Patient expectations are changing in the healthcare sector. Understanding them is important to design new growth opportunities and to ensure ongoing business success. This paper outlines the customer lead research, journey mapping and behavioural segmentation process, done with the National Skin Cancer Center team in 2018 to inform their growth strategy.

Preventing skin cancer through customer experience innovation

In today’s service environment, customers are more powerful than ever. They have more information and more choice than at any time before. This is affecting the health care sector. Gone are the days when health care professionals held total responsibility for making decisions on how to treat their patients and prevent disease.

As populations are increasing and aging, governments are also moving more healthcare costs, and choices, to the consumer. Today, advances in access to knowledge and an increased emphasis on consumer-directed care mean many people are becoming active participants in their own healthcare. This means what patients expect from healthcare service providers is changing. Their focus is now expanding from treatment to prevention and well-being. However, traditional healthcare providers have been slow to adapt to these changing needs.

For any organisation wanting to make a difference, understanding their customer needs is fundamental — this requires understanding who the firm’s target customers really are, designing the right offerings and executing them flawlessly.

According to Dr Robert Dew, Partner in CapFeather and author of Customer Experience Innovation: How to get a lasting market edge, when an organisation is successfully oriented around the customer, they will choose that organisation’s products and services more often, will happily pay more [either time or money] and then refer those products or services to other customers [1]. By training its focus on the customer, the business retains faithful advocates and is more immune to environmental change.

This approach gathers more importance when applied to preventative health. Specifically, what if we could understand more about skin cancer patients? Could improving the customer experience encourage people to get skin checks, and ultimately help save lives?

Australia has the highest incidence of skin cancer in the world. Malignant melanomas were projected to afflict 13,280 Australians in 2016 with 1,770 expected deaths[1]. A recent study by the QIMR Berghofer Medical Research Institute [2] noted that individuals who are affected by multiple skin cancers are relatively common. This has led many health advocates to suggest that skin cancer should be classified as a chronic disease. It was estimated the cost to screen and treat situ and invasive melanomas cost over $250 million a year in Australia and is increasing [3]. In total, skin cancer is estimated to cost the health system more than $700 million annually [3]. More alarming than the cost, in 2015, 2,162 people died of skin cancer in Australia [4].

How can customer-lead innovation help save Australian lives?

Understanding how we can encourage skin checks is an important contributor to reducing skin cancer deaths.

With rising medical treatment costs and significant Australian deaths each year, a comprehensive strategy that includes primary prevention of skin cancers and cost-effective sun protection initiatives is needed. To date, primary prevention activities have encouraged people to be sun safe [2]. However, with skin cancer almost doubling the number of people killed on Australian roads each year [6], more needs to be done to encourage prevention. Unlike most cancer types, skin cancer is almost entirely preventable.

Skin cancer healthcare is mostly government funded. Basic checks are available however only some patient types see them as relevant. Encouraging regular skin checks as a primary prevention method hasn’t been sufficiently explored in public or private research. We know that in 2012, 58% of Australians stated they ‘regularly check their skin for changes to freckles and moles’ [7]. That’s not enough.

Understanding why people book and attend appointments to have their skin checked is important for organisations that are committed to minimising Australia’s mortality rate in skin cancer. The critical question is (apart from the obvious safety concerns): why would someone want to go and get checked?

The National Skin Cancer Centres, a group of specialist skin cancer practices in Australia. They have a vision of a world where nobody dies from preventable skin cancer. In addition to running the practices and training doctors, encouraging people to get checks is fundamental to their success and growth. They hired the CapFeather team to help find out why people get skin checks.

The science behind customer experience research

CX research reveals what drives your customers. When you know what your customers want, you have a better idea of what to deliver.

Discovering meaningful insights into customer thinking and behaviour takes a rigorous scientific approach. The most reliable technique is to combine extensive interviews with statistical analysis. This is termed a mixed-method approach in research.

Qualitative research (structured interviews) uncovers information that experience designers need to know: the how and why behind people’s behaviours. Quantitative research measures how often or how much something happens. In both research methods, we want to understand behaviour in context, not stated attitudes or opinions. In qualitative projects, we typically interpret perceptions. In quantitative projects, we count activity.

Conducting patient research

Perceptions around skin checks were unknown, so for this research project, CapFeather used larger sample sizes to ensure the chance of missing something was low. Interviews included 31 patients and 12 doctors and staff. The research team also undertook 10 mystery shops to assess what other Australian skin and health clinics were doing. This was further supported by surveying 231 patients across the country.

Matt Woollard, COO of National Skin Cancer Centres revealed: “We thought we knew our patients after 10 years of working with them – but we learned more in one month than in that entire time.” For the NSCC, a laser focus on learning about their customers, and potential customers, made a difference. However, the team needed tools that were easy to use and interpret, in order to help their patients.

From the research, two important artefacts were developed: a customer journey map and a customer segmentation model.

Mapping the customer journey

A journey map outlines the end to end experience that someone is receiving – or should receive – when interacting with an organisation. Journey maps are useful marketing assets because they reveal insights about the stages customers progress through when purchasing a product or service. Understanding what customers do, think and feel when they deal with a company can be sobering for staff. Journey maps can provide a guide as to how to improve products, services, processes and communications so that a firm’s customer experience (CX) delivers an edge over the competition.

Leadership teams use journey maps for strategic planning and marketing operations. Front line staff use journey maps to more deeply understand what matters to customers. Empowered employees with empathy can dramatically move the needle on customer satisfaction and advocacy. The map allows people working in different parts of the organisation to co-ordinate efforts towards the ideal customer experience.

Journey maps are built predominantly from interviews. They add an emotional component to understanding the business from a customer’s perspective. Well-constructed and detailed journey maps last for 3-5 years. Annual refreshes can confirm pain points and track improvements to ensure maps continue to accurately frame long-term decisions and guide day to day behaviour.

For skin cancer patients, much of the journey centres on when results are received. For NSCC, this became an opportunity to further develop patient relationships. Understanding how to support doctors and staff to deliver what each patient type needs at this emotional moment or ‘touch point’ fosters valuable, hard to measure assets like positive word of mouth and intrinsic good will. When a patient feels cared for, loyalty to the organisation increases and they are more likely to refer. Caring deeply about the patient at this point, in a way that matters to them, can help save the lives of others.

Segmenting customers

Patient insights link what people do with what they are thinking and feeling. They translate observations into motivation patterns, helping innovators applying empathic design methods to ‘get into the patient’s shoes’.

Observation: I saw my doctor because he was also a trained plastic surgeon. I knew if he needed to remove a mole I would have a nice neat scar in the end.

Insight: Safety is not the only consideration influencing patients to get a skin check: how they want to look impacts who they are prepared to see.

Insights are used to identify innovation opportunities, craft incremental improvements and inspire organisational transformation. Insights are evidence-based but also subjective. They rely on core motivations we all share even though our individual personalities moderate how these are expressed.

To help understand the diversity of people that get their skin checked, CapFeather developed a matrix with four behavioural segments. The details are commercial in confidence and so are not published here. However the patient matrix described by John Quelch, Professor in Health Policy and Management at Harvard, gives an idea of what a segment strategy might look like:

In one corner, you have people who are healthy and involved in taking care of themselves. They may use a Fitbit or other activity tracking device, get regular exercise, eat a balanced diet, and follow recommended health screening guidelines. In another quadrant, you have people who are sick and who are not involved in their health. “Maybe they are unable, unwilling, or unprepared to become engaged,” he says. Patients in this corner may have multiple chronic conditions. The third segment comprises people who are healthy but uninvolved, who believe they are invincible and therefore don’t see the need to invest money on health insurance and care. Finally, the last segment consists of people who are sick but do engage in taking care of their health, like someone who had a heart attack but now eats well and walks every day [11].

Discovering what motivates people

Understanding motivational psychology helps us to design realistic methods to prevent skin cancer, that people are drawn to engage with. The dominant paradigm in most disease prevention initiatives is to appeal to the patients’ need for certainty (e.g. feeling safe that their skin is healthy). But there are other powerful patient motivations which can be the key to unlock advocacy and growth. These relate to connection (e.g. relationships with a doctor and | or family), significance (e.g. retaining a youthful appearance and | or referring others) and identity (e.g. being a parent and | or being an outdoor exerciser). The diagram above shows the basic need hierarchy used for CX design.

Eight insights on patient behaviour were identified from the research. NSCC is using these behavioural insights to determine how to attract those in need of checks who may not otherwise think to come in.

CEO Paul Elmslie was clear on the value of the research and innovation design focus for National Skin Cancer Centres: “When you are on a mission to save lives, knowing more about the patient really helps.”

While attracting more patients would contribute to the growth of NSCC clinics, encouraging more people to have routine skin checks goes to the core of their vision: a world where nobody dies from skin cancer. They are focusing on both strategies.

Not everyone is motivated by the same thing. We needed to discover why a skin check would be valuable for different types of people.

Dr Robert Dew, NSCC Project Lead

Getting CX right saves lives

Not all patients are created equal. By focusing on how they behave, think and feel, it is possible to design the right service that attracts different types of patients. How you approach this challenge depends on who you are targeting.

Next, National Skin Cancer Centres worked with the CapFeather team to design and pilot product and service innovations that target patient segments. Using the Lean CX [TM] process, they found and tested a novel method for attracting new patients who would not have otherwise had a skin check. It lead to a 40% conversion to skin check. The long-term impact of this individual initiative is enormous when considering the organisation’s growth goals and vision.

Find out more about how Customer Lead Innovation can help you understand and attract your customers

Why CapFeather?

We help mature firms find new and sustainable opportunities by looking beyond the immediate horizon.

Ambidexterity is needed for exponential growth. While your team excels at business right now, we help you design the path for its future success.

CapFeather is the vanguard for strategic consulting in a volatile, uncertain, complex, ambiguous [VUCA] world. With presence in Australia, the United Kingdom and North America, we have global reach.

Over 20 years of senior advisory, our people have worked on more than 200 projects to deliver bottom line growth and new revenue through product and service innovation - achieved though compelling customer
relationships.

Contact the authors

Dr Robert Dew
robert.dew@capfeather.global

Sarah Daly
sarah.daly@capfeather.global

Dr David Rosete

david.rosete@capfeather.global

References

[1] Dew R, Allen C. Customer Experience Innovation. Emerald Publishing; 2018

[2] Australian Institute of Health and Welfare. Skin Cancer in Australia. Catalogue No: CAN 96. Canberra (AUST): AIHW; 2016

[3] Gordon LG, Elliott TM, Olsen CM, Pandeya N, Whiteman DC. Multiplicity of skin cancers in Queensland and their cost burden to government and patients. Australian and New Zealand Journal of Public Health. 2018; 42(1):86-91.

[4] Elliott TM, Whiteman DC, Olsen CM, Gordon LG. Estimated Healthcare Costs of Melanoma in Australia Over 3 Years Post-Diagnosis. Appl Health Econ Health Policy. 2017 Dec;15(6):805-816.

[5] Australian Institute of Health and Welfare. Cancer in Australia 2017. Cancer Series no.101. Cat.no. CAN 100. AIHW: Canberra, Australia, 2017.

[6] Taken from https://roadsafety.gov.au/performance/road-deaths-age-group.aspx, where 1,205 died on our roads in 2015.

[7] Australian Bureau of Statistics, Australian Health Survey: Health Service Usage and Health Related Actions, 26 March 2013

[8] Taken from https://www.cancer.org.au/about-cancer/types-of-cancer/skin-cancer.html

[9] Cooley JH, Quale LM. Skin cancer preventative behavior and sun protection recommendations. Seminars in Oncology Nursing, V 29(3), 2013: PP 223-226.

[10] Day GS, Shea GP, “Innovating for Sales Growth”• MIT Sloan Management Review, 2019 p11

[11] Ellis L, A Roadmap to Improve Customer-Centricity in Health Care, Harvard TC Chan School of Public Health: https://www.hsph.harvard.edu/ecpe/a-roadmap-to-improve-customer-centricity-in-health-care/