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


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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.

Republished with author's permission from original post.

Maz Iqbal
Experienced management consultant and customer strategist who has been grappling with 'customer-centric business' since early 1999.


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