Why Understanding and Involving the Customer Matters in Behavioral Health

Mat Roosa, LCSW-R
NIATx Coach

Treatment organizations continue to face the challenge of improving access to and retention in treatment. NIATx (originally known as The Network for the Improvement of Addiction Treatment) was developed specifically to help treatment providers make simple, powerful changes that can improve service delivery.

NIATx is based on five principles. The first principle, Understand and Involve the Customer, is number one for a reason. According to the research that was foundational to NIATx, this principle has more impact on the success rates of change implementation than all of the other four principles combined!

Listening to the voice of the customer
Everyone has heard the old business adage, “the customer is always right.” Many of us struggle with this concept. While a shoe store might take back a pair of shoes with half the sole worn off, do we really think that the customer is “right” to ask for the refund? Principle #1 helps us to understand just how right the customer always is.

There is no more important vision and voice than that of the customer. The customer is the only one who can tell us what they feel and what they want. The customer is always right about their perceptions of their experience, and that perception is the most important concern when we are trying to engage and help them. The best product or service will not be successful unless it is embraced by the customer.

So, what steps can we take to engage and involve the customer better?
I recall being at a meeting during which a veteran administrator was asked how recipients of services would feel about a major change. As he waxed on about a number of variables, I could see a supervisor of peer services, a woman with a great deal of lived experience as a service recipient, growing more and more frustrated. When he took a breath, she simply said, “Why don’t you just ask them?”

Why don’t we spend more time “just asking them”? The asking of customers requires that we treat them as partners at the table of service development and service improvement. While most would say they are willing to ask, fewer are willing to invest the time and ready to relinquish the control that is required for genuine asking. The walk-through, the Empathy Map and the Nominal Group Technique are three tools that will help teams to build a culture that values customer input.

The walk-through
One essential NIATx tool is the walk-through. This role play exercise in which staff walk through the client experience is typically conducted at the beginning of the change project and helps teams see treatment barriers and process problems that are often hiding in plain sight. Walk-through exercises have uncovered issues such as an incorrect phone number listed as the agency contact information, poor directions to the treatment location, confusing signage at the facility, unwelcoming waiting areas, and lengthy intake sessions that require excessive or duplicative paperwork.

Here are a few tips for ensuring a successful walk-through:

1. Inform your staff: The team should be prepared for the experience. You want to see the process at its best, and then consider how it can be improved.

2. Stay in your role: complete the process in an authentic fashion.

3. Note the details of the process, and your emotional experiences

4. With each step of the process ask two questions: Is this necessary? If yes, Is it the best that it can be?


The Empathy Map
What do your customers say, think, feel, and do? What are their goals? Draw a large version of the Empathy Map grid, and ask your team members to write single ideas on sticky notes to be placed in the five sections of the grid. This tool will cultivate empathy for your customers’ experiences. It can serve as a way to gather all of the wisdom that customers have shared with administrative and treatment staff over time, and can help to identify key themes that will lead toward improvements. These questions are also an excellent structure for asking customers for feedback through interviews or focus groups.

The Nominal Group Technique

Using the Nominal Group Technique (NGT), another essential NIATx tool, is an excellent way to brainstorm with a team that includes customers, The structure of the process is designed to create inclusive participation among the team members. The four steps of the NGT process are intended to ask a powerful question and encourage listening to all of the answers offered. It can empower customers, and teach staff members about the value of the customer voice.

Four steps of the NGT

The walk-through, Empathy Map, and the NGT: three critical tools for understanding and involving the customer, and understanding just how right the customer is.

About our guest blogger:
Mat Roosa was a founding member of NIATx and has been a NIATx coach for a wide range of projects. He works as a consultant in the areas of quality improvement, organizational development and planning, evidence-based practice implementation, and also serves as a local government planner in behavioral health in New York State. His experience includes direct clinical practice in mental health and substance use services, teaching at the undergraduate and graduate levels, and human service agency administration.

You can reach Mat at: matroosa@gmail.com