Customer Experience: a personal insight into people and organisations (part III)

This third and last post regarding my experience withe UK healthcare system follows on from two earlier posts – Part I and Part II – if you have not read these posts you may want to do so.

Is the situation more important than the personality?

In our default way of being/thinking/acting in the world we make assumptions.  One such assumption is that good people do good stuff, bad people do bad stuff.  In the context of the customer experience we assume that if someone has treated as well then she is caring/good and anyone that does not treat us well we label as bad/uncaring.  Put differently, we attribute how people show up for us to the inherent (and fixed) characteristics of human beings – as individuals and even groups.

What if human behaviour is plastic?  What if the context, the situation, what has gone before plays a more powerful role in shaping/influencing/driving human behaviour than personality?  Social psychologists have shown that the social context is a powerful driver of human behaviour. Think about being a fire alarm going off.  If enough people run for the doors then so does everyone else and vice versa.  Yet, it is not just the social context the influences human behaviour.  The same person can act very differently depending on his/her state, allow me to share an example with you.

I met up with Dr P three times.   The first time she was totally present, she listened attentively, she examined me, she ordered a battery of tests, she assured me.   The second time I consulted her, to follow up on the same matter, she showed up pretty much the same way.  On both of these occasions I walked away grateful.  So how is it that on the third visit, I left with the feeling that Dr P had not really listened to me, was not really present and the consultation occurred as wasted time, a disappointment?  What was the difference?  On this third occasion Dr P was ‘tied up in knots’, was wrestling with her ‘own demons’ and so simply went through the motions with me.  How do I know?  I saw her run after a patient whilst this patient walked out of her surgery telling Dr P that she felt that she was not being taken seriously by Dr P.  And Dr P started my consultation by apologising for keeping me waiting for 30 minutes and mentioned that she had a difficult patient to deal with.

My broader observation is that the people who showed up as being the most caring were the people who showed up as not ‘running around having lots of stuff to do at the same time’ and those who were ‘happy in themselves’ and the ‘task that they were engaged in’.  The implication is clear:

  • if you want your people to take good care of your customers then you have to take good care of your people; and
  • before you leap to conclusion on the ‘goodness’ or ‘badness’ of a member of staff, or a group of employees, take a good look of the context (the broader situation including the environment) that gives rise to the being/doing of these folks.

There is world of difference between efficiency and cost-cutting

There is relentless demand on the UK’s healthcare system.  That is simply what is so. To deal with the costs associated with this demand the UK government has resorted to ‘making efficiencies’.  To make a system efficient is a really difficult task, it requires intimate knowledge of the system and the context in which this system is embedded.  This means that the most productive approach is for the right outsiders to work with broad range of people on the inside of the system to identify ‘waste’ and let go of the practices that generate this waste and to come up with smarter ways of doing the value added work.  It even requires grappling with the what really constitutes ‘value added’ and ‘waste’ – from multiple perspectives.

So it is no surprise that ‘making efficiencies’ within the healthcare system is code for ‘cost cutting’.  This is the kind of thinking where each departmental head gets told to make an x% cut in the budget.  In the UK healthcare system this seems to involve cutting the number of beds, replacing experienced people with less experienced people, splitting work that was one done by one role into multiple roles, outsourcing to the cheapest supplier……..  And importantly, it means that the customers and people on the front lines pay the price.

The customer pays the price in numerous ways.  Some of the burden is shifted on to the customer e.g. lack of beds means that customers are expected to find relatives/friends to take them hope and look after them when they should be in hospital.  Hospitals outsource their car parks to companies and the cost of car parking keeps rising.  When you are in pain waiting to be treated do you, the customer, really want to / are in a position to worry about finding the change to pay for the parking meter and so forth.  It simply takes more effort and more time to get things done…….

The front line staff pay the price of this ‘shifting of the burden’ onto fewer people.  How?  It is these front line people (nurses, doctors) who are under the strain of customer unfriendly policies, poor staffing practices, insufficient resources, fragmentation……  If you have studied systems and systems thinking then you will find that ‘shifting the burden’ is one of the classic/core systems archetypes.

In the long run cost-cutting is wasteful.  The ‘savings’ and/or ‘profits’ of today have to be paid for tomorrow – just thinking about the banks and the financial crisis.  What makes sense at the local level rarely makes sense at the level of the entire system.  What makes sense in the short-term rarely makes sense in the longer term.  Unfortunately, to be human is to be biassed, by default, to the local and to the short-term.  So we deliberately put in practices that penalise local and short-term, reward holistic and long term orientation, or we pay the price of our ‘stupidity’.

Fragmentation leads to a poor customer experience and higher costs

The central issue with the healthcare system is that if you were designing it from scratch you would not put in place that which is in place.  The whole system is riddled with fragmentation and the ‘waste’ that occurs as a result of fragmentation.  Let me give you just one example. When I woke up from my endoscopy I had three questions:

  • What did you find?
  • What is the ‘disease’ and how serious is it, what implications does it have for me?
  • What can you do about it?

I did not get these answers.  I did not get an opportunity to speak with the Consultant.  Instead the nurse told me that I was bleeding on the inside, that some part of my colon was inflamed and that a piece of it had been taken and would be sent for testing.  And finally, that I would get a follow up appointment within 4 weeks.    The two page document that summarised the procedure and findings that the nurse handed me was written in ‘medicalese.  What did I do?  I ended up going to seem my GP to get answers. Was she able to give me the answers?  No. The two page document was no clearer to her than it was to me.  This is just one example of where the hospital looking after its own interests has shifted the burden (and cost) to another part of the healthcare system.

And finally

The lever to make a fundamental impact on the system at hand usually lies outside of the system.  The most powerful way of reducing costs and driving up efficiency is to to do the following:

  • study the demand in detail – what drives it, what is ‘failure demand’, what form does it take….?
  • reduce the ‘failure demand’ – demand falling on the system because one or more parts of the system failed the customers;
  • reduce demand through policies and practices that encourage better health in the population;
  • find smarter ways of doing what needs (‘value demand’) to be done including involving/making use of customer – this means thinking in terms of the whole (as opposed to the parts) and of flow (as opposed to unit costs.

And that in turn requires leadership.  It occurs to me that whilst there is an abundance of manager and management there is a dearth of leadership within the UK healthcare system. A key facet of leadership  is to unleash the potential/passion of people to co-create a future that moves-touches-inspires-uplifts us.  Does the same issue plague the business world?  I’ll let you decide.

Customer Experience: a personal insight into people and organisations (part II)

This post follows on from the previous one – if you have not read it then you may wish to do so, as this post continues the story, the conversation.

Trust – I put my life in the hands of ‘others’

I awaken and notice that I am back in the day ward, what happened, what am I doing here?  Confusion.  My last memory is of being in the ‘operating theatre’: the nurses are hooking me up to equipment and assuring me that they will be monitoring my vital signs throughout the procedure.  The Consultant inserts a needle into my hand, the sedative flows I can feel that it is warm.  Now I am awake, here in this ward.

The nurse offers me a tea and sandwiches, I refuse.  She gently and confidently tells me that the right thing to do is to take the tea and sandwiches.  I agree – she comes across as she knows what she is doing and she is doing it out of care for me.  After finishing the ‘meal’ and the paperwork, she tells me someone will be along soon to take me to another ward until my wife can come and collect me.

As I am wheeled along to the other ward I reflect on what happened today and has happened before.  How many times have I put my life at risk – in the hands of the medical profession?  It occurs to me that trust is present between me, the doctors and the nurses.  I trust that they will act in my best interests, to take care of me, to safeguard my life by doing the right thing.  I can think of two instances where the medical profession saved my life: at the age of 8 when I walked into the path of van and then in my mid-20s when I had a blockage in an artery ……

What is the bedrock of this trust?   I am of the view that the medical profession is  bound by the prime directive: do no harm.  I am convinced that the doctors and nurses are here for me – to serve me, to cater for my needs, my welfare – and not the other way around.  I believe that there are rigorous standards in place to ensure competence – these folks know what they are doing, they haven’t just walked off the street.   What would happen if this trust was eroded?  Would we, here in the UK, end up in the same place as the USA?  Highly likely.  Trust is THE lubricant of friction free relationships between human beings.  Trust is what makes all forms of social organisation possible.

Now compare this with the business world.  What is the prime directive? Can you and I honestly say that the prime directive is to do no harm to customers?  What about the design of the business system?  Is ‘business’ there to serve me and my needs or is it there to find means to sell stuff to anyone who can be persuaded to buy it?  Is it somewhere in the middle?  What about competence?  How sure can you and I be that the business folks we depend on are competent?  I know of a  bank where the vast majority of customer services staff cannot accurately answer the top 10 frequently asked questions.  And then are the customer facing staff in stores – most of them do not have the requisite product knowledge nor the skills to listen to / talk with customers.

Care: the difference that makes all the difference?

The Consultant telling the nurse that he was going to give me a sedative as that was the right thing to do.  And instructing her to find me a bed showed up as care – care for me.

The nurse ringing around, finding a bed, coming back to tell me with a smile in her being, showed up as care – care for me, for my well being.

The Consultant and the team rearranging the operating schedule to put me lower on the list – as I was in lots of pain and not ready to be ‘operated’ on – showed up as care, care for me.

The nurses talking to me, explaining what was about to happen, pointing out that they were hooking me up to equipment to monitor my vital signs throughout the procedure showed up as care – care for me.

The nurse offering/encouraging me to have that tea and sandwich after the ‘operation’ showed up as act of care – care for me.

The trainee nurse coming up every so often to measure my blood pressure showed up as care – care for me.

The nurses on the receiving ward who got that I was not lucid, who first found me chair to sit in and then later moved me to the bed (when it became available) and then put blanket on me showed care – care for me!

What I am present to is the kindness/care of strangers, the kindness of my fellow human beings, the kindness of the medical professionals – at my GP’s surgery and at Heatherwood Hospital.  What showed up in my experience was caring and competence.  Caring is not enough it requires competence. Competence is not enough, it requires authentic caring for the other as  fellow human being. I say that if you care then you make sure that you do all that you need to do to be competent.  Put differently, ensuring competence is a key act of caring and if incompetence is present then that shows a lack of caring, indifference.

Authentic caring involves doing what is right including going against the wishes of the customer if that is the right thing to do.  After the procedure, when I woke up I was ready to get dressed and literally walk home – I felt that fine.  I told the nurses that I would walk to the other ward.  I asked the nurses to leave him outside on the lawn until my wife turned up so that I would not take up a bed that someone else needed.  They ignored me.  Why?  They had a better map of the situation – they knew that I was not lucid, not fit to make decisions, not fit to look after myself.

One other thought occurs to me, the level of caring varied from one person to another.  Put differently, caring did not show up as an organisational quality, it showed up as personal quality.  That is to say that some people cared and showed their caring whereas others did not.  Which suggests to that the organisation is not consciously, deliberately cultivating a culture of caring.

Now lets take a look at the business world, how do business organisations show care for their customers?  Does care show up in the lives of customers?  In what sense do customers feel cared for?  What would show up if genuine care, for customers and their well being, was present?  How would that effect product development, marketing, sales, customer service, logistics, finance…?  Could it be that genuine care will work where all the shiny toys and fashionable tricks are not working?

And finally

I will conclude this series of posts by sharing with you the aspects of my ‘customer experience’ that were not so great and highlighting issues’/factors that need to be addressed.

Customer Experience: a personal insight into people and organisations (part I)

Over the last four weeks or so I have touched and been touched by the ‘medical system’ in the UK – in particular my doctor’s medical practice and the NHS (national health service).  I want to share with you the key insights that opened up for me on people and organisations.

Women show up as being more caring than men

Women as a whole whether in the role of receptionist, ‘blood taker’, nurse, trainee nurse or doctor simply show up as being more caring.  In their being and in their doing they transcend the merely functional – the task.  They put their humanity into the encounter – they smile, they strike up a conversation beyond the merely functional, they reassure, they do more than is necessary.  The men, as a whole, focussed on their area of expertise and the task at hand.  They are distant.  They stand farther away (afraid to get close), they don’t smile, they are matter of fact, they focus on the task, time is clearly of the essence as they are keen to move on to the next person, the next job.     There are exceptions.  One female receptionist was particularly cold, clinical and showed up as being disconnected from even a thread of humanity. On the other hand Dr Jeremy Platt is almost always smiles and greets me warmly and takes the time that is necessary.

Insight.  If we genuinely want our organisations to ‘touch’ our customers so that we show up as caring and thus create a space for emotional bonds to show up and form then this challenge has to be addressed.  Men, as a whole, are one dimensional – functional.  Either they are emotionally illiterate – that is to say that they are not in touch with their caring emotions or the cultures/communities they are embedded in do not give them permission to express their caring emotions.  I suspect it is combination of these two factor – their is a lack of permission to show caring as this shows up as ‘soft’ and over time men lose touch with these soft emotions.

Question/Challenge.  If the Tops got to the top by being ‘macho’ and ‘functional’ then how likely is it that these people will undergo a transformation and embody the softer emotions, values and associated practices which are the key to showing up as caring?  Perhaps they will take the Steve Jobs approach – build that caring into the product.  Or they will take the Amazon approach: build that ‘caring’ tone into the design of the operations.  Yet, these approaches are not enough in services heavy industries where people (the employees) are the product, the experience and there is intimate contact between the customer and the employees.

The people on the front line can show up as ‘robotic’ and ‘inhuman’ because they perceive themselves to be powerless

I turn up at the scheduled 8am appointment for the endoscopy.  Pain is present – that is the reason that I am there, to figure out what is the cause of the pain.  The nurse ‘sells’ me on taking the right course of action – taking the sedative as it will relax me.  I agree, I tell her I am in pain and so the sedative is the right way to go.  Then she asks me who will be coming to pick me up and take me home.  I tell her that my wife cannot pick me up until 3pm and that if I am well enough to go home earlier then I plan to use my favourite taxi firm to get me home.  She responds by saying that she cannot offer me a sedative unless I have a family member to take me home and look after me for the next 24 hours – that is the hospital policy.  I say “If you are not going to give me a sedative then you are not going to give me sedative. I am ok with that.”  Except that I am not really OK with that.

Later the Consultant- the specialist who is going to do the endoscopy – comes to see me with the nurse trailing behind.  He asks me some questions, I answer.  Then he asks me why I have chosen not to have the sedative.  I tell him that I want the sedative and I have been told that I cannot have it.  And I tell him the reasoning.  He tells the nurse that he will be giving me the sedative as that is the right course of action given the pain I am in and the procedure involved.  He tells her to find me a bed.

Instantly the whole being of the nurse changes.  It is clear that ‘God’ has spoken and his command must be obeyed without question, no excuse will suffice.  She tells the doctor that she will ring around several wards and that she is confident that she can find me a bed in a specific ward.   There is no doubt in her voice, absolute confidence.  She leaves and several minutes later she comes back and tells me that she has found a bed for me.  I am amazed at the instant/profound change in this nurse.  It occurs to me that she is happy/proud at what she has accomplished; she has a big smile on her face and her tone of voice is different.

What is going on here?  For the better part of 20 minutes or so this nurse showed up as robotic – going through the motions, following the script and preaching policy, ignoring my needs and the right thing to do, even changing her advice 180 degrees.  Then the Consultant shows up, tells her what she needs to do and instantly there is a new human being in front of me: confident-resourceful-helpful as opposed to helpless and robotic.

What made the difference?  I say she was given permission from THE authority figure to bypass policy and put her knowledge, her resourcefulness, her caring into action.   I say that the Consultant showed up and instantly changed the context from which the nurse was operating from:  from be a good robot/ follow the script/procedure to here is challenge/make it happen.  Furthermore, the nurse was absolved from responsibility and blame – she was simply following orders.  Which reminds of the Miligram experiments in obedience to authority.

Insight.  When we look at poorly performing front line employees the tendency of managers, management consultants and the training industry is to assume that the fault, the deficiency, lies in the front line employees.  In short we have an automatic bias.  This reminds me of the story of the drunk looking for his lost car keys under the street lamp when he had lost them somewhere else.  The smarter place to start looking for performance issues is in the context/the environment/the ‘system’ in which the front line employees are embedded and operating from.  That means facing the reality:  in about 95% of cases ‘poor employee performance’ shows up because it is the natural, inevitable, result of the assumptions/prejudices of the Tops and the ‘system’ that they have designed, actively or passively, to cater for those assumptions/prejudices.  Let me put it bluntly, if you want to drive up performance and the customer experience then focus on the managers, the management style, the organisation design.  That is where the real leverage is for step changes in organisational performance, customer experience and customer loyalty.

And finally

I will continue to share my insight with you in the follow up post – part II will be coming soon.  If you are up for it then I’d love to hear your thoughts.

Some of you have been kind enough to enter into a conversation with me by commenting.  You will have found me wanting – I have been lax in responding to your comments.  I ask for your forgiveness, my excuse if there is one is simply that the last four weeks or so have been a struggle:  the body, my health is not showed up as being my own.