Quality - client experience
Service provision needs to meet the needs of its users to be effective. Social services have a need to connect with people in a way that promotes satisfaction and provides mechanisms for capturing their experience along their journey with services.
With rising prices, privatisation of services and increased competition in an open market place, there is a significant need to look at satisfaction of the people using services. If raised, questions about satisfaction are often asked indirectly in relation to client feedback as part of a quality framework; outcomes relating to funding allocations; advocacy outcomes; or self-management or planning outcomes.
Service user satisfaction is much more than service outcomes, and seldom is the journey through service access from a point of entry or crisis to a point of exit or stability discussed. It is this journey that, when considered, provides a basis for indicating quality of life impacts and measures.
How do we know if the services we provide really improve the lives of the people we work with? How do we know if the people we work with are satisfied their experience of our work and / or our service? The obvious answer is to ask them.
It is generally held that the reason services exist is to make the lives of the people they serve better. However, it is not always easy for services to know if the support they provide is optimal or even effective. It’s also difficult for funders to know if people are satisfied with the services they are funding.
It is common for services ask questions such as:
- What do people really want/ need from us?
- Are we really focusing our efforts in the right area?
- Does what people want match with what we are funded to provide?
- Are there gaps we don’t know about?
- Are our services sufficiently flexible and responsive?
Services may report on units and hours delivered, however while these may speak to the nature and quantity of services, they do not necessarily tell us about the experience of those receiving services. The quality of the service is judged by the people who use them.
Why measure client experience?
There are a number of reasons why it is important to measure the experience of people using a service:
- As an engagement and information collection tool, measuring experience and satisfaction provides service delivery organisations with a structured means of collecting information from service users to better infuse the needs and values of the people using a service into their organisation.
- As a service improvement tool, measuring experience and satisfaction provides a means of assessing what the main drivers of satisfaction or dissatisfaction are and focusing efforts on improving experience as part of an ongoing cycle of service improvement.
- As a performance management tool, measuring people’s experience and satisfaction provides a means of meeting reporting requirements for funding, demonstrating effectiveness when tendering for new funding opportunities and providing potential service users with information about performance.
What is important in determining client experience?
A large part of identifying satisfaction with services is understanding the drivers or determinants of satisfaction. It is important to reflect our satisfaction enquiries to what users feel is most important. Unfortunately, there is significant variance in the drivers of service quality and limited agreement on what are the key dimensions of satisfaction, to keep things simple, generalist determiners have been used to articulate what is most important to people at each point in the continuum.
- Assurance / Security – people using your service do not feel at risk, either to their person or to their lifestyle or emotional wellbeing by being with the service provider.
- Access – as well as physical access and ease with which contact is made and continued.
- Communication – maintaining communication with people in a way that is easy and accessible for them to engage with.
- Competence – the people in the service have the skills required to supply the services.
- Credibility – is the service and the people trustworthy and do they do what they say they will do?
- Empathy – people using the service have a feeling of being known and their needs understood by the service provider.
- Reliability – dependability and consistency of service and approach.
- Respect – this included general courtesy measures and feelings of value the person experiences, along with personal attention or person centred approaches.
- Responsiveness – the willingness of the people in a service to provide service. This also includes timeliness and convenience of service delivery.
- Tangibles – there is some evidence of services being delivered to the person.
The continuum of the client journey
Regardless of which field this work is applied to, whether in working with people experiencing mental health issues, people with a disability, young people, people who are experiencing homelessness or people experiencing domestic and family violence, the goal is the same: to make a difference in that person’s life. How then do we know if we are making a difference?
Condition, as in the situation in which the person finds themselves, is a subjective measure, but it is important to give us an understanding of the current state. Condition is different to a person’s situation. For example, a person may be an alcoholic or they may change that and be a recovering alcoholic. By measuring the changes in the person’s situation, services can determine whether individual programs or their organisation as a whole has contributed to a positive change for a person.
Condition, therefore can be a strong indicator of the person’s situation, positive or negative. If condition of an individual is not improved, then their situation may suffer.
If a service works with someone they have successfully helped to a status of recovering alcoholic, it’s important that they also consider the person’s condition. If this does not occur then the service may not recognise that the person’s condition is stable but requires ongoing counselling. For example; without continued counselling, the recovering alcoholic could have a negative change and revert back to being an alcoholic.
What does this mean in terms of satisfaction?
To be able to identify what is most important to a person in the context of satisfaction, it is necessary to understand and give an indicator of where they are on a continuum. It is not necessary, nor feasible to have established increments for every sector. A standard five stage continuum of stability has been found to suit a wide range of situations and service types.
By working with the person to identify where they are on the continuum provides a useful basis for discussing supports required.
The worst condition on the scale. The person is experiencing the worst negative effects of the specific problem. For example, a chronically homeless person may be sleeping on the streets in the dead of winter. A habitual substance abuser may be using to the extent that he has lost his job, his licences and home, A family may be torn by issues of domestic violence. In crisis condition is bleak.
This is a situation where the worst has not happened yet, or where the worst has been temporarily overcome. The key to the vulnerable condition description is that things are teetering on the brink and could collapse or return to the in crisis condition at any time.
The stable situation is one in which circumstances might not be ideal, but at least they are not getting worse at the moment. This is the situation where the corner has been turned & imminent danger is no longer there. At the same time, it is a situation where much remains to be done. The homeless person may have been placed in accommodation, but without continued support may be homeless again soon. The substance abuser may be on track and working, but without support, may slip back into the same patterns of using drugs.
The danger to this person, family or community has passed. While remedial services may no longer be needed, monitoring and perhaps a maintenance program is generally appropriate.
This is situation that begins to approach the ideal conditions. This is the situation where everything is going well, where dangers and threats are no longer in view there the service, or program’s involvement is no longer needed and the situation is self-sustaining.
A significant difference exists in the private and the public sector in the way in which people who access services are identified. The public and social services sector identifies people who access their services as clients, services users, constituents, or a range of other labels that suit their service type. In contrast the private and business sector are more likely to use the word customer.
Rather than just semantics, the use of language and identifying labels has an impact. There is an indication of passive versus active in the use of the terms client and customer. A client is defined as ‘one that is under the protection of another: dependant’ or ‘a person that is served by utilising the services of a social agency: welfare’. Alternatively a customer is defined as ‘someone that purchases commodity or service’.
These definitions bring up a paternalistic role for the service and a passive role for the client. Good clients are people who are often described as keeping their appointments; do what they are told to do; don’t complain; are motivated and responsive. In contrast, customer sparks a vision of an empowered active consumer and good customers are thought of as people who spend money; come back; recommend the service to others and provide feedback.
The language of client is sometimes seen as disempowered, dependant and paternalistic, while the language around customers paints a distinctly different picture. The language of customer portrays the image of a person actively seeking out products and services that they choose. However, in the social services sector, there are many situations in which the term customer can reference to situations of empowered choice that do not always reflect the reality of people using all types of services.
Tool and resources
The following tools and resources will assist you with gathering client feedback.
What is a focus group?
A focus group is a small-group discussion guided by a facilitator. It is used to learn about opinions on a designated topic or service, and to guide future action.
Focus groups allow for informal and frank discussion among individuals who share something in common. For example, a service may choose to facilitate a focus group of people who recently used their services as a way of learning what is working well about the service and what needs to be improved.
Focus groups generally are comprised of no more than eight to ten people, last no more than two to three hours, and are guided by some open-ended but focused questions. Again, an open-ended question is one that requires more than a yes or no answer, and this is important to consider when constructing questions.
How are focus groups different from regular groups?
A focus group is different in three basic ways:
- The group has a specific discussion topic. The group’s task is to stay on it, and not wander all over the place.
- The group has a facilitator. The facilitator’s job is to keep the group on course.
- The group’s composition and the group discussion are carefully planned to create a nonthreatening environment, in which people are free to talk openly. Members are actively encouraged to express their own opinions, and also respond to other members, as well as to questions posed by the leader.
Why run a focus group?
You will get more information from the group than you could get from any amount of questioning of individuals. This comes from the meaningful interaction between members. During a focus group, the facilitator gets the participants to interact with each other in a way that reveals additional information, so every other person can hear and respond to comments. The hallmark of the focus group is open-ended group interaction. People can answer in their own words, rather than being forced to give yes or no, multiple choice, or numerical answers. More importantly, people are able to freely react to each other’s responses.
Stimulation is created by the excitement, group support, challenge, new ideas and other features of the interaction. There is an almost irresistible pull to say things that they would ordinarily not reveal. Here are some types of interactions you may see in a well-run focus group:
- Reaction to each other’s comments
- Drawing each other out
- Asking questions you didn’t think to ask
- Building on each other’s ideas
- Sparking new ideas
- Jogging each other’s memories
- Modifying each other’s comments
- Filling in-completions and gaps in knowledge
- Nudging each other out of ruts and habitual thinking
- Taking opposing positions
- Persuading each other
- Changing their opinions
For more information on how to run a focus group go to this HubSpot article.
What is an interview?
Interviews are usually defined as a conversation with a purpose. They can be very helpful to your service when you need together information about the way in which people experience your service. Interviewing has been described as an art, rather than a skill or science. In other cases, it has been described as game in which the interviewee gets some sort of reward, or simply as a technical skill you can learn. But, no matter how you look at it, interviewing is a process that can be mastered by practice.
Why should you conduct interviews?
Using an interview is the best way to have an accurate and thorough communication of ideas between you and the person using your service. It’s a more thorough form of communication that surveys because you can engage with the person on a more personal level. In addition, you have control of the question order, and you can make sure that all the questions will be answered.
Moreover, you may benefit from the spontaneity of the interview process. Interviewees don’t always have the luxury of going away and thinking about their responses or, even to some degree, censoring their responses. You may find that interviewees will blurt things out that they would never commit to on paper in a questionnaire.
When interviews are not the best option
Interviews are not the only way of gathering information and depending on the case, they may not even be appropriate or efficient. For example, large-scale phone interviews can be time-consuming and expensive. Questionnaires and surveys may be the best option in cases where you need information form a large number of people. Interviews aren’t efficient either when all you need is collecting straight numeric data. Asking your respondents to fill out a form may be more appropriate.
How should you conduct interviews?
Being a good interviewer has been described and a special skill set that that is held be some people and not by others. Certainly, interviewing may come more easily to some people than to others, but anybody can learn the basic strategies and procedures of interviewing.
What is a survey?
A survey is a way of collecting information that you hope represents the views of the whole group that you are interested in hearing from.
Why should you conduct a survey?
You can collect information about the behaviours, needs, and opinions and ideas of your target group by using surveys. Surveys can be used to find out attitudes and reactions, and to measure the satisfaction of your user group.
You can use surveys to measure ideas or opinions about your service. For example, you may want to know what users think about your services, what new users expect from your services, and whether users are satisfied with what you provide.
Deciding whether to conduct a survey
There are advantages in doing surveys, but you should consider whether a survey will be the best way of obtaining the information you need. Even though surveys are a useful method of gathering information, they are not the only way. You will need to decide whether a survey will produce the information you need. The information you need may be obtained through other means, such as informal unstructured conversation that takes place in the course of another activity; focus groups; interviews; or observation.
When should you conduct a survey?
- A survey may be your best choice when:
- You need a quick and efficient way of getting information
- You need to reach a large number of people
- You need statistically valid information about a large number of people
- The information you need isn’t readily available through other means
Online survey tools
There are many online survey forms that you can use to connect directly with customers. Start by thinking about the needs of your service or organisation. If you’re looking for a quick, short survey, one that may have a just a few questions to use with customers in crisis, one of the free or low cost tools may suit your needs. In fact, a more sophisticated survey package is likely to just be considerably more difficult to use, so for ease and accessibility, keeping it simple may be very important.
To keep things simple and free, Google forms is a useful tool. Google Forms is 100 per cent free and offers much more than other free survey tools.
Alternatively, if there are others to consider:
There are some useful features in the free version, especially the unlimited questions and answers
It lets you use a variety of icons that may be suitable to use (with support) with people with impaired capacity
One of the best known tools, however you must have a paid account if you want to export your data
A paid version that offers some much more advanced reporting features
A paid online service
A free open source tool
A paid service that also allows the use of simple emoticons and sliding scales
Customer satisfaction literature review
The Customer Satisfaction Measurement Literature review, published by QCOSS in 2014, reviews the existing literature on customer satisfaction measurement and provides the theoretical background for the development of a number of tools to help the community services industry in Queensland measure customer satisfaction.
In the context of community service delivery, there are a range of issues to be considered when designing and using satisfaction measurement tools. There is a growing expectation, in the literature that individuals and their family should be at the centre of service design, delivery and review. Tools and processes for measuring satisfaction need to accommodate individual needs and preferences around literacy, timing and form. There is also an expectation that people who have contributed to such processes will receive information on the broader outcomes from their feedback and ideas.
At a broader policy level, contestability and a move to self-directed and in some cases, self-managed funding means the people who use services may be doing so under market or market-like conditions. This requires that people shift from being consumers to discerning customers which will bring challenges and opportunities for both organisations and the people who use their services. Read the review for more information.