Improved Customer Satisfaction Through Enhanced Feedback Capabilities

State: FL Type: Model Practice Year: 2013

Okaloosa County is located in Northwest Florida with a population of 181,000. We value customer feedback and strive to provide citizens and clients with an easy and accessible way in which to provide feedback to us. We have a demonstrated culture of continuous quality improvement, with measuring customer satisfaction being a priority. We want to increase opportunities for customers and citizens to provide feedback to us regarding services they received or desire to receive, to expand opportunities clients have to provide feedback, to increase ways in which clients can provide feedback, and to respond to complaints in a timely manner. We developed a system that allows feedback to be provided verbally, in writing, by telephone or through our website. An additional component is that each month all health department services are evaluated in the same week. Feedback received is responded to in a timely manner by the appropriate staff and complaints are resolved quickly. An unanticipated outcome of the customer satisfaction process is that the majority of comments we receive are compliments and supervisors have been able to use these compliments to nominate employees for Employees of the Quarter awards allowing us to highlight examples of quality customer service to all employees and reflect these positive behaviors on employee evaluations. A key component of the recently developed Voluntary Public Health Accreditation process is Continuous Quality Improvement. As Local County Health Departments move forward with the process of meeting Accreditation standards it is essential that they be able to demonstrate their ability to collect and act upon customer satisfaction data. The policy and system we developed is easily adaptable by most Local County Health Departments with minimal cost. The potential impact of having a cohesive way by which to gauge customer satisfaction and staff performance is the ability to assess where you currently have strengths and weaknesses and to be able to use the data to make improvements that result in higher customer satisfaction as well as the ability to meet PHAB standards and measures. The OCHD developed and implemented our current Customer Satisfaction policy and Quality Improvement Tracking System (QuITS) in 2009. Changes to the Customer Satisfaction policy and survey were made in July of 2011 to comply with new requirements of the Florida Department of Health. The major activities involved in the process were to write a policy that described how the organization tracks and responds to customer comments, to develop a database to track these comments, and to collect and respond to customer feedback in a timely and consistent manner. Major activities included developing the database, writing the policy, creating a form and a web-based system to collect feedback, and purchasing a license for the survey software. We were able to create and implement the system in 9 months. Outcomes included an enhanced ability to ensure that customer comments are responded to efficiently and effectively. We are able to track how complaints are responded to, by whom, how quickly, and how the issues are resolved. Staff has used the data to improve clinic flow, reduce waiting time, and improve efficiency of how clients are served. Supervisors receive comments about staff behavior from clients. This allows them to either take corrective action and provide additional staff training, or to reward and recognize positive behaviors. This positive feedback increases staff satisfaction by publicly recognizing their accomplishments. We have in-house Information Technology support and were able to develop an Access database we call QuITS. Staff worked on policy development and created the database during regular work hours. No overtime costs were accrued. Additional costs of customer satisfaction tracking are annual printing costs of client comment cards and customer satisfaction surveys in English and Spanish, and purchase of a license for a commercial on-line survey company that allows us to enter comments from comment cards into a database and quickly analyze survey responses. These costs are approximately $800 per year. The commercial survey company service eliminates the need for a staff person to manually tally responses and create graphs or charts to display the results. Since we collect thousands of responses a year, staff costs are off-set by the cost of the license fee. We met our objectives to enhance opportunities to collect feedback and to improve customer satisfaction. Factors that led to success were an already existing culture of quality improvement, leadership support for the process, staff training, and the ability of staff to create and implement the system in-house with minimal additional costs to the organization.
ResponsivenessThe public health issue that this practice addressesThe public health issues this practice addresses are twofold. First is the issue of increasing the probability of receiving and responding to customer satisfaction feedback in an effective and readily accessible way. Second is to increase the organization's ability to successfully meet PHAB standards and measures relating to quality improvement.Process used to determine the relevancy of the public health issue to the communityMultiple studies identify customer satisfaction as a key component of quality improvement. The Florida Department of Health requires local agencies to have a quality improvement system in place and to collect customer satisfaction data. Our previous system of doing this was limited to manual comment cards and verbal feedback. We did not track the comments or have a cohesive way to report on comments, respond to comments, or use the feedback for quality improvement.How the practice addresses the issueWe are now able to collect customer feedback from multiple sources, analyze the comments and suggestions, and respond to them in a timely manner. The ability to enter comments into an electronic database ensures that comments and complaints are appropriately routed to staff for follow up. We can readily track how the issue was resolved, by whom, and how effectively. The ability to track complaints ensures that client's issues are resolved in a timely manner, which is very important to the customer. We improve our public image as a caring and responsive organization. We receive many positive comments about how responsive we are to customer complaints. Staff finds the system easy to implement and there has been little to no resistance to collecting customer feedback. Innovation Evidence based strategies used in developing this practiceWe used tools from NACCHO's Toolbox "Customer Satisfaction Guide Tools and Templates" and the Public Health Foundation "Turning Point Performance Guide" and "Memory Jogger" to assist in the development of the strategies and policy we developed.The practice is a creative use of an existing tool or practiceProcess used to determine that the practice is a creative use of an existing tool or practiceA literature review and search of the internet showed that many Local County Health Departments have customer satisfaction systems.  We were unable to find any system as comprehensive and multi-modal as the one we have.  The NACCHO Tool Box only has one customer satisfaction tool developed by Genessee County , TN.  We developed our customer feedback system prior to this tool being posted.What tool or practice (e.g., APC development tool, The Guide to Community Preventive Services, HP 2020, MAPP, PACE EH, etc.); did you use in a creative way to create your practice?  (if applicable) (300 word limit total) Tool or practice used in a creative wayThe practice we developed was based on results from our assessment of our CHD as a beta test site when the National Voluntary Accreditation tool was being developed.  We did not have a comprehensive way to collect or analyze customer feedback.  We developed a system that allows us to capture feedback 24 hours a day, 7 days a week with a web page link.  We complete a traditional paper and pencil survey form once a month.  We have a client comment form available at all times when our buildings are open.  We have a written policy that informs staff how to accept a telephone or verbal complaint, a written complaint, or an electronic complaint or comment.  We can accept comments from vendors, community stakeholders, and clients.  We can also accept feedback from anyone in the community who is attempting to access services.  On our web link we have had people from out of state who were anticipating visiting our county ask questions about the BP oil spill and red tide.  We have gotten compliments from visitors about our beach water monitoring signs.  We have had people ask how they can volunteer at the Health Department.  We have also had questions about issues that we do not deal with but were able to refer the person to the correct agency or organization.  How the practice differs from other approaches used to address this issueThe practice we developed and implemented is different from other approaches because we use multiple methods of collecting customer feedback and use electronic databases to analyze results. Collecting customer feedback is identified in multiple public health practice tools and guidance but there is no description of the comprehensive program that we implemented.
Local Health Department and Community Collaboration Primary StakeholdersThe primary stakeholders in the practice are the Steering Committee of the Okaloosa County Health Department comprised of key leadership, supervisors and program managers. Our staff is also stakeholders because they have a vested interest in improving customer satisfaction and working on quality improvement processes related to customer feedback.LHD RoleThe LHD is the lead in this practice that relates directly to our performance as an organization.Partners/stakeholdersThe development of this practice is a result of our participation as a NACCHO beta-test site related to Public Health Accreditation. Our self-assessment showed deficits related to PHAB Standard 9.1.4 A Implement a systematic process for assessing customer satisfaction with health department services. We created a QI workgroup that looked at root causes for failing to meet the standard and then used brainstorming and multi-voting to devise a strategy that allowed us to meet the standard. Implementation Strategy Tasks taken to achieve each goalGoal 1: Develop processes and tools to collect customer feedback to include verbal feedback, written feedback, and electronic feedback. Action Steps to achieve goal 1 were: 1.1 Identify a work group to write policy and create tools. 1.2 Review current policy, look at best practices and draft a policy. 1.3 CHD Director and leadership review policy and submit recommendations for change. 1.4 Policy workgroup revise policy and submit for final approval. 1.5 Approve policy and train staff. 1.6 Identify data to collect for client comment cards. 1.7 Identify data to collect for electronic database. 1.8 CHD Director and leadership review draft comment cards and data elements. 1.9 Get quotes and have comment cards printed, install comment card boxes. 1.10 IT: Create database (QuITS). 1.11 Use QuITS in "test mode" and make needed changes. 1.12 Develop web link to allow the public to provide confidential web-based feedback to the OCHD. 1.13 Activate the web link. 1.14 Implement Customer Satisfaction System. 1.15 Monitor feedback. Goal 2: Collect and analyze customer feedback in a timely manner. Action Steps to achieve goal 2 were: 2.1 Implement customer satisfaction policy that identifies how data is collected, by whom, when it is collected and how results are shared. 2.2 Analyze and share feedback based on policy. Goal 3: Use customer feedback to implement quality improvement processes to improve customer satisfaction, reduce barriers to service and identify best practices used by staff to enhance customer satisfaction. Action Steps to achieve goal 3 were: 3.1 Review data from customer feedback 3.2 Identify QI workgroup 3.3 Use QI tools and Plan-Do-Check-Act/ Rapid Cycle Improvement to respond to complaint or institutionalize processes identified as having enhanced customer satisfaction 3.4 Use data to recognize and reward staffTime frameWe wrote the policy, created the database, trained staff and implemented the first part of the system (policy and capability for on-line comments) in six months. The customer satisfaction surveys were delayed because of a change in Florida Department of Health requirements that each CHD collect the same customer satisfaction data. It took an additional 6 months to create the customer satisfaction form, train staff and implement this additional part of the client comment system. Once we were given guidance on the required questions for the survey it was approximately 6 weeks before we implemented the new forms.Outline of steps taken Basic steps taken to implement our policy, create tools and train staff were:  Identify the problem  Brainstorm root causes  Create a work group  Determine solutions  Develop tools and write policy  Print forms  Develop database  Train staff Implement policy  Monitor and report (on-going process)  Make needed changes to the system (on-going process)  Use data for continuous quality improvement (on-going) Lessons LearnedIt took longer than anticipated to gain consensus and develop the policy and tools. Multiple changes were needed once the policy was implemented to collect the data we actually needed-database and policy were both changed several times to make them clear and user friendly. It takes continual reminders to staff to ensure the surveys are completed. Staff needs to be reminded to ensure comment cards are available at both sites and to check the comment card boxes daily so that we can achieve our goal of contacting clients who have complaints within one work day of the complaint being received.Costs of implementationCosts of implementation were approximately $800 Printing customer satisfaction surveys $400 Printing client comment forms $200 License for survey software $200 These costs are annual and expected to be accrued each year.
Objective 1:Develop processes and tools to collect customer feedback to include verbal feedback, written feedback, and electronic feedback. Performance measures used to assess this objective was the outcome measure of whether the tools and processes were developed. The tools and processes were developed and implemented as planned. No data were collected related to this objective. The OCHD successfully achieved this objective and implemented the customer satisfaction policy. Objective 2:We have an ongoing customer satisfaction process in place. Performance measures used to evaluate the practice include:Monthly customer satisfaction survey~1. Number of client comments received by site and program area.2. Number and percent of comments related to five key components of customer satisfaction (accessibility, clarity of information obtained, staff courtesy, staff knowledge, staff helpfulness and timeliness of service) as well as an overall satisfaction score. Verbal, web-based and paper customer comments~1. Percent of comments by type 2. Timeliness of response to customer complaints3. Staff is assigned to follow up on complaints4. Resolution of the complaintWe use all forms of customer feedback to develop policy or procedure change as part of continuous quality improvement. Data sources for the evaluation include:1. Analysis of client comment cards by Survey Monkey. Client comment cards are given to all clients receiving services at the OCHD during the week beginning the second Monday of each month (12 times a year). Completed surveys are placed in highly visible client survey card boxes and retrieved by assigned staff. 2. Analysis of data from the Access database (QuITS). Client comment cards are available at both CHD sites at all times. The comment card boxes are checked daily by assigned staff and delivered to the Community Health Section Chief who enters the comments into QuITS and routes the comments to the appropriate staff. Reports are generated to identify the number of client comments received, percent of comments received by type of comment (access to services, timeliness of services, quality of services, personnel behavior, other) and the timeliness of response to customer complaints. Reports are generated by the Community Health Section Chief for review by the Steering Committee. Objective 3:Use customer feedback to implement quality improvement processes to improve customer satisfaction, reduce barriers to service and identify best practices used by staff to enhance customer satisfaction. We use program outcomes to assess this objective. The following process changes resulted from customer satisfaction surveys and client comments: Use customer feedback to implement quality improvement processes to improve customer satisfaction, reduce barriers to service and identify best practices used by staff to enhance customer satisfaction. We use program outcomes to assess this objective. The following process changes resulted from customer satisfaction surveys and client comments: We established an electronic numbering system in clinics to expedite in-processing in the order in which the client arrived in the clinic. We purchased a new phone system with enhanced capabilities based on complaints about accessing appointment lines. We deleted our WIC Program appointment system and went to walk-in services only. This decision was based on client comments about waiting times and on staff feedback about the amount of time they spent making appointments, rescheduling appointments, and making calls to remind clients about their appointments. Our Environmental Health Branch implemented a plan to scan all construction, site evaluation and floor plans for facilities we regulate. These documents are in a searchable database and are accessible to the facilities as well as our staff. The ability to access these plans electronically cuts down on space required for storing the plans, on staff time to file plans and retrieve plans, and allows clients access to their information without having to drive to the Health Department to retrieve it.
Stakeholder CommitmentStaff is committed to improving and enhancing customer satisfaction as part of our QI culture. The commitment is ensured by on-going support from leadership, sharing positive customer comments with staff, reinforcing staff through recognition of their efforts as Employees of the Quarter, and incorporating customer satisfaction in our QI activities.SustainabilityThis practice has been on-going for over 2 years. The plan is to continue to evaluate how we assess customer satisfaction, to review the written policy annually to make needed changes and to sustain the practice by ensuring the policy is fully implemented. Our current staff resources and the minimal cost involved with keeping up computer licenses and printing comment cards are well within current and projected future resources.