The Department of Veterans Affairs discovered that
asking questions can help keep veterans healthy and
happy. The Veterans Health Administration, the
health-care arm of VA, regularly asks military
veterans to answer customer satisfaction
questionnaires to gauge its effectiveness in providing
health care. When problems are found, the agency quickly resolves
them, says Dr. Jonathan Perlin, the VA's acting undersecretary of
health, who heads the Veterans Health Administration.
Years ago, a number of patients complained in surveys that
some doctors didn't address all their concerns during their health
clinic visits. To correct that problem, health-care staffers now
routinely ask veterans and their families: "Are there any questions
we didn't answer?" and "Is there anything else we can do?"
The surveys also found that managing pain is a huge concern
among veterans. So rather than just asking about pain
occasionally, doctors and nurses now treat pain as a vital sign by
monitoring it regularly, along with pulse, respiration,
temperature and blood pressure.
These changes have boosted customer satisfaction scores and
improved health care, according to Perlin. "We survey veterans to
make sure our care is as satisfying and effective as possible," he
says, "and we use the information to make improvements."
Every federal agency must cater to the needs of its customers,
and the VA is a prime example. With the war in Iraq,
the VA will soon see an influx of new war veterans
to whom it must provide health care and benefits, so the
agency must continue to find ways to better serve its
A number of federal agencies have turned to internal
and external surveys, and even focus groups, in order
to better understand their customers' needs. The
Federal Aviation Administration (FAA), the United
States Mint and the National Library of Medicine,
for example, have analyzed their survey data to make
significant changes to their Web sites in order to give
customers what they want.
The University of Michigan produced an
independent survey called the American Customer
Satisfaction Index (ACSI). The Treasury Department's
Federal Consulting Group manages the federal
government's role in this survey, which gives customer
satisfaction scores on a scale of 0 to 100, and allows
businesses and federal agencies to compare themselves
with one another. (See "A Helping Hand" on page 42.)
Transforming a Bureaucracy
Eight years ago, the VA reallocated resources and made
new technology investments, such as computerizing
patients' health records, as part of a major restructuring that
transformed a bureaucratic, mediocre health-care organization into
the country's best, Perlin says. "Today, 100 percent of all VA hospitals
are computerized, providing veterans with safer, higher-quality and
more efficient health care," he points out.
In the mid-1990s, the VA had a negative public image. Medical
facilities were run independently, and, at times, they offered
competing services. As part of the overhaul, the VA developed 21
regional health-care networks, in which medical facilities
collaborate and share resources. Customer service also becameÂand remainsÂa top priority.
The department, which now provides health care to
approximately 5 million veterans, used customer satisfaction
surveys as one way to track its performance in categories that
include health-care quality, ability to rehabilitate, reducing wait
times for appointments and cost-effectiveness. VA employees
initially didn't like being held accountable for performance
improvements, but it was necessary, Perlin says.
"There were legitimate questions about the future of VA," he
recalls. "If we didn't change, we would have become deservedly
obsolete. In transforming the culture, we knew the system could
live up to Lincoln's promise, which was to care for those who have
'borne the battle.'" The surveys have worked well. For the past five
years, the VA has outscored private sector health-care providers in
the ACSI surveys, which the federal government uses as its standard
for surveying customer satisfaction. In 2004, veterans gave VA's
inpatient hospital services a rating of 84 and outpatient services
an 83 rating, compared with scores of 79 and 81,
respectively, for private sector health-care providers.
The VA surveys veterans once a month. Nationally, the agency
mails surveys to 50,000 veterans every month. In addition, the
regional medical networks design their own monthly surveys, using
Tablet PCs, comment cards and even phone surveys to track
their performance. "We want to make it easier for
veterans to complain," Perlin says.
Despite high satisfaction scores, the agency isn't sitting still.
Everyone from VA leaders to the health-care practitioners at
hospitals analyzes results on an internal agency Web site and look
for ways to improve, he adds.
"You can't make progress without setting ambitious goals," Perlin
Improving ScoresÂand Sales
To improve customer satisfaction, agencies should use a mix of
internal and external research, advises Gloria Eskridge, the United
States Mint's associate director of sales and marketing. That
approach includes gathering both quantitative data, such as statistics
from questionnaires, and qualitative information, which may be
derived from focus groups. The statistics provide a good assessment
of agencies' strengths and weaknesses, while focus groups
provide specific insights on customers' preferences, she says.
"If you gather numbers, they are just numbers," Eskridge
points out. "You need to make sure you have a plan of action."
The United States Mint, whose ACSI overall agency score of
86 last year was among the highest in the federal government,
uses bimonthly telephone surveys to poll customers on
everything from product quality and packaging to pricing,
order fulfillment and customer service interactions. The
agency also conducts regular online surveys, asking for
suggestions for Web site improvements, and it holds regular
focus groups and informal collectors' forums, where agency
officials talk to coin collectors at coin launches and conventions.
After reviewing the feedback, the agency made numerous
changes, including eliminating its midnight to 8 a.m. call center
and repositioning the staff to accommodate heavier call volumes
during the day. The United States Mint also introduced new
products, such as rolls of half-dollars and nickels, because of
In addition, survey results prompted the agency to introduce
its annual coin sets early this year, Eskridge says. In the past,
some of its annual recurring products weren't available until
summer, which made it difficult for customers who wanted to
purchase coins with the current year on them as gifts to
commemorate special occasions.
The United States Mint also has
revamped its Web site, which accounts for
$127 million in annual sales. The site's
improvements include larger pictures of
"Many collectors buy commemorative
coins based solely on the designs," explains
Sharon Bishop, the Mint's assistant director
for brand management, sales and
marketing. "They don't want to see a two-by-two-inch picture, they want a five-by-five-inch one, so we made them bigger."
Making Customers Happy
At the FAA, Web manager Phyllis
Preston believed airline passengers were
the agency's primary Web site visitors
until an online ACSI survey found that
wasn't the case. Instead, pilots were the
main users of the site, followed by
federal employees and mechanics. The
survey also revealed that visitors seek
information on safety, FAA regulations
and policies, and other data and
So Preston quickly revamped the
Web site to better serve its visitors. On
the initial survey, FAA's Web site visitors
complained about the agency's cluttered
design, which included about 85 links
and small fonts. She streamlined the
links to just a handful of broad topics
and increased the font size.
Three months later, the FAA's online
ACSI customer satisfaction scores
jumped six points, Preston reports. "We
take ourselves seriously with respect to
customer service," she explains. "We
care about creating Web sites that make
it easy for citizens to conveniently get
information and transact business with
Online ACSI surveys also helped the
National Library of Medicine identify an
audience it didn't know it had: artists who
viewed the library's extensive collection of anatomical
drawings. The surveys also revealed that grant seekers
found it difficult to unearth medical funding
information, so the library added a link to grant
funding on the home page.
"We don't have to work in the dark anymore," says
Susan Fariss, technical information specialist for the
National Library of Medicine, referring to the feedback
from surveys. "And we can get ideas for improvements
that we hadn't thought of."
When Fariss makes Web site changes, she conducts
online surveys to immediately poll visitors. The online
surveys pop up on a small percentage of Web visitors'
browsers, asking them a series of questions.
Those online polls help the library do a more
effective job of pleasing customers. "We can see right
away if something new is working," she says. For
example, when the library developed specific pages
for the educational market, ACSI satisfaction scores
from educators and high school and college students
Both the FAA and National Library of Medicine
continue to enhance their Web sites. ACSI survey
results show that FAA Web site visitors still want
navigation improvements and a better search engine,
so Preston is working on a new Web design and
showing samples to focus groups. The FAA plans to
unveil the new design early this year.
The National Library of Medicine also plans to
improve its search engines. Early survey results show
that users of English and Spanish Web sites like to
handle their search functions in different ways, so the
agency might develop different search screens to
accommodate both audiences, Fariss says.
The public, which sends the library roughly
100,000 e-mails a year with research requests, feels
that the library staff sometimes provides too much
information, and sometimes provides too little,
reports Eve-Marie Lacroix, chief of the library's public
services division. She recently learned of these
complaints after conducting e-mail and telephone
surveys of customers.
For example, when someone asks for drug
information, the library staff typically answers with up to four
options, when the customer often wants only one.
"We may streamline some answers," Lacroix says. "We're
erring on the side of giving them too much information. The key
is to reach the right balance for all our users."
While 80 percent of customers feel they get the
right amount of information from the library, those who want
medical advice feel they don't get enough. That's primarily
because library staffers aren't doctors and can't dispense medical
advice, she explains.
Employees Play a Role
Besides using surveys to improve products and services, federal
agencies need to hold their employees accountable for
improving customer service, says the U.S. Mint's Eskridge.
"Make sure you have a performance-based mentality," she
advises. "Ensure that every employee can identify with
your performance metrics and can see what contribution they
can make to affect them."
To do so, agencies also have to care about their employees.
The United States Mint, for example, surveys its workers on
their job satisfaction.
The survey tracks stress levels and teamwork to determine
whether the workers have the necessary training and tools to
do their jobsÂeverything that affects employee performance
and customer satisfaction. If employees need additional
training or tools, the Mint provides that for them.
Happy employees translate into good customer service,
Eskridge points out. "We try to hire and retain the best and
brightest customer-oriented employees," she says.
A HELPING HAND
The federal government has its own consulting firm to help federal agencies
operate more smoothly and serve their customers more effectively.
The Department of Treasury's Federal Consulting Group (FCG) offers a
variety of consulting services to federal agencies, ranging from strategic
planning to facilitating team building and resolving conflicts. The 16-year-old organization also coaches agency leaders to help them improve their
management skills and offers customer satisfaction surveys, which
agencies use to measure customers' attitudes toward their services.
The FCG, which receives no federal funding, competes against
private consulting firms. It operates as a business, charging federal
agencies for its work. The FCG's biggest strengthÂand strongest selling
pointÂis the expertise of its staff and roster of consultants, which
include former high-ranking federal executives, says FCG Executive
Director Anne Kelly.
"We have experience in government," Kelly points out. "All of us have
managed large programs or have held senior-level positions. We pay a
great deal of attention to customizing services, not just giving a cookie-cutter approach."
FCG's clients include the departments of Education, Homeland Security,
and Housing and Urban Development.
The group's most popular service is providing customer satisfaction
surveys, Kelly adds. The organization has partnered with the University of
Michigan to allow federal agencies to use the American Customer
Satisfaction Index (ACSI) to survey their constituents and uncover areas for
"In management, we don't always have actionable or predictive
information on which to base decisions, and through the miracle of the ACSI
model, we can take survey data and transform it into statistically sound
information that managers can use to set priorities and allocate
resources," says Ron Oberbillig, FCG's project director for ACSI.
The ACSI is an independent survey chosen by the President's
Management Council in 1999 as the government standard for measuring
citizen satisfaction. It is run by the University of Michigan, in partnership
with the American Society for Quality in Milwaukee and the consulting firm
CFI Group in Ann Arbor, Mich.
Two years ago, FCG partnered with Foresee Results, an Ann Arbor,
Mich., company that developed a Web-based ACSI survey, to provide
federal agencies with online surveys that specifically track customer
satisfaction of Web sites.
TEN TOP-RANKED FEDERAL AGENCIES
ON CUSTOMER SATISFACTION
95 National Cemetery Administration, VA
Health Resources & Services Administration,
Health and Human Services Department (Maternal
and Child Health Bureau state grantees)
Health Resources & Services Administration,
Health and Human Services Department (Maternal
and Child Health Bureau discretionary grantees)
86 U.S. Mint, Treasury Department
84 Pension Benefit Corp. (serving retirees)
Veterans Health Administration, VA (serving
inpatients at VA medical centers)
Veterans Health Administration, VA (serving
outpatients at VA clinics)
81 Social Security Administration
81 General Services Administration
79 Civil Rights Center, Labor Department
Source: American Customer Satisfaction Index, annual survey released December 2004