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An Ounce of Prevention: How Predictable Disasters Redefine Quality Healthcare 

Meaghan Hudak | Reading time:

In recent months you may have heard about the ISG Measuring Customer Satisfaction Initiative and wondered what our team is up to. Here we’ve answered some common questions about the work, how to get involved, and everything you should know to be looped in. 

What is CSAT? 

Customer satisfaction refers to initiatives that allow an organization to gather feedback from its customers about how well it is delivering its products and services and how it might improve delivery. Customer research methods allow us to answer a wide range of questions to better serve our customers. We often prioritize research methods that answer specific and immediate questions for our projects at hand. How much time do users spend on a critical task? Do customers understand our instructions? Though, questions that yield insights for the totality of the customer experience (CX), such as customer satisfaction questions, help us to strategically inform project planning and prioritization across the enterprise. 

While customer satisfaction as an idea is a general one, CSAT is more defined and refers to a particular type of customer feedback survey. CSAT surveys allow customers to assess and provide feedback, both quantitative and qualitative, on customer service and product quality. 

CSAT surveys are an ‘always on’ method of continuous data collection that allow us to measure aspects of the CX. These surveys typically provide insights related to: 

• Overall customer satisfaction 
• Ease of use 
• Efficiency 
• Open-ended, qualitative feedback 

Most commonly, CSAT surveys are delivered to customers via email or in the context of a user interface, with a site intercept survey tool/form. The latter has many benefits, most importantly that customers can answer questions while immersed in the experience when it is most fresh in their minds. 

Measuring the CX with a CSAT survey is an excellent step toward continuous improvement, but it’s what we do with the insights to drive and improve the experience that really counts. For this reason, it’s crucial to have a process in place for making sense of data, especially open-ended, qualitative feedback. 

What You Need to Know About the Initiative 

The goal of the ISG Measuring Customer Satisfaction Initiative, simply put, is to create a consistent and repeatable external customer feedback loop across ADOs and ISG-supported information systems, allowing teams to measure the CX and efficiently improve these experiences based on these new customer data points. 

Our benefit hypothesis is that obtaining CSAT data will result in: 

• Consistently tracked customer satisfaction and opportunities for improvement 
• Ability to provide consistent, recurring framework for reporting and objective-setting from ADOs on research and design 
• Business cost and time savings by reducing mistakes and need for rework  
• Quantitative indicators of how HCD adoption leads to improved customer satisfaction 
• CMS/ISG alignment with other agencies to improve the public’s trust in federal government  

Our focus is to create customer feedback loops across external-facing ISG systems via site intercept surveys. We are specifically addressing external-facing systems for the first phase of this work and hope to also expand this work to internal-facing systems in the near future. The site intercept survey tools we’ve prioritized for this work include Survey Monkey, an enterprise solution, and Touchpoints, a GSA developed tool for government agencies. 

How We Can Help 

The HCD Center of Excellence is here to support you as you participate in the initiative. We can partner with you through key tasks, such as: 

4 minutes 

Disasters such as wildfires and heat waves have well-understood health consequences. Historically, the U.S. has defined “quality care” during and after disasters as fast response. However, climate changes are turning previously uncommon events, such as massive wildfires, into annual tragedies.  

Attendees learned: 

• The immediate and residual impacts of natural disasters caused by climate change on communities and healthcare systems,
• What providers and health networks do when wildfire season joins flu season as a routine hazard for people with asthma and/or diabetes, and
• How Medicare can reimagine the services and models they provide to better serve their population.

Case Study: The Camp Fire​

Before I begin, I want to start with this quote provided by Kristine and Elizabeth, 

"Climate changes are turning what were rare events into annual rituals.​

Predictable emergencies challenge our current preventive healthcare model.

This talk explored how predictive modeling and equity-oriented healthcare might help us heading off hazards before they become public health disasters."

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The Camp Fire started at 6:30 a.m. on Camp Creek Road in Paradise, California, Northern California's Butte County. The fire ​spread at eighty football fields per minute. ​Within four hours, the fire burned down the town of Paradise and surrounding areas. This distaste is close to the heart of speaker, Kristine Nixon. She could see the fire from her home in real time and her community was directly impacted from the fire. As a result, 50,000 people were evacuated. ​The aftermath of the disaster resulted in over 19,000 homes and businesses destroyed, 30,000 people permanently displaced, and 86 people killed, ​most over 60 years old. Paradise was a retirement community. ​A quarter of the population were 65 and older. ​Many left behind medications, wheelchairs, walkers and essential medical equipment. ​Respiratory illnesses increased due to smoke and particulate matter. ​Norovirus (stomach virus) swept through the temporary shelters. The emphasis and support was on physical health and basic needs.

A New National Landscape of Community Risk​

Two months later, the need for temporary shelter became permanent. ​Hazardous materials, water contamination, and smoke damage prevented residents from returning to Paradise. ​The median house price increased from $325K to $400k. ​Seniors on fixed income didn’t have the energy to rebuild or the finances to buy. Butte County lost significant healthcare services: ​

• 101-bed acute hospital (and leading employer)​
• All emergency services in Paradise​
• Medical offices and providers​
• Long term care facilities and care homes​
  

Four years later, the senior population is priced out of housing and rental markets: ​

• 92% of Paradise’s population resettled elsewhere ​
• Medium house price in Chico increased by $175,000​
• Oct 2018 = $325,000​
• May 2022 = $500,000​
• One-bedroom apartment rent = $1,250​
• 26% of the homeless population in Butte County is now over 65​

The speakers explain that housing has become the main social determinant of health. Rural communities have to travel further for health care​. Providers have moved out of the area, exacerbating the healthcare shortage​. Rural hospitals lack the bargaining power of larger hospital networks to set rates, yet face increased demand and costs.

Image Added

Graphic: If you compare 1984 to 2001 to 2002 – 2020, more acres of each state burn each year almost everywhere from Alaska to Texas. 

The wildfire affects people of all ages. It’s especially bad for children, people over 65, and those with various chronic diseases. Kristine reminds us that western smoke isn’t just the West Coast’s pollution. This becomes a nationwide problem. The reason more people will be affected by wildfire pollution is that much of the US is likely to face conditions conducive to wildfires – especially in summer and fall. ​

It’s only relatively recently that all the necessary factors for reliable extreme event prediction have come together: ​

• Large datasets​
• Compute power​
• Tested scientific models​
• And, unfortunately, frequent events to test predictions against.​

Disasters are not inevitable 

​Not all wildfires are disasters.​ A hazard becomes a disaster when its negative effects overwhelm a community’s ability to mitigate them. The speakers emphasize that ​a disaster is a risk, ​not a certainty. ​

​Image Added

Graphic: The National Risk Index is an application from FEMA that identifies communities most at risk to 18 natural hazards. This application visualizes natural hazard risk metrics and includes data about expected annual losses from natural hazards, social vulnerability and community resilience. 

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Population-based risk practices plus preventive medicine have turned acute crises into routine management. Kristine asks us to to consider cardiovascular care. Since at least the 1990s, death rates from heart disease were in decline. In 2020, during the pandemic, they spiked up. What caused the spike? Lost access to preventive care.​ Risk-based screenings and preventive interventions made a difference. ​Preventative care uses statistical population risk factors to guide individual interventions.  The speakers ask us to question ​community-based disaster risk factors and community-based health ecosystem interventions. 

Conclusion

We learned that environmental disasters don’t end once they are cleaned up. They impact the most vulnerable populations first, and the hardest.​ They damage healthcare systems as well as communities.​ Wildfires are creating healthcare deserts.

Climate change is quickly becoming a social determinant of health. ​Lack of food, transportation, housing and access to care is impacting more of the Medicare population. ​

Kristine and Elizabeth challenge us to think,

"Maybe it’s time to think about expanding Medicare providers to include advocacy organizations?" "How might we all, together, become more resilient and prepare for predictable disasters?"

If you missed Kristine and Elizabeth's presentation, check out the transcript and recording on the CCSQ World Usability Daypage. This page also includes an archive of transcripts and recordings of speaker presentations, session materials, and event photos. For more information about the Human-Centered Design Center of Excellence, refer to the HCD CoE Confluence page.

Next Steps 

As we partner with teams across ISG to accomplish this work, we also plan to share our progress through case studies and lunch ‘n’ learns. If you have any questions about CSAT surveys, the ISG Customer Satisfaction Initiative, or would like to be added to our email distribution, please contact us at hcd@cms.hhs.gov. We look forward to working together and keeping you looped in to this work.