Is the Customer Always Right?
Avi Siegel published in Entrepreneurship Handbook
The author points out this “truism,” that the customer is always right, and he tackles the question from the position that this is nonsense. That hooked me. While in management at Group Health, I was introduced to consultants who tried to address this as an orientation for clinicians—and if done successfully would lead to growing enrollment and satisfaction. One of the examples held up proudly was an anecdote from Nordstrom’s: a man angrily insisted on a refund for an automobile tire he had purchased. Customer service worked with him, de-escalated his anger, and wrote a check. This was considered a wonderful example of service recovery.
Nordstrom has never sold tires……
As a physician, I saw many a problem with this model and never reconciled them. The author of the article stimulated some parallel thoughts with health care, which from my view is very badly in need of some reforms, begging the question: who is the customer, exactly?
He starts with the notion that the customer is rarely right, especially about software products (his business). He points out that their anger and solutions are usually, “wrong.” He wisely points out that does not mean their words don’t matter.
The Downside of hearing out your customers.
Hearing them out is important and not the same as reflexively, “doing what they ask for.”
If you do that, if you react, you will suffer from recency bias—prioritizing on the content that generated the most discomfort recently rather than prioritizing solutions to what is really important—from that same consumer’s point of view.
Jumping crisis to crisis, you will switch the focus on work’s content and lose focus and energy.
Your team will have falling expectations and he labels this a form of mismanagement. Trying to be all things to all people will find you designing a product that is overly complex and likely to fail.
You will suffer from short-term thinking and as such, have no well designed road-map to a better future
When everyone follows this approach, the ability to differentiate your products from others fails and your sales pipeline shrinks.
Innovation will stagnate and your teams will become demoralized. Your people will seek greener pastures and the process will repeat.
This software manager designing for the market has a far easier job than say, a health plan like Kaiser or a clinician balancing the needs of patients, running an office, and collaborating with insurance companies which in turn have their own needs as customers.
The Upside of Listening to your customers.
You will identify unmet needs and unresolved pain points flying under your radar.
When customers like what your are doing, it validates your plan and process; you are doing things right.
When there is no alignment between your plan and what customer’s say, you can avoid costly mistakes by avoiding a design the target audience does not value.
If you demonstrate to customers coming features, you can accelerate the iteration of the concept and help with decision making while building customer trust which in enhanced when they have a say in the future. Customers stick with products they feel involved in building.
You will come to understand the need to focus on improved user experiences because death-by-a-thousand-cuts is real.
You can uncover issues that other products don’t solve and make yourself more relevant.
All this motivates your teams.
How to Handle this Conundrum?
Don’t just hear what people (customers) say but rather, listen. Listen actively.
Use the Five Why’s model to clarify root causes—If a customer tells you something specific—what they need—they are telling you what they think they want—there is no depth or system contexts necessarily in their request.
Asking open ended questions with follow up questions to dig deeper is recommended. He thinks you should focus on the negative and not the positive with an eye on improved products.
Don’t seed answers in the question setting.
Embrace silence, hard as that is. Getting insight from customers requires patience.
Most of this advice should sound familiar to clinicians who have been tutored with the goals in mind. The difficulty is the malalignment of what a patient feels is important (tension headaches, failure to lose weight, stress) and that of the provider (cancer screening and blood pressure control) and the incentives provided by an insurance company (did you chart and code for chronic conditions like hypertension, asthma, diabetic complications?). The art of medicine requires a relationship whereby in twenty minutes, the patient and doctor negotiate what can realistically be done in that time and then prioritize that work. It is not easy.
He ends with
Rule 1: the customer always knows what they want.
Rule 2: When it is clear that the customer does not actually know what they want, ask questions and reread Rule 1.
RAM: I have worked in health care my whole life. Making entrepreneurial software products is different than building a health care system with staffing shortages with wide gulfs in patient and provider expectations in mind. His points do hit home.
Patient Experiences starting out:
I presume phone trees make economic sense. The trend, undifferentiated in all large companies I touch, is for really crappy customer service with wasted time and frustration of not having the selection that meets my specific needs in mind. Did I mention time lost?
Medical providers where I have worked reflect the bell-shape curve of empathetic, sympathetic, discerning, and temperamental personalities found everywhere else in all other lines of business. One’s experience will vary provider to provider all working under the same medical model of care. Customer ratings are not so helpful but should be checked; comments with ratings give one a feel for where a given provider falls with your choice in mind. Physicians in my world were angry about customer ratings noting that the people they disappointed (the common example was, “I did not prescribe the pain relievers they requested.”) were, most likely in a fit of anger, to give a very negative score. People known to them for years with whom they had good connections often did not reliably fill out the surveys. And yet, providers I knew who were principled, and had that active listening skill when I spoke with them, clearly scored better, regardless of their specialty or patient population..
The complexity of medical care contributes to many of the problems the author associates with the negatives of listening to customers (patients). As an administrator, it did seem like we chased our tails with a variety of targets and agendas— with many people giving input—and despite our best intentions, we were not especially good at “selling” this new and improved set of innovations to the providers who had to do the day-to-day-work. The complexity continues as my friends who fill out Medicare Advantage Annual questionnaires (Have you peed on yourself? Have you fallen in the last six months? How much do you walk every day?) or parents of pediatric patients who are expecting shots but face a litany of questions: (are there firearms in the house? Do you have a gas range that produces fumes? Do you worry that your child is being bullied in school?). I can make the case for asking the questions but as with the advice above, the process requires patience—you can’t identify or solve all problems in one visit much less one year—and it helps to know your audience. I met an obese woman while filling in for an ill provider who suffered from knee pain with degenerative arthritis the likely culprit. After learning the history, performing the exam, and reviewing the X-rays, I developed a plan of care that included non steroidal anti-inflammatories, paced regular exercising, a trial of PT, and then, trying to be complete, I suggested weight loss as a long term goal. Within 48 hours I learned she had complained bitterly about this advice. On reflection: I tried to do everything at once, I did not know my audience—we had no relationship—, and she was on a path to get is sorted, no matter what—my attempted intervention was fine medically but incorrect in its timing and the summary (?sermon) within which it was delivered, by a stranger, and likely advice she had heard over and over.
Relationships in medicine and their effect on diagnosis not to mention treatment, are why AI is not going to put doctors out of work at least in the near-term. I read this morning that some people are building AI ‘friends.’ Perhaps an insurance company will develop empathetic AI virtual doctors someday—for the computer savy—we have a generation of geriatric patients to get through first….… A New York Times guest essay by Daniela Lamas poses a common question in our specialized world: as a hospitalist, she confronts the wife of a man who was dying. The question of whether he should be intubated was the point of the discussion. The medical team made the argument that intubating the terminal patient would prolong his suffering but not extend his life meaningfully. They suggested supportive care with no intubation. The wife asks, “Why should I believe you….I don’t think that I do!” The doctor’s essay finds her asking, “Why should she believe me?” She was a young doctor, in greens and tennis shoes and had no knowledge of the wife, the patient, or their history. Her article goes on to review the issue of medical systems no longer trusted.
Medical systems can betray us; stories abound. The relationship issue is the key to resolving that as far as it can be resolved. For example, when I no longer did hospital work, I would still do “social rounds” ( I could not bill for this service) on seriously ill patients in the hospital ie I showed up and weighed in with how they were doing and made helpful suggestions to the hospitalist when appropriate. As my workload increased, my satisfaction for the time given for this decreased and with time, I stopped except for end of life situations—as the wife above faced. To support a family in crisis I had known for years in the hospital I no longer worked at was priceless to all parties—I was helpful in that setting in a way the hospitalist could not—unless they were blessed with that ability to actively listen, ask the questions, and be patient. Not all of them have that.
Lastly, a system of medical care can work against its internal parts. To get a job at Group Health in Olympia when I was hired, one had to provide Obstetrical services and be on a call schedule for deliveries. It was why I chose to work there. Group Health was consumer owned—and within years, consumers where pressing firmly for a midwife service working in the Obstetric Department. Many of the Family Doctors, mostly men, objected loudly. It was clear that female midwives would attract many of our patients away from us. The consumers rightfully got their way despite this resistance and sure enough, other than those family doctors who were women, the patients voted with their feet. Doing deliveries became less of a part of the job and more like a hobby—which from a system point of view, is a problem. You want you doctor to know the job and not dabble at it. The system worked however; the consumers were heard and the service improved their birthing experiences, I am sure.
What was inconceivable as a young doctor, having opportunities denied to me by the wishes of those I served turned out to be a growth experience but did required, patience. The beauty of a primary care practice lives in the relationships and there has always been more than enough to go around in a lifetime.
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