From Davis Balestracci -- Customer Satisfaction Surveys: Is the Goal a Good Score or Improving Quality?

Published: Mon, 09/30/13

From Davis Balestracci -- Customer Satisfaction Surveys:  Is the Goal a Good Score or Improving Quality?
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How Much Money Are You Spending on Surveys?

Hi, Folks,

I just got through looking at an expensive 186-page quarterly summary of (alleged) customer satisfaction data for a hospital.  My head was spinning by page 28.  There were lots of bar graphs, "trending," correlation analysis, and "top box" and percentile rankings on every -- and I do mean every -- aspect of a patient experience - e.g.,  "Did the TV call button work?"    In addition, numbers that were "above average"(> 50th percentile) were blue and numbers that were "below average" (< 50th percentile) were red.

In my opinion, it was all pretty worthless.  I'm not sure how the sample was chosen or if it was the typical "let's send out a bunch of surveys and analyze what we get back" sample.

Let's take a step back and re-frame customer satisfaction in a more holistic perspective.

Jim Clemmer talks about "three rings of service":

    1. The quality of your core product / service
        [Customer: "Does the product / service meet my needs / standards / expectations?"]

    2. The quality of your organizational design / processes to provide your core product / service
        [Customer: "Is the product / service convenient / efficient / easy to access or use?"]

    3. The quality of the customer's experience of both your product / service and how it was delivered
        [Customer: "How do they make me feel?"]

From the customer's perspective, it's all one ring, and it creates their perception of quality.

Surveys like the one I described above focus pretty much exclusively on the individual elements (touchpoints) comprising (2) and how the customer felt about those...individually.  What about the overall experience?

Amusing aside:  Regarding (3), the current trendy question to ask as a proxy is, "Would you recommend this product/service to your family and friends?"  Many times, the results are published in newspaper articles to "inform" the consumer.  Here is an actual example comparing 20 health systems of a large metropolitan area that makes the choice "obvious" [alternate analysis in a future newsletter].  It is attached should you wish to use it  for strategic purposes at an appropriate meeting.

Go Beyond "How are we doing?" to Make it Tactical

A Harvard Business Review article stated that organizations that move beyond focusing mainly on touchpoints to "the customer's end-to-end journey" have 30 - 40% higher customer satisfaction and higher revenues, repeat business, positive word-of-mouth, and higher customer retention.

These top organizations tend to use four steps to improve the customer journey:

1.    Identify the journeys in which they need to excel

2.    Understand how they are currently performing in each

3.    Build cross-functional processes to redesign and support those journeys

4.    Institute cultural change and continuous improvement to sustain the initiatives at scale

The article concludes with this key point:

"Optimizing a single customer journey is tactical; shifting organizational processes, culture, and mind-sets to a journey orientation is strategic and transformational...engages the organization across functions and from top to bottom, generating excitement, innovation, and a focus on continuous improvement. It creates a culture that's hard to build otherwise, and a true competitive advantage goes to companies that get it right."  [My emphases]

An initial survey could help identify the journeys in which they need to excel -- with a well-chosen, appropriate sample.  A less cumbersome alternative could be several well-run focus groups. 

Actually, in the case of a hospital, this may not be necessary.  Quint Studer's excellent book Hardwiring Excellence advocates calling every patient at home the day they are discharged.  The customer perception it creates is pure gold -- as is any information you get on their experience of the discharge process and, in many cases, their overall care experience.  The call is scripted and based on data to gain maximum information on which to take action.  

I can hear some of you now, "Are you crazy?  People are already too busy.  It's too much work and the culture will never go for it!"  If that's an accurate assessment of your culture, then why do patient satisfaction surveys at all?  Until that attitude changes, patient satisfaction efforts are pretty much a waste of time.

Two Key Points

I remember a conference I attended 25 years ago that made two key points:
  • You cannot even begin to satisfy external customers until everyone is satisfying their internal customers.
  • Stop talking about "full customer satisfaction"  until your workforce knows its jobs.
Measures, priorities, and resource allocations with an internal perspective are a root cause of the large gaps between what customers expect and what they perceive is delivered.  As many organizations work to focus on customers and increase service/quality levels, a growing problem is "internal customer tyranny." That's where one department uses its status as a "customer" of another department or support group to make their own lives easier. Too often there's little or no connection to whether the real customer -- those paying the bills or being served by the organization -- gets better service / quality. In fact, the service / quality real customers get is usually worse.

So, how do you create an organization that keeps everyone looking at what they do from the outside in -- being able to define, plan, implement, and measure their jobs around external customer expectations? For the many people who are not dealing with external customers directly every day, how can they define their contributions on the basis of how well they are serving their internal partners so that external customers can be better served?

Maybe there should be some serious thought to diverting  money being spent on routine ongoing expensive surveys to the creation of such a culture.  Then you can invite anyone to survey you any time -- I guarantee that you will be top-rated.

For those of you who continue to say, "I can't recommend that," keep wasting, er...uh...spending your money on those expensive surveys.  But remember: there is no such thing as "improvement in general."  Statistics on performance by themselves don't help to improve performance -- especially if exhortations in reaction to such data has become a routine "input" to your organizational process.  In fact, I heard of one executive team that went to every unit every week and planted a red, yellow, or green flag in reaction to the latest survey result...

Until next time...

Kind regards,

P.S.   Chapter 11 in my book is about surveys...
...but using them tactically and strategically for true transformation is a most non-trivial process.

Do you have:

  • the will to approach "improvement" differently?
  • the belief that your organization can do it successfully?
  • the wherewithal to keep learning and do whatever it takes?
  • the fortitude to begin to do it quietly to finally solve a longstanding issue?

* It's a process I would cover in a leadership retreat CO-facilitated with you to create will and belief

* Maybe a mentoring relationship to guide and harness your wherewithal

* Perhaps a plenary speaking engagement at one of your professional conferences or internal quality
conferences to create will and belief in a critical mass of  like-minded colleagues

* A "data sanity" seminar to expose the invisible everyday opportunities that will help you gain the respect you deserve when you do it

* Show the power of "plotting a dot" to change conversations and eradicate data INsanity

* Or just about any other reason!  I love corresponding with my readers and answering questions.

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