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The measurement of Client Experience

Karana Nursing Home
Hedley Sutton Nursing Home
Karingal Nursing Home
Baptcare Northern Metropolitan Home Care Packages

Residential and Home Care – Metropolitan/Regional, 80 + beds

Award descriptors:
Leadership and culture, Communication and engagement, Technology

About the program
In aged care we have historically engaged our clients by proxy, through asking their families if they are satisfied. Through the exploration of innovative approaches to engage our clients to ask what truly matters, and the development of  new ways to test and measure their experience, we have commenced a journey to improve and design services that will not only meet their needs, but exceed expectations.

What we did
With Client Experience an essential component of the organisation’s strategic direction and the Net Promoter Score chosen as the high level key performance indicator for how our clients experience our services, our move from satisfaction surveys was seen as paramount to success.

The Net Promoter Score is a strong indicator of loyalty and growth, and measures the willingness to promote our organisation. Evidence suggests that the reason this is such a strong indicator is that when a customer recommends an organisation, they are placing their own reputation on the line. The use of the Net Promoter Score in healthcare has highlighted that although clinical reputation is important, the emotional experience is a key element in the willingness to recommend; with our clients’ narrative throughout our project further evidence of this. Companies with world class loyalty have a Net Promoter Score of 75-80%

We knew that to improve the Net Promoter Score we would need to identify what the key drivers of the score were for each of our client groups. We believed that to do this we would need to seek what truly mattered to our clients and thus  completed a deep dive of our clients across the organisation. This deep dive collected narrative from our clients and occurred through a number of mechanisms:
1.       Leadership  conversations: Baptcare leaders engaged in  phone conversations with clients, gaining real time insight into how our clients and carers experience our services, and displaying organisational leadership and commitment to improving client experience. 

2.       Client Discussion Groups:  In collaboration with Lifestyle teams a number of discussion groups with residential service clients were completed, these included such topics as “What is dignity?”

3.       Experience story telling:  Clients across all service types were visited on a 1:1 basis collecting the narrative of their experiences and seeking answers to questions to gather data on how our services make clients feel and what truly mattered. These included questions such as “What do you want to feel like when staff leave your room?” 

We then explored robust mechanisms to use the themes of our clients’ narrative to develop an alternative to the satisfaction surveys which could be collected and collated in real time. A lean data approach was chosen as the mechanism to develop questions sets. Using the application of lean experimentation principles this approach has three main advantages. It had a customer first mindset with a shift toward creating what clients value, the use of technology as a collection method and the ability to collect feedback at multiple and continuous stages that could inform improvements and service design. Through the use of this approach we were able to frame an impact hypothesis of what we believed were the key drivers to the Net Promoter Score, and four questions to measure this using our chosen technology. The technology chosen was electronic handheld devices, known as Client Experience Trackers with five questions that measured our impact hypotheses and the Net Promoter Score.

Why we did it
The measurement of client satisfaction in health care has traditionally been undertaken by satisfaction surveys. Most surveys offer standardised questionnaires for aged care clients and families, with the benefit of benchmarking results across the industry.

As the organisation moved toward a customer experience model, the quality team explored the opportunities that might exist beyond the client experience surveys. This included an analysis of both the advantages and disadvantages of the traditional satisfaction survey format.

Current research is now revealing that clients may well be satisfied with the outcome of a service or care, even though they received an indifferent or poor service. Satisfaction is often equated with gratitude for care or services, rather than a description of an experience during care or services.

Measurement of customer experience will deliver both qualitative and quantitative data, including the customers’ experience in narrative form, which can give insights into customers’ experience about how the care and services impact individuals and groups. This experience of service is made up of the emotions is evokes, the sense it stimulates, and the actual events measured against the client’s original expectation of the experience.

Who worked with us
Along with our clients and their families we collaborated with CFS-Australasia who supported the organisation through the use of Client Experience Tracker Solution and as Net Promoter Score Certified Associates through the use of the Net Promoter Score.

What we learned
Through the various methods we used to deep dive what truly matters to clients, we identified that across our various service types there was indeed common themes. 

These themes were then used to in the lean data approach to develop an impact hypotheses for our Home Care Packages. This hypothesis was "that  flexibility, reliability, staff expertise and overall experience (made up of the relationships with our staff and the ability to engage with a community) are important to our home care packaged clients." Following the development of a lean data survey which included four questions related to our hypothesis and the Net Promoter question we surveyed 197 Home Care clients via the Client Experience Trackers.

On analysis of the results, we realised that achieving a Net Promoter Score of over 75% was not going to be easy, and thus we felt it was; as expected a measure that would truly drive service improvement. As outlined in Table 1 our overall Net Promoter Score was 49%, amongst our services the highest being 80% and the lowest being 0%. We identified that to have any real impact on the Net Promoter Score services did not have to score well in one areas but had to have
a score of over 90% in flexibility, reliability, staff expertise and overall experience. It was interesting to us that this was achieved by our regional surveys and we believe that his is due to the size of the services and the ability to form close relationships in these settings. With the link between the four aspects of service and the Net Promoter Score we believe that we have identified aspects of service that truly matter and have now commenced the development of the next layer. 

Through another deep dive we are identifying what truly matters in relation to flexibility, reliability and staff expertise and will explore these and our belief that overall experience is impacted by relationships with our staff and engagement with community through further development of impact hypothesis and lean data surveys.

With the use of the Client Experience Trackers we now have the ability to quickly collect and use real time data to drive service improvement which will exceed our clients’ expectations. Our goal is to engage with our clients to develop a suite of survey tools which will cascade from the Net Promoter Score for each service type and reflect what truly matters rather than what makes our clients families satisfied.

More information on this program: 
Michael Wilson, or phone (03) 9831 7319.


Thursday, 10 January 2019 - 1:23pm