Category Archives: VoiceSage

Lean Service – Part 3 – Practitioner, Measure Thyself…

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Looking at some of the principles of Lean Thinking to see what we might be able to apply to the customer service environment has led me down some fruitful paths. Today, I was at the supermarket and was faced with a poster that said this:

“If you have a waistline more than 32″ you are overweight at any age“.

It was a government agency health warning. Even in my very fit early twenties, I would have been two inches over this measure. It’s clearly incorrect. Oh wait, the 32″ referred to women, the male measure was 37″ waist. Oh wait, the 37″ waist measure is a proxy for Body Mass Index (BMI), but the distribution around the middle is a better indication of dangerous distribution (ok, It’s a deliberate tongue twister, with a statistics joke).

Which leads me to the Third lean principle I’d like to explore in brief:

3. Measures are derived from “the work” (sic)
 – or “measure; measure flows; measure outcomes – but think about it’.

There are different perspectives “out there” on how we should measure, what we should measure, and even if we should measure. Are measures to be taken from the “piece work” (i.e. widgets made per hour/ calls answered per hour); from process pieces (right person contact per hour); or from outcomes (money collected/ agent/ hour)?.

Some consider finance and budgeting measures at the customer service front end to be wrong full stop.  It can encourage gaming of the system by it’s participants in order to “make the numbers”. It happens. Some consider any ROI measures for future customer service initiatives to be misconceived because these ROI calculations tend to be “validating a decision you’ve already made” (i.e. future realizable ROI is notoriously difficult to establish prior to a project). But ultimately customer service, customer contact, and customer engagement have to “deliver financial value”. The question is what do you measure to establish this fact? Are our measures essentially equivalents of “32″?

The lesson is take care of what you measure, you might just get it. I would be interested to know for instance what the other system effects of focusing on First Time Call resolution as a metric might be? Mark Tamis has an interesting customer service failure example of where you might phone your Telco due to a broadband failure, receive an appointment booking in the first call, and yet everything under that metric is wrong.

Finding out what matters is what matters.

Let me give you one real world example. When moving from one system of collecting Net Promoter Scores to another, a major organisation found that the NPS fell for no other reason than the automation. “Hey, we didn’t automate to watch our NPS fall” might have been the cry, but in fact, they weren’t actually getting a real NPS score before due to some agent based bias errors in the previous methodology. This anomaly spurred the company in question to drive down “in to the detail of this thing” and get granular at the Interaction Level.

What they found was that measuring “our company’s NPS told them next to nothing about what they could do to improve it”. Getting down to the “customer- company agent/ employee interaction” level drove out a whole new set of data that surfaced issues it was not aware of and which could be actioned.

They found out what matters in the Interaction that later, would show up in Brand values.

So here is my endpoint about measuring “work pieces” vs measuring “process flows” vs “measuring outcomes”: be reflective. Figure out why you measure things the way you do, and figure out what thinking led you to this belief. Then, set up a hypothesis, and test it.



Lean Principles 2: Variation In The System

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Continuing Thoughts on Lean Service Principles. Part 1 is Here.

2. Variation is in the system, not the people -
 so watch the incentives. 

When we are looking at why some people or parts of the business just don’t seem to be improving we look to better incentive schemes, more measurement, more oversight. It’s commonplace to say “you get what you measure” but also “what you measure isn’t always what actually matters” (i.e. what matters can’t always be measured, or you are measuring the wrong thing).

But many times the nature of the work, and the nature of the workflow, means that improvement is not possible without changing the fundamentals of how the work itself is defined. In some approaches to this topic, it is pointed out that highly structured, rigidly process driven conversations are the best way to get to the customers required answer.

And there is some evidence to show that we actually feel quite comfortable in this “known and formalised process”. It feels corporate. Until it doesn’t work of course. Then it feels corporate in a whole other way. But this line of discussion also reminds me of a line that JP Rangaswami pointed out recently:

Teachers who can be replaced by computers should be replaced by computers

Formal, well understood routines, as far as they can be automated, should be automated.

Theoretically, call center and customer service are ideal “pull environments” where customers should be able to get the information and actions they need for right now. We can automate this though really good “self service” portals, good search, and good content.

When we challenge some of the fundamentals around how customer service is provided (or indeed what it is, and what it is for) new possibilities arise. For instance “call centers” are required because that’s where this work is done. The rise of the hosted contact center and the home based agent radically challenge this idea. Agents don’t always need to sit together, attached to the information-software and telephone via cubicle, and be “seen to be working” by supervisors.

So are agents custodians and curators of your enterprise knowledge bases?

As we move to hosted and cloud based solutions what has changed in the underlying logic of the systems, oversights, and permissions we use at work? Some things I can see that are potential disruptors underpinning customer service processes I see here are:

  • Extended collaboration strategies: puling the right people into a process at the right time based on what they need to do right now is a basic co-ordination capability deliverable through CEBP. In the context of this post the customer can be “pulled into” the process at the right time, in the right mode, in order to achieve the right outcome. Customers can not only be pulled into processes, but into information contexts, into applications, and even into relationships and communities. How people give and gain access to others, and permissions to access information and resources may become mediated through CEBP.
  • Business processes-as-a-service: buy or rent an entire process or micro-process. Some technical examples are emerging in this space such as RunMyProcess and Cordys. There is even a very cool micro-process example in Ifttt which neatly ties social media elements together. There are very few complete examples here but to be clear I am speaking about “process orchestration” not just outsourcing all your customer service”.
  • Mobile everywhere: new devices change “presence”, location and what tasks can be completed (i.e photo, video conference/share, ID confirmation). Circa 25% of customers now have a smartphone and we are seeing more tablet-enablements in all customer facing environments. For instance Cisco Cius is now on iPad. Workday are designing for “mobile first”. Salesforce.com have Desk.com with a totally redesigned for mobile and social customer service. That should give you an idea of the scale of disruption to come.
So if you think about how our customer service workflows are going to be connected to many more applications (because they will be hosted); we will have far more people available to us for conversations because far more people will now be connected through new Social Business Layers; Mobile will change the when, where and how much we can interact with an organisations business processes. When you look at all these many people would still think “yeah, it will be just like now, only in the cloud”. I think that how we design processes, who designs them, how we control them, who we give control to, could all change.
(Hat Tips to @GrahamHill for comments on an early draft of this, and @Jobsworth for recent posts on flows. Get yourself a cup of silver needle tea and sit yourself down for a long read.)


Lean Service Principles: Costs In Flow

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Lean On Me

Note: This is part 3 of our "Lean Service" topic, you can find part 1 here and part 2 here.

 ”The present style of management was a modern invention, a prison created by the way people interact” W. Edwards Deming, 1994

Imagine A New Pathway

Imagine A New Pathway

It’s the new year and we all make our resolutions: lose weight, exercise more, pursue the important goals in our lives. We give up smoking and put on more weight; we exercise but injure ourselves; we follow our personal goal only to lose something else we did not realise we had. Our bodies, our relationships, and our world are all interconnected systems and how these systems influence each other often goes unnoticed.

Systems are also dynamic also can be adaptive in ways we did not appreciate. Take a recent article “The Fat Trap” in the New York Times. Many people when they lose a lot of weight can’t keep it off because their bodies ‘readjust’ their chemical settings and trends them back towards that pre-set fat level. Looking at the weight loss problem from this point of view is an example of systems thinking.

Systems Thinking and the principles of Lean Thinking make for an interesting journey. Companies can spend a fortune on software products and training but the metrics don’t move, or the metrics move but the customers are still no more satisfied than before.

In this post I am going to present some lean service principles and I will pepper the discussion with examples of systems effects. I am very much hoping that all this ties up in some great point about how cloud communications, SaaS, and ‘next generation’ platforms could learn from delivering value as per Lean Principles.

Some Principles

1. Costs are in flow, not exclusively in the activity or scale effects
:

We’ve tended to look at efficiency as being driven by “scale” and through getting subsystems and departments to the right scale through seeking the appropriate degree of focus. So we break customer service away into a call center, into a shared services center, or into an outsourcer that amalgamates the work from many other clients to achieve scale effects. Breaking work down into manageable units that can be standardised, given standardised times, that can optimised via specialisation (lower cost training). It isn’t always bad, but as a system produce suboptimal outcomes.

That’s because in service environments not all customer interaction work is “the same”. Thus applying mechanisation to what is essentially an organic (high variation) problem is bound to create failures and these failures cascade through the organisation creating unaccounted for costs (sic – I’ll return to this in a future post, this depends on an agent being able to effectively “pull the right” answer from the knowledge base. Of course, the percentage of the overall interaction work that is non-standard, or dynamic in nature, is also a factor here). But if the question and answers are standard and non-changing surely some kind of self service solution is preferred, i.e. for codified information it is best to automate.

As the nature of knowledge stocks becomes even more dynamic and rapidly changing our ability to respond to these changes needs to become more flexible. Simply put, the information we had about an issue yesterday, may not hold today. Fortunately the world is moving towards “collaborative work” and the ability to self organise and to create adaptive workflows is increasing. Many see promise in the new social enterprise layer to make a further impact here.

This is not to say that basic fundamental analytical attention to variation has ceased to add any value. Predictable failure demand is driven by “common underlying causes”. These are faults in the system that prompt us to look to the system itself and redesign. These causes can be quite simple such as having a confusing product install manual or a configuration that is prone to short-circuiting. You can address the inbound calling by removing the underlying cause of this failure; a better manual, a different product design. Of course if you are not capturing the true cost of these inbound calls you may never achieve a business case for redesigning the manual or the product.

Some root causes have been considered “small black boxes into which no one can see”. Why do people just not show up for appointments? In the hospital appointments post we saw that failure to attend an appointment was “predictable” in that X amount of people would just not attend. The unpredictable part of the equation was we did not know exactly which ones would not attend. Through proactive contact, at a low cost per contact, you insert a small feedback loop at a time closer to the event and receive confirmations. You thus remove one underlying root cause. People forgetting or people not “renewing their promise to attend”. These kinds of Nudges are now part and parcel of online commerce, service design, even policy development.

Breaking down the contexts of how, where, when, and between whom these interactions occur reveals a variety of contexts that previously “showed up” as the one “black box” in our flow. The delay in confirming an appointment, what does it indicate? can we generate more context information and re-ignite the flow of communication, co-ordination, and commitment cycle?. If we can, we introduce increased velocity to the process.

Thinking about all forms and modes of communication in terms of “jobs to be done” in a process flow reveals many opportunities to be more effective. Nudges, feedback loops, automations that can at the right time, in the right mode and context help both parties complete the job that needs to be done at the point in the process.

Indeed my friend Mitch Lieberman at Sword-Caboodle has a lovely post about the various “jobs to be done” of email. Each mode of communication can be mapped to different contexts in the customers life and in their journey “to get things done” with you.

Next post I will look at Variation in the System

Lean Service: Hospital Appointments

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The 8 Wastes In Lean

The 8 Wastes In Lean Methodology

In yesterdays blog post (part one of this topic) we took a brief look at the role of failure demand in driving inbound calls. These calls are zero value-add even if you handle them very well. A great example of failure demand is when people don’t show up for appointments. “No Shows” or “Did Not Attends” are one point in the entire patient journey, but even this one area has the ability to return significant improvements through applying some lean principles.

Appointments occur in the “flow of time” and if they are missed they are gone forever. In lean manufacturing this loss of time might be called “muda“- a wasteful activity. Delayed appointments also shift out a whole range of resource queues and care managers have to readjust on the go leading to multiple bottlenecks and inefficiencies. Let’s take the example of a typical hospital appointment:

How Much Does A Missed Appointment Cost?

In the UK missed appointments cost around £600m ($930M) per year. In 2007/2008 around 6.8m appointments were missed and hospitals lost average revenue per appointment of circa £100.

Cost of Missed Appointments Distribution UK

Outpatient appointment no-shows cost hospitals £600m a year

In a detailed multi-year study conducted by VoiceSage partner HealthCom at Portsmouth Hospital Trust it was found that out of 43,000 outpatients per year Did Not Attend (DNA’s) ran to 3,300 and through a combination of missed appointments, lost capacity, and lost or delayed, cost them £4m ($6.1m) annually.

Cost of Missed Appointments at Portsmouth Hospital Trust

Cost of Missed Appointments at Portsmouth Hospital Trust

What you will notice from these results is that interventions to control variation at the root cause surfaces dramatic improvements in cost outcomes. A planned, automated and pro-active communications strategy that reaches out to patients at the right time, with the right message and re-communicates their appointment details, or attempts to reconfirm their intention to attend, removes some of the variation in attendance.

Portsmouth NHS Trust

Portsmouth NHS Trust - Impacts of Proactive Confirmation Cycles

Why Do People Miss Their Appointments?

We know that missed appointments happen but if they are so important to everyone, why do they happen and why did proactive communications make a difference?

A 2005 Study of General Practice Doctors Appointments in the UK cited the reason of ” I simply forgot” by 40% of respondents, and “rescheduling difficulty” (i.e. tried to cancel but could not/ appointment was at an inconvenient time) by 20% of respondents. These, coupled with practice specific factors were significant drivers of missed appointments. In general the younger you are, and the more socially disadvantaged your background, the more likely you are to miss an appointment.

Although there are a number of studies into appointment keeping, a 2004 Study cited three main drivers as to why people missed appointments without notifying the clinic staff:

  1. Emotions – Fear and anxiety about procedures or of getting bad news
  2. Disrespect – Patients feel that the system/ provider does not respect them
  3. Understanding – Did not understand the scheduling system itself

Rather than leave these drivers unaddressed a decent case can be made for looking at the actions, behaviors and processes that propagate them.

  1. In the case of Emotion of Fear cited above how much more care could be taken around all the communications which we send to patients?
  • If we send letters could we take more care with the language used?
  • Could we follow up the letter with a simple phone call to give assurance?
  • Could we better match patient and customer care staff to encourage communications with nervous patients?

Many sectors that VoiceSage is working with have realised significant improvements through personalising messages and tailoring them to customer types or personae and matching these to each stage on the customer-patient journey. This is where the power of flexibility and iteration shows up clearly in results and outcomes.

2. To take the second point for Mutual Respect, proactively reminding people might be seen to show you care about the appointment and that it happens. It creates a sense of being in a managed process, that you are being cared for, and progressed.

However this should be seen in the wider context that when a person shows up for an appointment that they are seen to within a reasonable amount of time. When you do not account for the financial and social costs to the patient of being in a long queue at the clinic you run the risk of being seen to disrespect the value of their time and them as individuals. It stands to reason that just getting someone to keep their initial appointment time and then keep them waiting does not encourage them to show up on time next time. Indeed it’s likely that they will tell others not to worry about arriving on time. This would be a classic example of where you get one point in the process right, only to have it’s beneficial effects dissipated elsewhere.

This “disrespect factor” showed up strongly in a recent “Cost of Waiting Report” produced by TOA Technologies with regards why such long waiting windows were experienced in general appointments and deliveries. In general when dealing with larger companies and organisations many people find that their time isn’t being respected.

TOA Cost of Waiting Report 2011 - Why The Long Wait Windows

TOA Cost of Waiting Report 2011 - Why The Long Wait Windows

Of course waiting times at the clinic are not the only driver of feelings of disrespect. Overall levels of patient care and quality of overall interaction will also drive “Did Not Attends” that have their source in this feeling of disrespect. Perhaps this is one reason why the Care Quality Commission uses these missed appointment measures as a proxy measure for overall Quality of Care evaluations, particularly in the interface with community based care and the quality of the referrals process. I should give an absolutely shameless plug to the VoiceSage Survey product here because this is an ideal example of where you can conduct a post-interaction survey to gather a Net Promoter Score (NPS) measure and tie it back to specific factors underpinning that opinion (VoiceSage won European Call Center and Customer Service Product of the Year 2011 for this).

3. Not Understanding The Scheduling System – while I expect that much user experience of computer and online systems have improved over the last few years there are still gains to be made from addressing the usability of systems. By giving patients simple interfaces online, and clear plain language communications via SMS and Interactive Voice you can present patients with clear choices and clear actions. Although it is expected that smartphones will account for nearly 10% of all phones in the very near future, higher level impacts can still be attained today through simple, well thought out communications strategies that use SMS and simple Voice Interfaces.

The Point Of Interaction In The Patient Journey

Missed appointments can be mitigated by deploying proactive contact strategies that are simple, thoughtful, and caring. People do forget to make arrangements so that they can make agreed appointment times. People do get frightened and avoid going to the appointment. People don’t always feel they are respected by their service providers in healthcare and in other sectors. As we have seen above reducing missed appointments has meaningful cost implications. What I think is worth exploring further is how these appointment confirmation events tie into a more holistic appointment experience measure and how in turn these show up in overall customer care and quality of service evaluations.

 

A few quick notes from VoiceSage USA

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We have made good progress over the past few weeks with VoiceSage’s launch into America. Mark Oppermann, VoiceSage’s Sales Director, spent a week with me in and around Boston talking with partners and potential clients.

One of the highlights of this visit was our chance to provide a keynote presentation called Social Media meets the Contact Center for the NECCF Spring event. This is a slightly edited version of the presentation that we gave to the folks in attendance. I am confident we will be seeing lots more of the NECCF community. Our practical message that VoiceSage helps enterprises move their business metrics using a variety of phone and web tool sets was very well received. The questions about great business cases were fantastic. The business challenges seem to be the same regardless of where we are in  the world.

A second highlight was our meeting with members of the Dialogic team. VoiceSage has been a long time Dialogic customer and is now a member of their partner program. Dialogic has been an early advocate and enthusiastic supporter of the CEBP space. We look forward to working with them.

We enjoy providing a bit of a promotion to the April ECOMM conference being held in San Francisco. I will be attending with colleague Paul Sweeney. VoiceSage sponsored the ECOMM European event last Fall. This is always a fantastic gathering of thought leaders in the Telco industry. For those not able to attend in person, I would encourage following the event via several virtual back channels that are available.

Sincerely

Patrick Murphy

VoiceSage USA

April, 2010