Customer Satisfaction and Needs Assessment Market Studies Medical Supplies, Devices, and Services Steven J.

Fuller InforMedix Marketing Research, Inc. A. Who Needs to Measure Customer Satisfaction? Since the early 1980s, everyone in the medical industries has known how the challenge of cost reduction has revolutionized hospitals and alternate-site providers. What is new is the speed with which medical suppliers are forced to redesign products and services to meet customer requirements, as providers struggle to boost efficiency and while ensuring their quality of service. How can a manufacturer or service provider continue to meet the changing requirements and preferences of this complex customer base? By regularly measuring customer satisfaction and assessing needs using formalized market research. This article explains six key steps for designing and conducting a customer satisfaction investigation. It includes examples of survey questions and discussion topics, taken from actual surveys performed by InforMedix Marketing Research. The term Customer Satisfaction Study covers a broad range of methods for measuring performance and finding ways to provide a better product, service, or delivery method. During the past few years, InforMedix Marketing Research has carried out studies with each of the following basic goals: To support continuous quality improvement programs with consistent and periodic measurements To monitor the level of customer satisfaction to look for early signs of change. To find product and service improvements to help medical professionals perform their jobs better. To measure sales force and distributor performance. To find opportunities for improving in-house customer support. To identify special customer groups which need enhanced or alternative types of products or services.

The most basic customer satisfaction investigation is simply a formalized scan of the customer base to see how well a supplier is doing. Asking a large number of customers how they feel

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about products and services can give the vendor a wealth of information for planning new marketing strategies. More comprehensive customer satisfaction studies can be developed which ... show how to attract unserved customer groups, clarify the problems in weaker sales territories, show strengths and weaknesses in home-office support, and explain why a competitor is gaining ground with important customers.

These broader investigations are often termed needs assessment studies, because they not only measure satisfaction (or lack of satisfaction) they also offer clear direction as to what should be done to improve a companys relationship with its customers. Since 1991, InforMedix has designed and conducted many types of customer satisfaction and needs assessment studies, each specifically planned to provide a manufacturer or service provider with information needed to meet specific broad objectives. B. How Do I Measure Customer Satisfaction? Customer satisfaction and needs assessment studies can be simple or complex, as stated above. But six important steps seem to be necessary for practically all of these investigations passing over one or another can result in incomplete information, and leave the manufacturer with too many questions about exactly what to do, in order to effectively increase sales, market share, margins, and loyalty. The six basic steps are these: 1. 2. 3. 4. 5. 6. List the customer groups you are concerned about Specify which decision-makers are most important Define the criteria you want to measure Measure customer satisfaction Report results in total and for customer subsets Take corrective action, conduct follow-up surveys

Different studies may concentrate on or de-emphasize any of these six steps, according to the immediate goals of the investigation, but planning any study should include attention to each of these areas. To help with setting up your customer satisfaction or needs assessment investigation, suggestions for carrying out each of the six basic steps are presented in the next few pages. 1. List Customer Groups You Are Concerned About Most medical manufacturers and service providers must market their products to a variety of customers and users besides hospitals and other patient-care facilities, they also sell directly or indirectly to patients, salespersons, distributors, and regulatory organizations. When a company wants to improve its performance in customer satisfaction, it is worth considering all these customer groups as targets of creative market research. Some customer groups are more likely to respond to changes in service, marketing tactics, and communications than others; some types of customers are simply easier to reach with new messages, services, and support. A key factor in deciding on which customer groups to survey,

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then, is the issue of determining where new marketing tactics will have the most effect. Most often this leads to a satisfaction study among the principle facilities buying and using a product (such as hospitals, outpatient facilities, independent labs or imaging centers, etc.), but measuring satisfaction within a sales force or among patients is not uncommon. Even when a general customer group is targeted, decisions must be made as to the priority of segments within that group. To get the most information with a limited budget, or to solve a specific marketing problem, one might limit a customer satisfaction investigation to market segments such as: hospitals, surgery centers, homecare facilities, physicians offices, etc. higher-volume customers those whose sales are declining new customers, or only those who have made a recent purchase

By focusing an investigation in this way, it is easier to be sure that a significant sample of the customer group has been surveyed, since one can usually list or clearly define a targeted market segment. Also, it is easier to draw concrete conclusions when the survey respondents comprise one or two identifiable groups (rather than a random mixture of customer types). 2. Specify Which Decision-Makers Are Most Important Exactly whose satisfaction do we really want to improve? Within a healthcare system, there are many types of professionals who have some influence on the decision to purchase a product or service, and it is important to decide who should be responding to the customer satisfaction questions we are asking. This section provides lists of typical customers, decision-makers, and decision-influencers, whose opinions matter in a purchasing decision. This is a good starting point for identifying the proper respondents. Better and longer lists can be made by talking to salespersons, experienced marketing managers, and customers themselves. Most medical products and services are specified by clinicians who select and use them in their jobs; these individuals are the most common targets of customer satisfaction studies. Titles vary, of course, from one facility to another, and from department to department, but a short list of the most common respondents for these investigations is... Clinicians: Physicians Nurses Technicians Medical Assistants Residents, Trainees Departmental Directors, Managers, Supervisors

Beyond those who user a product, there are often several key decision-makers and influencers in Purchasing and Administration who can limit the list of potential vendors, before clinicians begin the selection process. Cost reduction efforts are usually driven by administration and purchasing, and so the requirements of these individuals are very important for customer satisfaction. Some titles and positions are listed here; each has been the respondent in customer satisfaction studies.

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Buyers and Decision-Influencers: Central Purchasing Departmental Purchasing Managers (Pharmacy, Surgery, Nursing Units, Radiology, ER, Laboratory, etc.) Administration: Hospital Administrators Financial Managers, CFOs Healthcare Network Administrators Group Purchasing Organization Managers For technical products and devices, service and repair may be a key factor in product selection. Therefore, individuals involved in product service are sometimes contacted as part of customer satisfaction studies. A brief list of likely respondents is shown here. Product Service: Biomedical Engineering On-site service and maintenance organizations Third-party service companies The manufacturers own product service department Salespersons and distributors are less often the subjects of customer satisfaction studies than clinicians, but most marketing departments do view their distribution network as a customer. Providing products and services that meet the needs of these individuals can be just as important as satisfying the users themselves. (Certainly, a failure to meet requirements set by the distribution chain can have a very rapid and serious effect on sales and shipping volume.) To completely address customer satisfaction, a manufacturer or service provider should consider whether anyone in the list below qualifies as their customer. Sales and Distribution: Salespersons Sales Managers Distributors Shipping, receiving, and warehouse personnel Anyone involved in disposal or recycling Finally, there are the patients and related care-givers who also must be considered as customers, even though for many medical supplies they are rarely involved directly in the purchase decision. For products which are used in the home, at bedside, or by the patients themselves, the need for monitoring patient satisfaction is most obvious. In other medical markets, it may still benefit the supplier to find out how patients, as ultimate end-users, are affected by product design, usage regimens, and particular features. This group is listed briefly here. End-Users: Patients Families of patients Prospective patients Former patients No customer satisfaction study can cover every possible type of decision-maker and influencer in the industry, but the lists in this section can be used to ensure that no important customer type is left out when developing a study. You can also use market research to learn who should be included in the list of relevant decisionmakers and product users. Whether this is done as part of the customer satisfaction survey
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(using survey questions to network through to new respondents) or as a separate pre-survey investigation, it is often a good idea to let the customers themselves be the judges of who really matters in assuring customer satisfaction. Here are some discussion questions that can help in designing a customer satisfaction study:
What is your role in selecting the vendor of these products? Who else participates in the selection process? Describe the discussions that occurred, and all of the people involved, in a recent move from one vendor to another If you yourself prefer to buy and use a particular brand, is there any reason that your facility might force a change to another vendor? Who (or what department) could cause this to happen? Does everyone here like the product as much as you do? Do you know of anyone at your site who would rather use a different brand or product?

Using these questions in a few preliminary in-depth interviews, you can quickly decide which respondents should be included, and which can be excluded, in planning the investigation. 3. Define the Criteria You Want to Measure It is not enough to simply ask customers whether or not they are satisfied. Usually, individuals answering a questionnaire cannot think of every aspect of service, product usage, etc. that the vendor needs to know about. Specific questions, covering all the areas of interest, should be constructed so that the whole range of important topics is fully addressed in the survey. A crucial part of defining which criteria should be measured is the identification of the aspects of customer service that make a difference to the customers themselves. Some surveys fall short of their goals because the manufacturer believes that they already know what factors should be measured and corrected, when in fact customers may have different ideas about what constitutes good quality service. Therefore, it is a good idea to begin with a few questions aimed at determining what really makes a difference to the customers themselves. Here are some examples, based on ones from actual surveys.
Im going to read a list of seven factors which may be important to you in selecting a vendor. Please rank them from one to seven, in terms of how important they are to you in determining your choice. Ranking _____ Quality of contacts with salespersons _____ Innovative product design _____ Ease of using products _____ Easy access to good technical support _____ Twenty-four hour availability of customer support at the home office _____ Quality of training provided by the manufacturer _____ Customized delivery schedules or assistance in stocking

If you were to list the characteristics of good customer service in this industry, what would be the top three things that come to mind?

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Sometimes, an entirely new research investigation should be constructed, and carried out before the customer satisfaction or image study is started. The goal must be to create a prioritized list of the factors that customers believe are most important, in determining their level of satisfaction. This may require using a qualitative technique such as focus groups or in-depth interviews, giving customers the opportunity to describe their own experience with vendors in the industry, and clarifying which aspects of this experience have been influential in forming their opinions. A few useful questions for these discussions are listed here.
Which manufacturer in this industry stands out as providing the best support for their customers? What has that company done to make you feel so positive about them? If the products from two vendors seem about the same, and pricing is equal, what could cause you to choose one rather than another as your supplier? Can you think of any situations that could cause you to change from your current vendor to another company, knowing that you might pay a bit more after the change?

4. Measure Customer Satisfaction Measuring customer satisfaction in medical markets is usually accomplished with quantitative telephone surveys; the advantage of using the telephone is that respondents can be selected by the interviewer. Mail and fax surveys may be less expensive in many ways, but the results can be biased if a group of customers fails to respond because they are very satisfied, because they are very dissatisfied, or because they have no strong opinions to express. To avoid these risks, a technique such as telephone interviewing is a good choice. A decision has to be made about whether to reveal the source of the survey to respondents. In most other types of market research, it is considered poor practice to alert respondents to the identity of the company funding the research. With customer satisfaction studies, though, this is sometimes unavoidable, because the goal is primarily to assess the activities of a single vendor. If the manufacturers products are very important to the respondents, or if there is only one supplier of a narrowly-defined product category, then customers usually seem willing to spend a few minutes in a frank discussion of the companys products and services. Incentives are usually not required, because the survey can be introduced as an effort to provide better service, lower prices, or other benefits to the customers themselves. For some customer satisfaction surveys, it is useful to evaluate all major vendors in the industry or a list of competitive products. In these cases, one need not reveal the name of the company funding the survey, because a valuable data point can be gained by discussing any of the competitors which are known to the respondent. Start-up questions like the ones suggested here will help focus the survey, and allow the respondent to choose which product they can best evaluate. (In this example, the survey was fairly short, and allowed time for evaluation of two vendors.)

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3. Which companies provide most of the products that you use in this category? [record all mentions] [ ]1 Competitor A [ ]5 Competitor E [ ]2 Competitor B [ ]6 Competitor F [ ]3 Competitor C [ ]7 Competitor G [ ]4 Competitor D [ ]X other : ______________ 4. Which two would you consider to be your primary suppliers? [record maximum of two] [ ]1 Competitor A [ ]5 Competitor E [ ]2 Competitor B [ ]6 Competitor F [ ]3 Competitor C [ ]7 Competitor G [ ]4 Competitor D [ ]X other : ______________ You said that [vendor #1] provides these products to your hospital. I would like to focus on just that one company for a minute, and ask for your evaluation of [vendor #1] with a few specific questions...

After these preliminaries, it is helpful to move ahead with some general questions, to let respondents become comfortable with evaluating the company being discussed. Here are a few examples of useful start-up questions.
5. How long has [this company] been providing these products to your group practice? ______ years 6. Overall, how would you rate this company on their support of your needs as a healthcare provider? [read list] 1 excellent 2 very good 3 good 4 poor 7. Has the quality of the companys products increased, decreased, or stayed about the same over the past year? 1 increased 2 decreased 3 remained the same

With these background questions, the interviewer provides more classification data and also sets the stage for moving into more detailed assessments of satisfaction. Satisfaction survey results are most useful if they contain averages based on numerical scales, such as 1 to 10 ratings. If questions are phrased in the same way from year to year, repeated applications of the customer satisfaction survey can yield trend-lines showing increases and decreases in these numerical averages. Use of these highly quantitative techniques makes results easy to report, and avoids the subjectivity involved in interpreting descriptive, narrative answers. As in all surveys, questions should be designed so they give the respondent the opportunity to respond at any point on a quantitative scale, without leading responses toward a high or low rating. Wording of the question should also be specific enough to avoid mixing evaluations of separate issues. (A few test runs with a typical respondent who agrees to tell you when a question could be ambiguous may be well worth the time.) Here are a few examples of questions from actual surveys. They can be reworded to fit any desired industry or product area.

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For the next few questions, please provide ratings for [company] using a 1 to 10 scale, where 1 is poor and 10 is excellent. Compared to your other suppliers, how would you rate [company] on... 8. The ease of learning to use the companys instrumentation 9. Convenient packaging and labeling of products 1 2 3 4 5 6 7 8 9 10 X 1 2 3 4 5 6 7 8 9 10 X

10. The sales representatives dependability in delivering products when you are preparing for surgery 1 2 3 4 5 6 7 8 9 10 X 11. Their ability to answer questions about products and show you how to use them 1 2 3 4 5 6 7 8 9 10 X

Although good survey design and screening of respondents will ensure that they are all able to answer every question, it is advisable to include an option next to the 1 to 10 list for those who for some reason feel that they cannot rate a specific item. In the example above, telephone interviewers can circle the X to show a non-response. Naturally, low ratings raise new questions about the reasons for serious dissatisfaction. More depth can be added to the findings of a survey if especially low ratings are investigated. Since most respondents tend to use the top few rating points (ratings of 1, 2, and 3 are very rare!), one could decide to inquire about ratings below six or seven, as shown in the following examples.
24. How would you rate the overall quality and reliability of this device? 1 2 3 4 5 6 7 8 9 -----------------------continue---------------------- -----------skip to Q.26---------10

25. Why did you give that rating, rather than a higher number? __________________________________________________________________ 26. Using the same scale, how would you rate the way [the company] handles telephone orders for this product? 1 2 3 4 5 6 7 8 9 10 -----------------------continue---------------------- -----------skip to Q.28---------27. Can you describe any specific problems you have had in placing telephone orders? __________________________________________________________________

These qualitative questions are helpful in another way they break up what can be a monotonous list of numerical evaluations. After six or eight rating scale questions in a row, respondents will become tired of giving such short answers, and the quality of the results will fall. A few thought questions which give them the opportunity to express their views more fully can provide a change of pace, allowing the interviewer to return to numerical evaluations later in the survey. Toward the end of the interview, it is a good idea to give the respondents a chance to mention any other issues that they may consider to be relevant to their satisfaction or which they may have thought about during the questioning on specific subjects. For instance, this type of question makes a good wrap-up:
Can you think of any other comments or suggestions that would help [vendor #1] serve you or your department better in the coming year?

5. Report Results in Total and for Customer Subsets Overall measurements of customer satisfaction among an entire customer base are useful mainly as benchmarks, allowing marketers to assess improvement as new strategies are implemented.

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Major concerns affecting a very large fraction of customers will also appear in this aggregated data, but the more subtle problems unique to specific market segments can only be found by subdividing the data. When problems develop in customer satisfaction, it is either because the vendor is providing different levels of service to different customers, or because the needs of a particular group are changing (and no longer being served optimally by the marketing company). Satisfaction and needs assessment studies will yield the most usable results, then, when measurements are separated into (a) groups of customers who are served differently by the marketing company, and (b) groups of customers who are likely to have different needs in one way or another. Typically, customer satisfaction survey results are easily separated by sales region or individual sales territory, because this will highlight geographic locations (and parts of the organizational structure) which are performing better or worse than others. For this reason, some customer satisfaction survey results are used in salesperson evaluation and compensation planning. Similarly, satisfaction measurements among customers served by a central national accounts group should be separated from those served by local salespersons. Other groups which are best measured separately from the total are those served by independent distributors, those reached only through telemarketing, and those contacted only by direct mail. In each case, the companys way of reaching and serving the customer group may differ from methods used for other customer types, and this may be an underlying reason for variations in customer satisfaction. In some cases, how a customer is served may not be clear at first; satisfaction surveys may benefit from including questions to address this problem.
Who (or what organization) is your main contact when you order these products? Who provided the initial training in operation and usage? If you have a product failure, breakdown, or damaged goods, who do you call for help?

The answers to these questions can be used to classify the respondents as to how they are being reached by the marketing company. The second important way of segmenting this data is by grouping customers according to their needs, meaning their general interest with regard to using the product or service. For instance, it is logical to report separately the satisfaction levels among different types of decision-makers and users, as listed earlier in Section 2. Physicians, for instance, often have a very different view of proper customer service than nurses; the interests of purchasing managers (and their level of satisfaction) will likely differ from those of technical product users. Here are some other ways to subdivide satisfaction data, which will often highlight differences in the quality of service provided to subgroups in a customer base: Customer size, reflecting total potential sales Purchasing volume, for the companys own products Buying history reflecting growth, decline, or stable sales New customers vs. long-term customers Accounts dominated by each major competitor

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Although these types of classifications usually serve to split customer satisfaction data into useful subgroups, survey questions can often help to identify new market segments where customer needs differ from those in other groups. Here are some sample questions:
If we surveyed all the physicians in your specialty, do you think your counterparts would express exactly the same views on this companys service? Why would they be different? You seem very satisfied with this product (or service), and yet the company is not the dominant supplier in the industry. Why do you think that some people with your position would actually prefer an alternative product? Do you think that this product is really designed for a particular type of user? Who does it seem to be designed for? Why do you say that?

6. Take Corrective Action, Conduct Follow-Up Surveys Implementation of a customer satisfaction survey process is incomplete if it does not include activities designed to improve the aspects of satisfaction that are being measured. Similarly, the loop must be closed by continuing to monitor customers attitudes, to be sure that the process is resulting in a positive outcome for the company. The right corrective actions may be obvious from the results of a customer satisfaction survey, or they may need definition through additional market research. Surveys that highlight sales territories where customers find it difficult to reach their salesperson, for instance, show the source of the problem very simply, and corrective action is easy to plan. On the other hand, if the survey shows that product designs are too cumbersome for rapid training of new operators, then a more detailed investigation is probably needed to identify opportunities for changing the user-friendliness of the product. As indicated above, carefully planning the questions included in these surveys can be a big help when the time comes for deciding on corrective actions. If the length of the customer satisfaction survey permits, questions like these can be included, to give some guidance as to what actions would yield higher satisfaction on the next survey:
What do you think [this manufacturer] should do to make the product easier to use? What delivery methods would work the best for your own department? Have you ever seen a product that works better than the brand you use now? How was it different? Can you think of any specific things a vendor could do, which would really establish them as the top provider in the industry? What has a sales representative done for your department that showed you that they really cared about your business?

Customer satisfaction investigations are most helpful if they are conducted on a repetitive basis, over a period of months or years, because these measurements will show the long-term effect of corrective actions. At the very least, such a survey should be conducted twice: before and after changes are made in sales, marketing, or product design plans. There is no specific interval which is always appropriate for repeating a customer satisfaction survey; the time period should be decided on by considering how much time is needed for corrective actions to have their effect. For basic customer satisfaction issues, this may be a year or less, while for the fundamental attitudes comprising a companys market image, the time period is usually longer than a year, and may be several years.

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Naturally, maintaining as much of the format of the original survey (wording of questions, length of the survey, and so on) should be a key goal, so that changes in findings, measured over time, can be attributed to changing customer attitudes, and not to shifting survey techniques. It is easy to think of instances where subtle changes in the wording of a question can yield very different survey results, and this is to be avoided, for obvious reasons. On the other hand, there is nothing wrong with expanding the reach of a survey to new types of customers, and gradually (and carefully) revising topics and questions if this is necessary for better measurement of attitudes and clarification of corrective action. C. Conclusion Preparing a customer satisfaction (and needs assessment) study can be simple or complex, and the investigation can serve a great variety of objectives. Regardless of the scope, from a basic first-time effort to a comprehensive and detailed measuring and reporting process, a common structure is found in all good customer satisfaction studies. This article outlines six steps which help avoid common mistakes, and ensure that such a survey yields the kind of results that can be applied directly and with confidence to a companys product development and marketing strategies. D. Afterword: What Kind of Market Research is Not a Customer Satisfaction Study? Although it is true that all market studies have customer satisfaction as their ultimate goal, the term is usually used to describe a fairly general investigation of customer attitudes and needs. Manufacturers and service providers usually carry out customer satisfaction and needs assessments when they want unbiased, structured reports on how they are serving existing customers, through the entire cycle of sales, delivery, installation, service, training, and customer support. Here are some other types of market research investigations, which may seem similar to customer satisfaction assessments, but which are normally designed to provide information about specific products, services, or customer groups. Image studies can tell marketers what kind of general perception their company has developed over the long term. These investigations can show whether the vendors way of doing business has established the company as a technological leader, an aggressive price-cutter, a dependable source for a broad product line, and so on. Customer satisfaction studies, on the other hand, are oriented toward customer assessment of day-to-day operations and product usage. Product development studies seek to design or refine individual products to meet particular needs. A customer satisfaction study might identify areas where a product development investigation would be useful, but it usually would not yield the kind of detailed information needed about any one product, to show how it ought to be changed to meet specific customer requirements. Market share measurements report the results of customer satisfaction: they show how much customers are buying or how much they are paying. Measuring market shares accurately is usually complicated enough by itself, without pursuing the additional goal of determining why product choices were made, or what will drive

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future decisions. These latter issues are normally the goals of customer satisfaction studies. Opportunity assessments are studies that look into new markets for sales potential and future customer needs. Customer satisfaction studies, in contrast, normally address the interests of an existing customer base. On the other hand, some aggressive marketers have looked for new sales opportunities by conducting customer satisfaction studies among competitive accounts; where they find unserved customer groups, they move in with a superior product or service. Of course, it is possible to combine any of these goals with the basic objectives of measuring customer satisfaction and assessing needs. Usually these combination studies require the use of multiple techniques and/or survey samples, to be sure that complete and unbiased information is gathered to serve both research objectives.

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