Net Promoter Community

Fred Reichheld joined Steve Bonner, CEO of Cancer Treatment Centers of America for the closing session of the conference. Fred opened with a new point of view on Net Promoter, describing it as a way of taking a biblical proverb and turning it into a management system:

Proverbs 22:1

"A good name is more desirable than great riches. To be highly respected is better than having silver or gold."

Fred suggested a familiar sounding formula: "Think of it as Lives Enriched minus Lives Diminished, divided by Lives Touched." Is it really that simple? Ultimately, the goals of NPS are, but as we saw throughout the conference the actions and processes that allow you to create this outcome take a lot of hard work.

Steve Bonner – Cancer Treatment Centers of America (CTCA)

Steve Bonner reinforced this by describing the many systematic things CTCA does to define it’s mission, design it’s desired experience, and reinforce quality of healthcare through regular feedback and management approaches.

He started by offering his personal view on the challenges for the health care industry to transform patient care. Steve pointed out that 16% of GDP in the United States today is being spent on healthcare, and this number is trending upwards in an unsustainable way. The vast majority of money being spent is on helping sick people get well. The real opportunity for us is to convert this into a true "health" care industry, to help healthy people stay healthy.

How NPS Can Shine the Light on Healthcare Quality

Quality and efficiency are the other big issues for the industry. This is where NPS could play in transforming this major sector of the economy.

Steve asked, "How could we use Net Promoter to accomplish more than reform. What would happen if we gave the consumer the same level of control over their choices that they have in other healthy industries?"

Steve called it a "renaissance," with the voice of the consumer at the center of it. He shared with us two videos from real patients, starting with Jerry Bradshaw, a police dispatcher from North Carolina, who was treated at CTCA’s Tulsa, Oklahoma facility. The video was from their "celebrate life" event, for patients who return to celebrate their 5 year anniversary of seeking treatment at one of the CTCA facilities.

CTCA’s average patient travels over 500 miles one way to come to one of their centers for treatment. This demonstrates how consumers are willing to take control of their own healthcare. Steve believes that when consumers take control of their healthcare decisions and choices, it can truly transform the quality and efficiency of healthcare delivery: and the patient experience.

What does CTCA do that is different?

Here are a few examples that Steve gave:

• They publish on their website outcomes based on length of life, quality of life, and NPS.
• They start every board meeting with a visit from a patient.
• They do regular focus groups to explore how they could improve care.
• They round with patients in the hospital every day, talking with them informally.
• And they survey patients continuously in all of the facilities, to understand how they are doing in accomplishing their goal of top quality delivery of care.

Operating units get feedback from the survey each night, and they close the loop with the patient the next day. This closed loop entices patients into the process because they understand (and believe) it will make a difference. Most patients are contacted, and the vast majority (60-90% of them) respond with their feedback. They have brought the NPS down to the level of individual physicians, allowing them to compare their feedback to their peers in their specialty.

What this approach has gained for CTCA is a community of cancer survivors who are Promoters for the organization. The company’s four facilities, located in Illinois, Pennsylvania, Oklahoma, and Arizona, all operate at NPS levels of 80%+.

For some companies, this may seem incredible…but think of it this way. Imagine that you or your parent was diagnosed with stage 3 cancer, and you went on a search to find the best place to receive care. Imagine that you not only received great medical care, but also had an amazing overall experience that built your trust. And imagine that the treatment worked.

While the last step in this chain is not in CTCA’s control, I’m guessing most patients understand that….so what would you say if someone asked your opinion? How would you feel about an organization that accomplished this?

Peronally, I think the upside for healthcare oriented companies is huge. What industry has a greater potential to develop trusted relationships with its customers? I’m hoping that 5 years from now, this industry will have taken the example of CTCA and created a true "renaissance" in customer-focused care. Thank you, Steve, for the inspiration.

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The tellers at Wright-Patt Credit Union check their email religiously at 3:00. Why, you ask…that’s when the Exceptional Service emails are sent each day. Employees, or partners, that provided an exceptional experience to members interacting with the credit union the day before, receive special recognition through these “thank you” notes. This is just one component to the credit union’s Net Promoter program.

Amanda Minehart, Service Quality Manager at Wright-Patt Credit Union, shared their experience with beginning their Net Promoter journey. “At the credit union, we measured everything…how many transactions we did, how many errors, call times, the list went on and on. But, we never measured what happened next. What about when the member left? How did they feel about their experience? What is the story they’ll tell. That’s when we decided that we needed to create a Net Promoter program.”

Now the credit union sends daily post-transaction and quarterly relationship surveys to gather member feedback to help them answer these questions. This feedback is collected and reported via online dashboards, monthly and quarterly meetings, and the partner intranet.

Member Centers, or branches, post boards that track how many Exceptional Service emails each partner receives. Employees receiving the most emails are recognized with Star Promoter awards and other small awards are given out. They’ve also been participating in weekly competitions called the Net Promoter League. Each week Member Centers “play” each other for top NPS for the previous week’s transactions. This all culminates in a NFL-style playoffs and Super Bowl. What does the winner get? A huge trophy and bragging rights…till next season.

At Wright-Patt, you have one of two jobs:

1. Serving members
2. Serving someone who serves members

So, in October, Amanda rolled out the Service Excellence Ambassador program as a way to engage the second group, back-office partners. The Service Excellence Ambassador (a cute orange cartoon, cardboard cutout) is passed from partner to partner to recognize staff for providing great service to each other. He arrives with a note that thanks them and describes why they were chosen. The partners love to take photos with him – he’s even been to an Ohio State football game – and post them on the Service Excellence Ambassador blog page.

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Aspire to be the next Nordstrom’s or Zane’s Cycles? Do you marvel at the legions of Apple fanatics? These companies all have one thing in common: a customer experience that is completely unique in their market.

Henry Jones, VP Western Region at Satmetrix, provided a how-to guide for creating a differentiated customer experience.

You have to start with the money…well, at least, you need to build a business case that shows that you can create value by delivering great service.

• Show that improving loyalty will drive growth. Henry described a client with a theory that happy customers are less likely to default on their loans. And they actually proved it to be true for their business – improvements in NPS generated revenue from customer income and reduced the risk of the business.

• Show the link between service and growth. Henry showed a call center team NPS ranking from highest to lowest. Now, these were service reps that were also charged with selling. They saw a 26% purchase increase between the top 5 NPS ranked teams and the bottom 5 call center teams. Since the key driver of the score differences was staff knowledge – there’s a direct linkage for the CFO - if I invest in creating knowledgeable staff…we’ll sell more.

• Understand what creates loyalty & destroys loyalty. What are the moments of truth where we can put in proactive processes to prevent detraction/customer churn?

You and your employees must to act with heart and passion. This isn’t something you can fake. It must be real and genuine.

• Create empathy with customers
  • Show employees verbatim customer comments – Things always appear more clearly when you can read them in your customer’s own words.
  • Ask employees to follow up with customers – There’s nothing more humbling than having to say “I’m sorry”.
  • Put yourself in your customer’s shoes…literally – employees at USAA dress in full military gear and eat MRE’s on their first day.

• Generate ideas from the front- line
  • Ask your front-line employees for their ideas – They see/talk to your customers every day, your employees are the gateway to their wants, needs and feelings.
  • LISTEN to your employees and USE their ideas – There’s no sense in asking for ideas, if you’re not going to use them.
  • Publicize the adoption of employee generated ideas – Make it clear to employees that “you are changing the way we do business”.

• Communicate & celebrate success
  • Rewarding employees for good performance – Everyone loves to have their name in lights once in awhile.
  • Show employees that this is important from the top – down.

You must invest in mechanics to build the process. Successful programs have systems in place to do this efficiently.

• Collect data at the right touchpoints – Identify the key moments across the customer journey that drive your relationship with the customer.
• Automate processes to drive & share information – Get information into the right hands quickly.
• Put process in place to ensure that customer concerns are responded to – Developing a process for closing the loop with customers ensures that it gets done right.

Money + heart + mechanics = differentiated customer experience AND a slew of loyal customers

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Dr. Vince Nowinski, Director of Methodology for Satmetrix, discussed a newly completed assessment of how organizations are doing when it comes to Net Promoter best practices. Dr. Laura Brooks was originally scheduled to present this topic, but fell ill with the flu…we were lucky to have Vince already with us in New York, since he worked directly with Laura on development of the assessment.

From Vince’s perspective, many companies excel in one area or another. But they are asking, “How do I know where the gaps are?” That’s the question he set out answer today.

Vince described why Satmetrix calls the assessment Net Promoter 360. The feedback on internal practices includes viewpoints from the Executive Sponsor of NPS within the organization, the Senior Executive Team, and Program Sponsors who manage the feedback operations. Think of this as a 360 degree view of what’s going on with your Net Promoter program.

Who Participated?

Vince presented data from a group of 22 different companies from 12 different industries, with an even split of B2B and B2C business models. Most of the companies (about two-thirds) had over $1 billion in revenue.

The assessment itself was designed jointly by Satmetrix and Bain & Company.  Questions on the assessment capture a mix of internal attitudes, behaviors, and business results to assess a company’s maturity level in adopting the Net Promoter discipline. It includes questions like, “Does the organization invest resources? Do executives believe the data they have is reliable? Do they understand what the top customer priorities are? Do they have closed loop processes in place to address individual customer issues?”

How Mature Are You?

Vince separated the 22 companies into 3 groups, to understand different levels of maturity.

Level 1: Developing

Adoption of Net Promoter is limited to some parts of the organization. Data was not yet trustworthy, or fully used operationally within the business.

Level 2: Progressing

The biggest difference here was that NPS had wider adoption, and companies were regularly taking action on the data. This group also had a big focus on root cause analysis…indicative of a phase of adoption where tactical insights are being developed.

Level 3: Advanced

These companies had Net Promoter fully integrated with the decision making culture. They were focused on understanding relative competitive position, and had processes in place to focus both on limiting Detractors and, more importantly, generating more Promoters.

Some Key Differences

Ultimately, Vince pointed to the measures of customer centricity as the most linked to overall level of adoption. Many people describe this as “culture.” I like to think of it as passion for the mission of the company.

What really struck me was the internal NPS for the Net Promoter program itself. Advanced companies had 96% Promoters of their NPS efforts, with no internal Detractors. These are organizations where all the key executives and core team members are “on the bus.” In contrast, those at the developing stage had closer to 50-60% Promoters and a group of Detractors within the core circle that should normally be leading the rest of the organization.

Advanced companies (100% of them) felt that NPS was involved in the day-to-day operations of the business, while none of the advanced companies described it as a “research initiative.” I found this point interesting. What language does your organization use to discuss Net Promoter internally? I’m sure the advanced companies have “research” resources involved with the program, but they understand that the ultimate value of the research is its use in strategic and tactical decision making. The other word that jumped out at me was “initiative.” The advanced companies don’t think of it as a one-time initiative. It is part of the way they do business.

Finally, Vince turned to the big question: What’s more important, eliminating Detractors or creating more Promoters? Ultimately, companies need to do both, but we found that the more advanced companies were in their adoption of NPS, the more likely they were to be focused on creating more Promoters. That’s really the end goal, isn’t it? You may indeed need to focus on eliminating Detractors, but if that’s all you ever focus on, it can be hard to define a winning vision and sustain the motivation of your employees.

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As you may have already figured out, the “Ultimate Question” that is the foundation of Net Promoter is not actually a question, but questions. Just like Batman cannot exist without Robin or Peanut Butter without Jelly  <insert cheesy analogy here>, likelihood to recommend has limited business value if there is not some way of tying context to the response that was given. The numerical values captured from clients is extremely useful for quantitative analysis, including correlation and regression analysis to identify drivers, while the open ended question is extremely useful for qualitative analysis.

Is too much data a bad thing? Not at all if you have the means to process large quantities of data. With numerical data, it is quite easy to ingest volumes of data into a database and crunch numbers with little to no regard for the volume that is being processed. However with unstructured data, like verbatim comments, we face a much more formidable challenge.

As Vince Nowinski, Director of Methodology, Satmetrix, shared during his session today, there are multiple ways of managing qualitative data in the form of customer verbatims.

1. Single Punch Categorization – This is where most comment analysis occurs. Verbatim comments are “bucketed” into a single themes or category.  Categorization may be more subjective due to interpretation or bias from the person categorizing the comment.
2. Multi-Punch Categorization – Similar to the above, however comments are bucketed into multiple themes or categories.
3. Comment Intelligence - Using software algorithms, open ended feedback are processed analysis is performed by the incidence of particular words and their relationships with other words within the comment.  In contrast to the single-punch and multi-punch categorization techniques which require categories to be created by the person (or people) performing the categorization, comment intelligence uses technology that analyses the patterns which exist due to interreliability of the keywords in a data set.  Objectivity is not an issue since software performs the analysis.

The output of comment intelligence allows an organization to uncover relationships amongst different concepts and themes, along with the frequency and likelihood of association of keywords within themes.

For organizations with very large volumes of open ended feedback, comment intelligence solutions may be a good investment simply due to the time and effort required to manually process verbatim feedback.
While verbatim feedback is very useful to dovetail into quantitative analysis, Vince shared the following insights to take into account when using qualitative feedback:

• Qualitative feedback diminishes as surveys lengthen
• Open ended comments require more thought and effort on behalf of the client
• Motivated customers share more and their sentiment influences responses
• Tailored/targeted questions are best for asking verbatim
• Customers are unreliable narrators and raters due to halo effects, fatigue, satisficing, ballistic responding and both cultural and response biases (Is it root cause or top of mind?)
• Don’t’rely just on quantitiative feedback because you’re bound to miss what you don’t measure!
  

Used wisely, however, verbatim comments can inform thinking about the customer experience, shed light on how customer segments differ and prove better insights into root cause of customer experience issues.

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