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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.

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.

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.