action

Service is about delivering value to customers by facilitating outcomes. Customers are the recipient of the value delivered by the service — usually, but not necessarily, the ones who pay for a service. A family goes out to dinner, they are the restaurant’s customers; you buy a new pair of shoes at the mall, you are the shoe store’s customer; a homeless woman receives shelter and meals from a donor-funded organization, the woman — as opposed to the donors — is the organization’s customer.

While these examples are seemingly straightforward, this concept can get lost in the day-to-day operations of a service organization. Customers are a discrete subset of their stakeholders, but at times these other stakeholders have more direct influence, control, or presence which can sometimes distract us from the needs of the consumers. For this reason, it is critical to build a customer-driven mindset into the culture of the organization and integrate it systemically into the core operations of the service. In addition to being good for customers, it also renews the sense of purpose that likely called employees to public service in the first place. Service business philosophy permeates all aspects of program management.

In our practice, we identified nearly a dozen key aspects of a government services where a customer-focused shift can significantly improve overall program performance. This means that solutions to improve your organization’s customer experience will also have a direct impact on your mission’s bottom line — lower costs, more efficient processes, higher employee productivity. Look closely and you will find there is a role for your customers in nearly every aspect of your business.

Not understanding that the mission is always to do something for someone also has consequences. Opportunities to grow on what government does well or eliminate waste are not detected early enough. Not understanding that every mission has a customer means that public service will only sometimes include customer service and public satisfaction as legitimate metrics. Not thinking of itself as a service business means that improvements in government performance will be isolated and driven by a random cadre of passionate leaders constantly challenged by the long-term average of “good enough for government work.”

It Is Time to Change the Tone of Government Services

Government is fundamentally a service business, at least for nations in which government is founded on the consent of the governed. All who touch government would be decidedly better off if they conceived of government as a service business and operated as such. This extensive ecosystem includes government executives and employees, legislators, judges, suppliers, service providers, consultants, lobbyists, and every citizen.

Once we acknowledge that government is fundamentally the provision of services we will be better able to assess government value and performance. The debates over what missions the government should and shouldn’t undertake will continue as long as the Republic stands, but each time a new service is provisioned or a program funded, it should start out with a clear understanding of who the customers’ are they are expected to serve, what risks are the customers’ trying to avoid, and what outcomes those customers are expecting.

customer experience in government

For the People – Government as a Service Business (Part 1 of 2)

Can you recall your last great service experience? Maybe it was at a restaurant, a hotel, coffee shop, or a dry cleaner. Perhaps the clerk remembered your name or your preference. Or the service was particularly easy to use, available on your schedule at the push of a button. Or instead of being way over the top, maybe it just served its purpose simply without being overly complicated. In any case, the chances are your experience didn’t happen by accident. Rest assured that the service provider knows you have other alternatives and, in order to stay relevant, put considerable energy into understanding their customers’ needs and crafting their services to meet them. Furthermore, they are continually monitoring the customer experience and looking for ways to improve, lest be judged irrelevant and cast to the wayside. As customers, it may be transparent to us during the transaction but the service providers behind really great service experiences are working hard behind the scenes to bring it all together.

We believe that a similar model should apply to government services. Government is a service provider (we believe it is the world’s largest). Government has customers. These customers have a choice whether or not to transact with the government or seek out an alternative solution elsewhere. Customers may not exchange money at each transaction, but we do pay for government services. And yet, when people recall their best service experiences, examples in government hardly ever make the top of the list.

Service is a founding principle

The nature of government as a service business has its roots in the social contract that binds the governed and the governing and legitimizes government. While retracing the origins of the modern state beginning from the Magna Carta would be tedious, it is interesting to note that these concepts are hardwired into our democracy. We can look at the three men who together are the philosophical architects of modern Western government — Thomas Hobbes, John Locke, and Jean-Jacques Rousseau. They provide the notion of a social contract between the governed and their government.

  1. In Hobbes’s Leviathan, society occurs when fundamentally selfish individuals come together and cede some of their individual rights so that others would cede theirs (elevating themselves from the nasty, brutish state of nature by, for example, John giving up his right to kill Chris if Chris does the same for John). A social contract exists when all individuals in a population beneath a sovereign authority cede some of their natural rights for the sake of protection.
  2. Locke’s conception of the social contract differed from Hobbes’s in a number of ways, importantly that it featured a separation of sovereign powers and the consent of the governed is a constant essential for legitimacy (Hobbes allowed for the occasional abuse of power by the sovereign). In the Second Treatise of Locke’s Two Treatises of Government, the social contract exists to provide civil society — a “neutral judge” that could therefore protect the lives, liberty, and property of those who lived within it. Locke’s social contract was particularly influential for the framers of the American Constitution.
  3. To Rousseau, the social contract derived its legitimacy from popular sovereignty, the direct rule by the people as a whole in law-making. In Rousseau’s The Social Contract, the law, inasmuch as it is voted by the people’s representatives, is not a limitation of individual freedom, but rather its expression; and enforcement of law, including criminal law, is not a restriction on individual liberty, as the individual, as a citizen, explicitly agreed to be constrained if, as a private individual, he did not respect his own will as formulated in the general will.

When we bring these schools of thought together, government is formed when citizens collectively agree to cede individual sovereignty to an individual or group (the sovereign) in exchange for the provision of a defined portfolio of services. In the United States, this portfolio of services is summarized in the Preamble to the Constitution as, “establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity.”

While it may seem a little wonky at first, there are some grounding principles here that should matter when we conceive of the services that government provides. Ok, so what? Part 2 of this article describes how a shift in thinking towards a customer-driven strategy could improve the performance of government services.

This is part 1 of a 2-part article.  If you enjoyed it, jump to Part 2 here.