Voice of the Customer (Patient) for Six Sigma Processes in Healthcare

Every organization serves a unique need for the customer. And a key feature that differentiates a successful organization from a not so successful organization is that a successful one listens to what the customer needs and creates products and services that exceed the expectations. I personally believe that healthcare attracts the most dedicated, well-intentioned professionals who truly care about the well being of their customers, the patients. However, unlike other service organizations (think hospitality industry), the healthcare professionals will tell you what they think their customers want and need, but will often fail to directly ask what their patients actually want by determining the Voice of the Customer.

This column examines the importance of eliciting the Voice of the Customer, introduces some common methodologies used to elicit the Voice of the Customer and provides helpful tips for successfully utilizing Voice of the Customer for Six Sigma projects in healthcare.

Understanding the Voice of the Customer (Patient) is Critical

The impact of customer satisfaction on profitability is widely researched and reported. For every patient complaining, there are 20 more who do not complain, but will not return. Have you seen the recent YouTube video of a disgruntled passenger taking on a mighty airline, which caused a PR nightmare (send me a note, I will share the link)? Understanding the patient’s wants has an immense implication on the satisfaction, retention, staff morale and profitability of an organization.

Six Sigma Tools for Collecting the Voice of the Customer (Patient)

Some common Six Sigma tools used to elicit the Voice of the Customer in healthcare are surveys, customer complaints data base, focus groups, Kano Model analysis, leadership patients rounds (management by walking around), process observations (watching the actual process), encounters based on "moment of truth" (Carlzon defines moment as truth as the point where the customer interacts with the organization and forms an impression on the quality of the service provided), mystery shopper, Critical to Quality Trees, Quality Function Deployment (QFD) and some proprietary off-the-shelf packages.

Surveys are commonly used and are at one end of the spectrum (low complexity, with accuracy dependent on the survey). Surveys typically polls the patients for his or her overall satisfaction and likelihood to recommend the experience; these are usually employed after a patient encounter (a few days to a few months lag). A key limitation of a survey is that it polls on what the organization’s perception of value to the patients is, rather than what the patient actually values.

On the other end of the spectrum is the Quality Function Deployment, a powerful tool that starts with the patient’s needs (the "what"), the patient’s importance of this "what," followed by the technical descriptors (the "how") for each of the patient’s needs and finally the team’s rating of the strength of the relationship between the "what" and the "how."

Keys to Being Successful in Collecting the Voice of the Customer (Patient)

Voice of the Customer consists of both qualitative and quantitative methodologies. It is important to capture this information early on in any Six Sigma project before product development and throughout the process improvement cycle. To be successful in correctly identifying the true need of the patient, the Six Sigma process improvement team should be staffed to a) have a process to solicit information from the patient, b) collate the data, c) conduct analysis, d) be able to interpret the results e) develop actionable goals and f) execute the project to realize the goals.

Some key considerations for success: Though the process sounds simple, it actually tends to be resource intensive (time, scope, costs). The organization should have a key individual accountable for the Voice of the Customer process, a centralized data collection plan, developing priorities that align with the strategic vision and goals of the organization, clear metrics and goals for the actionable Six Sigma projects coming out of the process. The implications of not meeting the customer expectations (profit and revenue impact) should be tracked to get support for this critical effort from the leadership. The Six Sigma tool selected should be credible, reliable, precise, accurate and useful in making prediction based on responses about future trends.

The Mayo Clinic Works to Meet and Exceed the Expectations of Patients

The often heard quote here at Mayo Clinic is, "The best interest of the patient is the only interest to be considered..." This quote by W. J. Mayo sums up the patient centric focus of our 50,000 plus employees. The primary value, "The needs of the patient comes first," serves as the guiding light for the organization. We use several of the Six Sigma tools mentioned above to elicit the Voice of the Patient as we seek out to learn both the stated and unstated needs of the patients. Every employee is actively working to meet and exceed the expectations of the patients. Lest we forget, what is an Exciter or Delighter today for the patients on the Kano Model will become a Must Be on the same model in the future. Therefore the key for success for the next 100 years is to continue the tradition of innovation in healthcare.