Voice Of the Customer (VOC)

  • Voice Of the Customer (VOC) – Sent my way by e-Patient Dave. So now I'm curious – can we set up VOC customer programs in health care? The first step is to define the customer as the patient – not every place I have been believes in this basic idea (basic to me anyway). I'm going to avoid creating a new term and stick with a term that's already accepted in industry. I have a tag on this blog called “Voice of the Patient”. Should I just use “Voice of the Customer” instead?


But isn't that arguably the fundamental market problem with American Health Care, that the patient isn't the customer — the insurance provider is? As such, it is really difficult to create an effective feedback loop, since the financial incentives are all skewed against satisfying the _consumer_?

Our buddy Gilles Frydman cautions us against using the term "consumer," and I've come to agree. It connotes a position of relative powerlessness: "Others have the power to create, and they offer us what they want to; we consumers select from what they offer us."

That seriously misses the reality that patients today often bring genuine value into the care event: they don't just consume, they literally produce. And that's quite unlike what a consumer does in the ordinary retail sense.

But to me, "customer" doesn't have those subtly risky connotations. And if we're interested in adoption by organizational leaders, there's practical value in taking on an established term that's relevant and has proven value as an effective method of change.

It would be good to find a Six Sigma black belt, who might be better qualified to assess the question rigorously.

Dr. Ernie,

> patient isn't the customer – the insurance provider is?

Yes. Paul Levy at Boston's Beth Israel Deaconess has target="_blank">written

The problem with the health care "marketplace" is that it is not a real market. There are so many intermediaries that the usual connection between buyer and seller that we see in other fields does not exist. Thus, the incentives for suppliers (doctors and hospitals) to engage in efficiency improvements and value enhancement are extremely slow to emerge.

Otoh, the question arises, who's the US insurer's customer? Largely, it's the employers, and increasingly they're speaking out – see slide 2 here: "This is a 'game over' scenario."

Hi Dave,

I'm all for a more direct engagement with patients than as passive 'consumers'. However, "customer" has a well-defined meaning — the person who _pays_ for the service. Right now, that's the insurance company, not the patient.

Perhaps "clients" would be a better term, since it connotes the idea that they are the ones who 'hire' the doctors to help them achieve a goal.

Or maybe we should just go back to "patients" — or would that imply they're already sick?

— Ernie P.

Gentlepersons, great comments –

From my experience, I think the way you use a term is as important as the term is. In other words, I have spent less time on which word (having come from a consumer-governed health system, created during a time when such a thing was not fashionable to say the least). When I went to visit our neighbors to the north, in beautiful Canada, they took the work that I and others were doing and changed their Information Technology plan to refer to "the people we serve." What matters is that people feel respected – many a customer, patient, person have not felt that way even when the right words were used.

With regard to who the customer is, I'd suggest in today's American system, the physician is who is marketed to (and here you can see the data, that they spend 83 cents of every healthcare dollar today.) and a lot of resource is spent ensuring that they spend it a certain way. Ironically, despite all the resource used promoting their spending of the 83 cents on things that are done to people, there isn't as much resource spent in allowing them to be there for the people they serve.

In terms of the feedback loop, ultimately, the people do pay, in terms of their tax dollars, and in the cost of the goods and services they buy from employers. Making that connection is at the heart of the most successful improvement efforts, for example, LEAN and the Toyota Management System.

Would you entertain taking a look at the presentation I made at Partners Healthcare Recently? It capped almost a year's journey to discover for myself what was real here, and whether what I had done in an integrated system was possible elsewhere (hint, it is).

Guess what I found out – people want to get care from systems who treat them as customers, people want to work at care systems who treat the patient as the customer, and as a result, those health systems do better financially and with better outcomes. As it is said in the LEAN world, when you see the impact of what you do for people, it changes your behavoir.

Personal health technology creates that feedback loop in many cases, where it didn't exist before.

See what you think,


> Would you entertain taking a look at the presentation…

Okay, here I am, cross-posting my comment that I just put on that post. 🙂 But here I'll sum it up:

This is so "e" that I'm about jumping out of my skin. If you can't show those slides anymore, how can I get Group Health to show them?

Here's a VOC for ya: Your rendering of the slides in whatever format that was, was unreadably small for me! I HATE whatever this geek technology is that's dimming my screen on so many sites, then displaying its schtuff in a fixed amount of space, with no concern at all for my having a high-res tiny-pixel display (or a huge monitor at work)! I couldn't read a bunch of those slides!

And I want to see the videos.

Seriously, people, these are really really good slides. Amazing things are happening. I want to be vigorously engaged in this, and Dateline or somebody ought to do a show about it.


Holy crap. You just post so much juicy stuff that it takes me two months and a reminder to see it.

Here are things that caught me – misc. notes.

—"I prefer to see facts at the level of the patient" – yes, please do; it's too rare in your business.

—Man I love that "Health 2.0" definition. I know I was involved in writing it, but I forget things easily, so sometimes I get re-inspired. That's when I know we done good.

—Huzzah about fragmented care. When that happens to me it's so STUPID! And Huzzah to the hospitals who've shortened shift change and reduced errors by having shift change at the patient's bedside! (AND at the same time have unfragmented the care.)

—Superb point about the power of the parental bond – "wasteful to ignore this energy, foolish to encumber it." It's an issue that's hinted at in the e-patient white paper, but not addressed directly.

—Image 7: I gotta get that Deloitte graphic on mismatch between "want" and "have." Where is it??

—I want to see those videos.

—These graphics are too small on my 1680×1050 display.

—Slide 16: I want to know about that book Silo Busting. The graphic is compelling.

—I want to see the slide 17 video too!

—And all the things you can do about it are spot on.


Okay, I'm supposed to go to bed now.

Ted Eytan, MD