Anne Salter

Anne is a development professional. She has undertaken a number of research projects as part of the Ashley Insight team with clients including the World Bank Innovations team, Business Call to Action and the Global Innovation Fund. Anne has worked with the Federation of Social Organisations in Costa Rica, Ashoka Mexico and Social Enterprise UK.

Interview: Dr. Consulta, improving services through customer feedback

16. Feb 2017

As a part of our February 2017 theme on consumer insight we spoke to Jorge Tung, Chief Product Officer at Brazilian inclusive business Dr. Consulta.

What does your business offer to your clients? What is the core value proposition?

Dr. Consulta are a network of medical centres that provide both primary and secondary care. We started five years ago, and have been growing quickly, expanding in the metropolitan area of São Paulo. We have about 85,000 visits a month, with a database of roughly 250,000 people. We are different to other medical centres; we are very affordable, about one fourth or fifth of the price. We focus on lower income populations and on making sure all the treatment is done very efficiently. Our business is to service customers quickly through the process, so we can afford to set lower prices.  We also focus on quality- our physicians are rated on average 9.5 out of 10 and our services are rated 9.4.

Who are your target customers and why is understanding them important to your business?

In Brazil, the healthcare service is free, but it’s quality is bad, with patients waiting 3-4 months for an examination. On the other hand, one third of the population have expensive private healthcare insurance. We sit in between those who cannot pay for healthcare insurance and those who have it. There are about 100 million people in Brazil without healthcare insurance, so we try to serve them.

It is a big enough market, the challenge is serve it affordably, accessibly, and efficiently, so we rely on our understanding of the customer and technology, to tailor the service. We have to make the process extremely lean.

First, we try to understand our customer, build some insights, or try to understand a problem and try to figure out a way to solve it and deliver best customer service.

So, for example, if we need to understand what are the motivations for people going to our medical centres, we usually find three types of patient: some are stressed, a portion have chronic diseases and some that are only just going for check-ups. Each one requires a different treatment. We try to understand how we should treat each one. So, those who are stressed are usually male and younger, every time a disease appears they get stressed. Those with chronic diseases are usually older, and they are usually more likely to go see a doctor, they are not stressed, they are just trying to maximise their life time and get good treatment so they can hopefully improve over time. Check-ups are somewhere in between, they just want a green light. They are not stressed, they do it every year, but they get upset if something goes wrong. Through customer insights, we see how we should treat these 3 types of people: what type of communications should we send them, how we engage each one and so on.

Talk us through how you collect this customer feedback, do you use any tools such as Acumen’s Lean data initiative?

We have many tools for getting feedback, mostly from patients. The first are SMSs to all patients after every visit. One SMS rates the service and other rates the physician. That is an internal tool that allows us to evaluate our performance and patient satisfaction.

We have other tools for customer feedback. We use Survey Monkey on a monthly or weekly basis for getting more information about customer satisfaction. We have ratings for NPS, medical services, specific issues, e.g. if we have issues with delays, we send specific questions asking what exactly is the problem, is it the queue, the entertainment, if the physician was too fast or too slow.

We worked with Acumen Lean Data as a part of our customer discovery using a 2-fold research approach. First was qualitative research- we sent a psychologist in the field, she experienced the whole process, a ‘user safari experience’.  She pretended she was a regular customer, she went through the process and looked at the issues that came out; a lack of communication, not understanding how the flow works or how the physician treats her. She then interviewed our customers in the medical centre. It’s more than a conversation, she followed step by step questions about where they came from, why they were there, how they found out about the service, how they are feeling, what they did before. A series of questions in a 20-30-minute interview.

Then, we built personas of customers, assessed customer journey and created some hypothesis. After that, we engaged with Acumen Lean Data to get quantitative information to validate some ideas and answer- are the hypothesis correct?

For example, we believed that the physician is very important to the relationship with the patient. This proved not to be exactly true, it was only true for a part of the population, the ones that had a chronic or ongoing disease. It is important for them to build a relationship. Other customers just wanted to get in and out as quickly as possible, they just want to understand their disease or get an exam. Other regular customers prioritise availability and relationship with the physician equally.

How often do you do this?

So for our three types of research:

  1. Operations: SMS’s are sent daily, they are short, simple and easy.
  2. Monthly surveys: 10-12 questions in a survey monkey.
  3. Research: in depth, run once or twice a year.

As we are growing fast we understand that our customer base is morphing over time. Last year we had less than half of the medical centres we have today. As we are expanding, the profile of the new patient changes, so we should continue doing research and surveys.

Are there any challenges to collecting that data and how have you overcome them?

There are a lot of challenges. For research, that is a long conversation or survey, we offer prizes. For example, we sent around 50,000 invitations and only 1,500 came back and answered the questionnaire, even with rewards. For text messages, we have engagement of around 20%.

Cost is also very important; we use the available technology to do it as broadly and quickly as possible. Only on in depth research can we afford to interview customers.

How much of a role does technology play in how you collect feedback?

Throughout the entire process. The recruitment process, engagement, how we send surveys, collect data how we analyse. We are still developing the strategy, so there are patients, for example, with chronic disease that complain they receive too many text messages. The other issue is the data that we analyse, we understand that many people mistake the keys answering SMS messages. We rate from 1 to 10. Many people rate their physician 1, when they want to send 10, there are also lots of human errors.

How do you use the data to ensure it is feeding back into the business and worth doing?

We are still trying to work it out. For example, customer satisfaction for physicians are part of their reward, the ones that hit 9.5 get a bonus, the ones who don’t hit 8.5 don’t get any bonus. The physicians know how they can improve based on the more detailed monthly survey, where we ask patients how the physicians can improve, what they like and dislike about the service. We compile that and send it to the physician, so they can evaluate and see how they can improve, and when they improve they are rewarded for it.

The yearly research, we feed that back into things like building the website and mobile application. We are trying to build a website that can serve most of our patients, but we understand that some don’t have access to technology, some don’t book services online. For example: It’s very common in Brazil that the wife schedules an appointment for her husband, so it doesn’t matter if we build a website for the husband, 70% of visitors on our website are female, so we have to build the site more towards their needs.

Do you have examples of how you have improved the service for customers?

Through the research we understand which features we should improve first. For example, helping customers understand we are real! Believe me. Many don’t trust us, they say: your service is 20% of a real one, its too cheap, you are probably fake or low quality. As, we want to build trust with patients, how we can overcome that reaction? We are publishing physician profiles on the website. We have around 700 physicians, each one will have a short profile and patients will be able to schedule appointments with physicians, instead of just looking for available slots. So we’re getting closer and closer to the customer, they can see the face of the physician they will see, they can see their legal registration number. It may overcome one issue that come up in our customer service very often: our elderly customers trust older physicians. So one common question is, how old is the physician? We don’t give out the age of the physician, but having the photos of the physicians allows people to decide who they would be comfortable seeing.

What advice would you give to other inclusive businesses who are looking to setup feedback systems to understand their customers?

Before you try to setup any surveys or feedback systems, sit with the customers and talk to them in person. Experience the service you are offering, get some insights, and build your hypothesis. You’ll be amazed how much you will learn. Once you have that learning, you can deploy the survey or research far more easily. If we hadn't done that before engaging with Acumen Lean Data, we would have done a very long questionnaire, looking to answer all our questions and once we got the results, we wouldn’t have been able to make sense of the results. So, build the hypothesis first, then look to prove or break them with data afterwards.

This blog is a part of the February 2017 series on Customer intelligence revolutionising business at the Base of the Pyramid in partnership with Acumen Lean Data.  Access the series for more from social enterprises, as well as blogs from Business Call to Action, Social Value International and many more.