When your EOB becomes an SOB!

When is information from a service provider (or any vendor) too little or too much? I'd like to share a recent experience with my health insurance company.

When It Is Too Little. 
My university offered me health insurance on an "opt-out" basis, meaning I was included unless I chose not. The insurance would only covered me and not my family, so I did not want it. I missed the opt-out deadline, and unbeknown to me, I was added to the university policy, which used the same health insurance company as my family policy.

This insurance company, seeing two policies under my name, automatically dropped my family policy. They did not call me, they did not write me; they just sent me a refund check in the mail.

When I received the check, I called them to find out why – it was a refund of my family policy which has been in place over decades with no lapse in premium payment, and yet they decided to cancel it without ever asking me. Stunned and outraged, I had to buy a separate "bridge" policy for my family from a different insurance company.

Eventually I was able to reinstate my cancelled family health insurance policy and get off the university plan, but it took a month of calls to both the insurance company and university and dealing with their bureaucratic processes before finally getting things straighten out.


When It Is Too Much. 

Yesterday, my insurance company just sent me a revised EOB (explanation of benefits), about a hospital treatment from a few months ago, for which they had already reimbursed since then. I have the original hospital bill as well as the first EOB showing a balance of $0.00.

However, the revised EOB I just received indicated that nothing had been paid to the hospital and that I was responsible for the full amount (it was expensive!).

I called the insurance company and they explained these details: After the original bill was reimbursed, the hospital lowered their price (hospital billing error) and re-sent a smaller bill to the insurance company. This triggered the insurance company to "take back" the original payment and send me a revised EOB explaining nothing had been paid.

Then, the insurance company paid the hospital the lower amount, and issued a "revised, revised EOB" showing that my balance was now $0.00 again. This revised, revised EOB will be mailed to me next week, they tell me. How confusing!

In other words, in this case the insurance company, for some internal reason, decided to write to me the intermediate information that I did not need to know. Because of this intermediate and incomplete information, I became very worried and spent a lot of time, trying to find out what happened. It would have been better had they told me nothing and just handled the transaction between the hospital and the insurance company. SOB!

Kansei Engineering and Education

One of the "cousin" methods we use in Modern QFD is called Kansei Engineering, which I often translate as emotional quality (when used by itself) or lifestyle deployment (when combined with QFD).

The original concept creator, Dr. Michio Nagamachi, also uses it for ergonomics (both physical and emotional) in order to elevate a produce above its pure functionality.

In a January 5, 2013 article in the New York Times by Al Baker, "Ergonomic Seats? Most Pupils Squirm in a Classroom Classic", the subject of school chairs interested me greatly. It seems that even today, most schools see chairs as a means to corral children so they can learn in the traditional school settings that date back to the 19th century 5-S approach: sit straight, speak only when spoken to, study only the books we approve, store easily, and save money.

Saving money seems to still trump the others, as schools continue to buy chairs that will last 30-50 years. Despite a German study and recent experience that children's comfort and engagement are improved with more ergonomic and mobile chairs, schools are slow to change. Professor Galen Cranz in her 1998 book "The Chair: Rethinking Culture, Body and Design," wished child movement were accorded more consideration.

From a QFD and Kansei perspective, children should be seen as "customers" and users of the chair.  Today's classrooms, group work, electronics, and other educational tools should be observed in "gemba" visits (actually go to a classroom and see how teachers and students interact), so that 21st century chairs and desks can be created to help children achieve their educational goals.

I know observing children is problematic, and adjustments to the gemba methods must be made. You may find these papers helpful:

• "Jurassic QFD" (1999) where children were observed in a petting zoo during the design of an animatronic triceratops

• "Elementary QFD: Using QFD to Assess and Evaluate the Learning Environment of a Private School Library and to Systematically Engage an ISACS Review" (2012) where an elementary school library was evaluated for improvement.

• "Brand Engineering using Kansei Engineering and QFD"(/u> - a student research paper on chair design by using Kansei Engineering and QFD.

Capturing voice of social network and using it

Brian X. Chen reports in the January 2 2013 Bits section of the New York Times, "The iPhone Goofs Up on Telling Time, Again," that the new Do Not Disturb (DND) function on iOS6 iPhone failed to turn off for many users on New Years Day.

This is a new feature that allows iPhone users to set a quiet time (like when you sleep) to block incoming calls and alerts. It is suppose to turn itself off at a pre-determined time so that calls, alerts, and alarms can be heard.This bug is even more noteworthy because it is featured in a new television commercial airing this week. NYT readers first blasted Apple for the bug, and then turned on themselves for whining about such a small inconvenience.

This brings to mind two QFD concepts. The first is the famous "Sales Point" column in the quality planning table room on the right side of the House of Quality matrix (or done independently in Blitz QFD^®) where a selling point is given extra weight which eventually strengthens the improvement calculation for related technical requirements. Below is one example of a HOQ with Sales Points weights (the yellow highlighted column).

The purpose of the "sales points" column has been frequently challenged as it seems to do the same job as the relative importance and the level-up columns, and is thus redundant. Dr. Akao's purpose, however, was to add a sales point value when the associated customer need is going to be promoted, as in the case of this Apple commercial. The added weight would direct engineers and software developers to  pay more attention to its auto on/off functionality.

The second point, I commented myself back to the New York Times:

"I see the DND issue as one of software quality. Developers often have incomplete or inaccurate use cases around which they design their features and code. They do not fully understand how the feature gets used in real life, and so sometimes get it wrong. Like the proverbial mushroom, they are kept in the dark and fed s**t!

It is comments from users like you who post here that can provide the necessary insight to do the job right the first time. There are methods for analyzing the voice of the customer, like QFD, that actually build on your feedback and help marketeers and engineers do their jobs better. So keep on blogging and contributing your experiences - we will all benefit."

My second point is that every opportunity to get customer feedback should be welcomed by a company. Many companies do monitor social media as part of their customer relationships management (CRM) programs, but not all companies forward the information to new product development departments.

The customer voice table is the QFD tool for analyzing these comments. In order to give engineers direction for improvements and next generation products, negatives and complaints should be reversed into positive statements, and technical solutions should be translated into product independent customer needs.

Related Reading...

• QFD for Software and IT Projects

• QFD for Predicting Future Technology Risks

• Trusting Front Line Employees To Be Customer Advocates

• Learn Blitz QFD^® tools ... QFD Green Belt^® Certificate Course