Getting a clearer picture

Editor’s note: Catherine M. Wolfe is senior director, corporate and strategic communications, at Toshiba America Medical Systems, Tustin, Calif.

Diagnostic medical imaging saves lives and improves quality of life for millions of Americans annually. For instance, to ensure early detection and treatment of breast cancer, once a woman reaches the age of 40, if she follows standard protocol, she will annually have a mammogram. If anything suspicious shows up on that mammogram, she’s likely going to then have an ultrasound. If those tests are inconclusive she may have a magnetic resonance (MR) or even a breast biopsy. And that is only to diagnose the problem. If she requires treatment there will be other follow-up imaging exams.

Similarly, if your child falls and hits his head skateboarding, depending on the level of trauma, he may have a computed tomography (CT) scan to check for internal bleeding - something for which the other major method of diagnosis could be surgery. Or, if your elderly parent exhibits signs of stroke, part of the diagnostic procedure may include a CT scan or an MR. The more quickly the test is accomplished, the more quickly treatment can be given and brain cells saved, reducing the impact of potential disability.

These high-tech medical imaging capabilities are the result of years of investment and research. Installing these imagers and educating health care providers on how to use and maintain these systems requires complex processes that involve many individuals over the lifetime of the equipment.

Understanding the needs of the users of this equipment and maintaining the systems at optimum performance without inhibiting the health care provider’s ability to deliver care is a complicated process. At Tustin, Calif.-based Toshiba America Medical Systems, customer satisfaction research has helped the company better understand its customers, provided a quick synopsis of the company’s level of performance over time and allowed it to improve support.

A significant challenge

Late in the 1990s, Toshiba created its customer satisfaction research program when the company faced a significant challenge: flat to negligible sales in a growing market. Independent, third-party survey findings indicated current customers were just as likely to buy from competitors as they were from Toshiba.

With that frightening information in hand, the company reinvented itself, creating a mission statement with marching orders that said it would become “the industry leader in customer loyalty by delivering quality products and services through long-term, customer-focused relationships.” It’s that very clear declaration which set the foundation for an organization committed to reshaping itself through an evolution from industry laggard to industry leader in after-sales support.

Auto manufacturer Lexus served as inspiration when Toshiba created its customer satisfaction and feedback program. Launched in 1989, the Lexus marquee quickly came to be associated with quality, luxury and superior customer satisfaction. The brand reputation grew steadily until, barely a dozen years after its founding, Lexus became America’s best-selling line of luxury motor vehicles. As anyone who has owned a Lexus can tell you, the company gathers customer feedback all along the purchase and service process - a practice that helps catch and correct problems early, protecting the company’s reputation in the market.

Critical junctures

Based on that model, in 1999 Toshiba created its program (Figure 1) to collect customer data. Gathered at critical junctures on the relationship timeline, that data is analyzed and provided to process owners. Also, it is compared to feedback from third-party analysts. Used together, these data sources help Toshiba understand where problems reside, implement changes and then evaluate if changes are improving the customer experience.

Toshiba’s customer satisfaction survey process (Figure 2) consists of data collected six to eight weeks after system installation - the post-install survey; data collected two years after initial installation - the installed base survey; and then random surveys conducted when customers contact Toshiba’s call center (InTouch) for support, or when a customer engineer is sent out to a site - called IT and CE surveys. The post-install and installed base surveys ask questions about the sales process, installation and maintenance of the equipment, the applications or training process and the performance of the system.

These surveys have been designed on a 10-point scale, with 10 being best, because that methodology reflects measuring systems used by third-party analyst organizations and the way they conduct their research. This 10-point scale helps Toshiba personnel understand and respond to the customer based on the site temperature. Ratings of 9 or 10 are believed to reflect loyalty, 7-8 ratings are viewed as neutral and a rating of 6 or below generates what the company calls a performance alert. Performance alerts require the engagement of Toshiba personnel with the customer to resolve the issue.

Surveys were designed internally by the company, but Toshiba works with a research vendor that conducts the surveys by telephone. The surveys are lengthy, some including as many as 40 questions. However, because of the complexity of the medical imaging business and the partnership nature between customers and vendors (customers include technologists, physicians and administrators from hospitals and imaging centers) respondents are generally willing to provide feedback, expecting that the investment of time will result in improved performance.

With Toshiba, it definitely does. For instance, a Washington hospital recently gave Toshiba low ratings for applications, product performance and service after the install of an X-ray system. Although the system met specifications, the chief radiologist was not satisfied with the image quality of the hospital’s pain management studies. When viewing clinical images, beauty is often in the eye of the beholder. However, a dissatisfied customer is a dissatisfied customer with an issue that needs to be addressed. So a Toshiba team of national technical support, local service, senior applications and management visited the site. National technical support and management explained different options to the physician. The company made a focusing adjustment and scheduled two consecutive weeks of additional training to ensure the customer understood system operation. The situation was resolved to everyone’s satisfaction.

Being in touch

Company growth and success come from being in touch with the market. Early-warning indicators can also help protect a company’s reputation. Toshiba’s survey process gathers customer feedback as close to the event as possible, allowing the company to spot problems before they escalate into disasters.

A particularly challenging situation can occur when an institution currently using a competitor’s system then purchases one from Toshiba. Systems work in diverse ways, clinical images can look different and protocols vary. Users often prefer the system they used when they learned their craft. According to recent survey data, a Pennsylvania hospital rated Toshiba’s applications and the magnetic resonance imager subpar. Careful investigation resolved product issues, but ongoing communication turned up the fact that the technologists who had previously used another manufacturer’s system didn’t want to move their protocols to the new MR system. Ongoing communication with the customer via a weekly call eventually helped the hospital radiology team transition over.

A data collection and analysis process can also help address issues before they become pervasive in the market. Sharing information with internal process owners and giving visibility to customer satisfaction measures throughout the organization allows Toshiba to maintain industry’s top third-party ratings.

According to author John Goodman in his book Strategic Customer Service, the act of gathering customer feedback, making changes and then communicating those changes back to the customer serves as a critical closed-loop process that ensures on-target performance in a changing market. An example of the efficacy of that approach arose following a Maryland medical center’s purchase of a Toshiba CT. When the post-installation survey was conducted six weeks after the install, the customer provided low marks on product performance and service support. The local service team found power issues, which they helped the customer correct, but that didn’t resolve all performance issues. National technical support then came in and was able to help diagnose a problem with the power supply. Keeping in constant contact with the customer and involving greater levels of expertise as required helped successfully resolve this situation.

Leading ratings

Within a couple years after Toshiba began its customer satisfaction survey program, the company achieved leading ratings by most industry measures. For instance, the company has held the No. 1 rating for nearly eight years in cat scanners - one of its core product lines - in data compiled by MD Buyline, a Dallas medical technology information firm. And the company holds top ratings in most modalities and with another third-party analyst organization, KLAS Enterprises, an Orem, Utah health care vendor performance measurement firm (Figure 3).

But maintaining those top ratings is not always easy. Toshiba hit a rough patch a couple years ago when the company began to see declining MD Buyline ratings in its premier product group - CT. Fear and uncertainty related to the unknown causes of the drop elicited several months of initial delay in action. Jack Welch once said, “Deal with the world as it is, not how you’d like it to be.” It took Toshiba time to accept that its performance was not at the desired level and take steps to improve performance.

Clear indicators of the issues were not readily apparent in the internal survey data, so the company tried some new things, such as auditing the organization and creating a hit list of performance inhibitors. A cross-functional team investigated and developed a priority action list made up of three major actions.

First, customer support managers (CSM) became the central focus for addressing customer issues. This moved the process from several different functions contacting the customer when there were problems to one person, the CSM, serving as the central contact, with other functions providing needed background information. This one change centralized and simplified customer communication and made accountability clear.

Second, Toshiba created a voice-of-the-customer team representing each function that reported to the general manager. This ensured that issues that weren’t being addressed received senior management visibility.

The third action required an investment of more than $1 million to upgrade software at CT sites to be consistent. Much like the way that computer systems work off different software versions, so too do CT systems. Investing in revision consistency made it easier for Toshiba employees to detect and resolve system problems. System downtime decreased.

As a result of these changes, ratings improved and today there is a substantial gap between Toshiba’s CT rating in MD Buyline and the market average rating.

Continue to enhance

As the market changes, so must organizations and the data their research teams provide. Budget constraints recently required that Toshiba discontinue its win/loss survey data, something that had provided great insight on market perception and helped the company fine-tune its operations to meet customer expectations. Recently though, market changes have increased needs for that data and the company will renew collection of win/loss data - specifically why Toshiba may have won a sale and why it may have lost a particular sale.

With this renewed data source, along with the other currently collected data on the customer experience, Toshiba expects to continue to enhance its perception, position and opportunity for growth in the market. With its ongoing customer satisfaction research program, Toshiba’s ultimate goal is to transition from best-in-class to best-in-industry and, finally, best-in-business.