on 23-May-2022 (Mon)

Companies of all stripes have invested heavily in tools and technologies to help them understand their customers more deeply and to gain the advantages of superior customer experience (CX). Yet as leaders strive to form a more complete picture of customer preferences and behaviors, they continue to rely on aging survey-based measurement systems that for decades have formed the backbone of CX efforts. Companies use these systems to track CX performance through brand or relationship surveys, “close the loop” on customer feedback via post-transaction surveys, and even plot strategic moves by attempting to mine the feedback from their regular surveys over time.

The trouble is, executives increasingly recognize that survey-based measurement systems fail to meet their companies’ CX needs—although surveys themselves are an important tool for conducting research. In fact, this article draws on our recent survey of more than 260 CX leaders from US-based companies of all sizes. 1 Ninety-three percent of these respondents reported using a survey-based metric (such as Customer Satisfaction Score or Customer Effort Score) as their primary means of measuring CX performance, but only 15 percent of leaders said they were fully satisfied with how their company was measuring CX—and only 6 percent expressed confidence that their measurement system enables both strategic and tactical decision making

As problems with traditional survey-based solutions: Leaders pointed to low response rates, data lags, ambiguity about performance drivers, and the lack of a clear link to financial value as critical shortcomings

A few leading companies are pioneering a better approach that takes full advantage of the wealth of data now available. Today, companies can regularly, lawfully, and seamlessly collect smartphone and interaction data from across their customer, financial, and operations systems, yielding deep insights about their customers. Those with an eye toward the future are boosting their data and analytics capabilities and harnessing predictive insights to connect more closely with their customers, anticipate behaviors, and identify CX issues and opportunities in real time.

In this article, we explore how data and analytics are beginning to transform the art and science of customer experience. We present new research that brings clarity and a fact base to the shortcomings of survey-based measurement systems. We then examine how a few leaders have implemented data-driven CX systems and in turn reduced churn, boosted revenue, and lowered cost to serve. We end with insight on how to get started, including four key steps for CX leaders as they transition toward data-driven insight and action.

The CX programs of the future will be holistic, predictive, precise, and clearly tied to business outcomes. Evidence suggests that the advantages will be substantial for companies that start building the capabilities, talent, and organizational structure needed for this transition. Those that stick with the traditional systems will be forced to play catch- up in the years to come

While surveys themselves are a valid means of gathering customer insight, they fall short as a management tool for measuring CX performance and identifying and acting on CX opportunities. For organizations to lead from a customer-centric position, they increasingly need a comprehensive view of the full customer journey, as well as the ability to obtain deep, granular insight on what is driving customer experience. They need immediate and individual signals in order to take action “in the moment” and to create relevant experiences for each customer, and they need to demonstrate that the experience enhancements they would like to invest in will result in positive ROI.

Disadvantags of survey-based CX measurement

1. Limited: The typical CX survey samples only 7 percent of a company’s customers, providing an extremely limited view of what customers experience and value. In fact, only 13 percent of the CX leaders we surveyed expressed full confidence that their CX measurement system provides a representative view of their customer base

2. Reactive: Surveys are a backward-looking tool in a world where customers expect their concerns to be resolved increasingly quickly. Nearly two-thirds of respondents ranked the ability to act on CX issues in near real time as among their top three priorities, but only 13 percent of leaders expressed certainty that their organizations could achieve this level of rapid insight through existing systems

3. Ambiguous: Surveys often fail to reveal the root causes of customer sentiment. In fact, scores can vary based on many outside factors, including geographical bias and industry shocks, making it difficult to perform reliable root-cause analysis using surveys alone. Only 16 percent of CX leaders said that surveys provide them with granular- enough data to address the root causes of CX performance

4. Unfocused: As one executive at a large financial-services company put it, “The association between survey-based scores and business outcomes is not well understood, and, as a result, many parts of the organization simply claim a business impact from their CX initiatives with no real evidence.” Several companies have recently come under fire for basing investment decisions on a survey-based score alone. Remarkably, of the CX leaders we surveyed, only 4 percent said that their system lets them calculate the ROI of CX decisions

Why use a survey to ask customers about their experiences when data about customer interactions can be used to predict satisfaction?

Why use a survey to ask customers about their experiences when data about customer interactions can be used to predict both satisfaction and the likelihood that a customer will remain loyal, bolt, or even increase business?

Predictive customer scores

The company develops analytics—often using several types of machine-learning algorithms—to understand and track what is influencing customer satisfaction and business performance, and to detect specific events in customer journeys. The algorithms generate predictive scores for each customer based on journey features. These scores allow the company to predict individual customer satisfaction and value outcomes such as revenue, loyalty, and cost to serve. More broadly, they allow CX leaders to assess the ROI for particular CX investments and directly tie CX initiatives to business outcomes

Action and insight engine

Information, insights, and suggestions are shared with a broad set of employees (including frontline agents) and tools (such as customer-relationship-management platforms) through an application-programming-interface (API) layer. For example, agents can receive alerts and notifications about the actions they should take to personalize customer experiences and improve CX outcomes. The API layer serves as a single source of truth, fueling recommendation engines based on both the data lake and customer scores. Importantly, the predictive platform, unlike survey-based systems, delivers timely insights and spurs swift action, both by employees and through digital interfaces.

Rather, my outcome is only a function of my own treatment. We’ve been using this assumption implicitly throughout this chapter. We’ll now formalize it.

Assumption 2.4 (No Interference) 𝑌 𝑖 (𝑡 1 , . . . , 𝑡 𝑖−1 , 𝑡 𝑖 , 𝑡 𝑖+1 , . . . , 𝑡 𝑛 ) = 𝑌 𝑖 (𝑡 𝑖 )

Currently, the mortal- ity of IE is reported between 14% and 37%. 3–7

Higher risk for IE is now being found in patients who are elderly, 3,5,7,9,11,12 chronically ill, 6 have prosthetic valves, 11 or go through invasive procedures. 1

Within the past couple of decades, there has been a world- wide increase in IE caused by S. aureus. 3,6,9–11,13,14 Chronic hemodialysis (CHD) mimics the intermittent venous access seen in IVDU and could possibly contribute to this rise, par- ticularly in the United States where there is a large population with end-stage renal disease (ESRD) and many opt for CHD over peritoneal dialysis. 15

By independently analyzing the epidemiology of IE in the Hampton Roads, Virginia area, we determined the risk factors that are most prevalent in our IE population. By reviewing each risk factor’s associated microbiology and clinical outcomes, we hope to determine associations with 30-day mortality.

For analysis by risk factor, risk factors studied were CHD, history of IVDU, other long-term cardiovascular (CV) access, presence of a prosthetic valve, other intracardiac device (ICD), known valvular or structural heart disease not already included above, immunocompromised state, and poor dentition.

Immunocompromised conditions were defined as HIV infec- tion, use of immune-suppressants for transplant rejection, and active non-skin cancer or chemotherapy. Those with HIV were analyzed for CD4 count closest to admission and for appropriate highly active antiretroviral therapy (HAART)

A total of 492 potential cases were identified through the above ICD9 codes with 363 that met definite criteria for IE and the rest meeting possible criteria for IE.

The mortality for all cases of definite IE was 20.7%, 26.2%, and 29.2%, respectively, at 30, 90, and 180 days after admission.

The number of patients who experi- enced embolic phenomena is shown in Table 1.

CHD was the most common risk factor, associated with 91 (26.5%) cases. The number of cases associated with each studied risk factor is shown in Table 2.

There were 22 cases associated with an immunocompromised state with only 7 associated with HIV (1.9% of all definite IE cases). Of these 7 HIV-associated cases, 2 had CD4 <200 with="" both="" on="" appropriate="" HAART,="" 3="" CD4="" between="" 200="" and="" 500="" two="" 2="">500 that were not on appropriate HAART.

There was a total of 256 (74.6%) involving a native valve, 63 (18.4%) involving a prosthetic valve, and 27 (7.9%) involv- ing a device.

There is a general decreasing trend of S. aureus IE and an increasing trend in CoNS and enterococcal IE as age groups got older

The likelihood of undergoing valvular surgery was greatest in IE caused by fungus and other streptococci (χ 2 = 20.24, p = 0.0025). VGS IE was more likely to have valvular surgery than S. aureus (OR = 3.2, 95% CI = 1.48–6.81, p = 0.0020) as well as CoNS (OR=2.2, 95% CI = 0.86–5.43, p = 0.0993) although the latter failed to reach significance.

In our population, CHD was the most common risk factor found in all definite IE cases. CHD patients had the highest 30-day mortality and were also more likely to be infected by any staphylococcal species.

IVDU-associated IE had the lowest 30-day mortality. This may be explained by IVDU patients’ better immune status and younger mean age than CHD patients, possibly allowing them greater survival and the ability to clear bacteremia by less virulent skin flora.

The higher incidence of VGS IE in the IVDU population is likely due to the practice of cleaning needles with saliva and subse- quently introducing oral flora into the CV system with drug injection.

Additionally, it has been discussed in prior reviews and studies that technique for accessing arteriovenous dialy- sis fistulas predisposes to bacteremia. 24

However, one study used mupirocin gel prophylaxis in CHD patient that had a history of local or systemic infection and showed no differ- ence between access methods. 25

VGS had the lowest mortality which may be due to its association with two risk factors with lower average ages and possibly healthier immune status (IVDU and native valvular/structural heart disease) as well as more bactericidal antibiotic options

ur study showed a similar 30-day mortality to that reported in the literature at 20.7%. Those aged 58–77 years had the highest mortality.

While age and comorbidities likely accounted for higher mortality, it is interesting to note that those aged 78–97 years had the lowest mortality (p = 0.0393). This differs from prior findings in the literature that found that age >65 years was an independent predictor of mortality in IE. 26 This difference in our population could be due to sev- eral reasons. One is that those living past 78 years may not have suffered the comorbidities of those in next youngest age group, such as CHD due to ESRD. It also could be an age- related general decrease in immune status predisposed them to more infections by organisms not as likely to affect younger populations that we have better antibiotic coverage for. This was shown by having the highest likelihood enterococcal IE (p = 0.0406) along with their lower likelihood of S. aureus IE than those aged 18–37 years (p = 0.0305).

Most emboli located to the brain. The reason is likely two-fold. First, providers are more likely to take neurologic symptoms more seriously, from altered mental status to clas- sic stroke symptoms, and be more inclined to order brain imaging. This can possibly identify infarcts that may or may not explain the patient’s symptoms. Second, the arteries to the brain make up some of the first branches of the aorta, with their upward direction being more of a straight-shot than the lateral branches going to the upper extremities

Those with poor dentition did understandably have higher rates of VGS, although S. aureus was still the most common causative organism. This is likely due to poor dentition in our study being discovered by imaging rather than signs or symptoms, giving a bias toward dental abscesses which may be more associated with S. aureus.

Those with other valvu- lar/structural cardiac disease had a higher prevalence of VGS IE than those with CHD, likely due to the same mechanism that predisposes those with rheumatic heart disease to develop subacute IE caused by VGS

Despite the large HIV population in the area, less than 2% of cases were asso- ciated with HIV which does not appear to be an important risk factor given the various CD4 levels and use of HAART

In our hospital, CHD is often a condition that prevents a patient from being a surgical candidate as many studies show increased mortality in CHD patients undergoing valvular surgery for IE versus non-CHD patients. 21,27 However, one study found that of patients with CHD-associated IE, those who underwent valvu- lar surgery had a 15% lower in-hospital mortality compared to those treated only medically. 28

Our study population for CHD-associated IE undergo- ing valvular surgery was too small to draw conclusions from.

First, the decrease in rheumatic heart disease and the increase in degenerative heart diseases have led to an increase in patients’ age and frequency of comorbidities [2, 3]. Second, the use of prosthetic valves among patients h as increased steadily [3]. More recently, it has been suggested that a growing proportion of cases of IE were hospital acquired [4] and/or healthcare related [5], especially cases involving Staphylococcus aureus [6]. Finally, injection drug use [7] and hemodialysis [6, 8] may also have contributed to changes in the presentation of IE.

Of the remaining 632 patients, 135 did not fulfill the criteria for definite IE (IE was probable in 105 cases and excluded in 30). The present report is based on the remaining 497 cases of definite IE.

The crude annual incidence of IE was 32.4 cases per million inhabitants (95% CI, 29.6–35.4), with 50.7 cases per million in- habitants in men (95% CI, 45.6–56.1) and 15.9 cases per million inhabitants in women (95% CI, 13.3–18.9).

Interestingly, most of the increased incidence of IE in male patients aged $50 years was attributable to healthcare-associated IE (Figure 2)

Of note, 262 patients (52.7%) had no previously known heart disease. Sixty-six patients (13.3%) had an intracardiac device (8 had implantable cardiovertor defibrillators, and 58 had pacemakers)

The time between the last surgical procedure and IE was ,1yearin 23 cases (22.1%).

For 493 patients, fever was absent in 69 (14.0%). Heart failure was common (in 168 patients [33.8%]), reaching New York Heart Association class 3 or 4 in 100 of 455 patients (21.9%).

An imaging procedure (cerebral, thoracic, or abdominal) was performed for 434 (87.3%) patients, as part of routine screening in 310 (71.4%) patients for any imaging, in 256/349 (73.4%) patients for cere- bral CT/MRI, and in 323/337 (95.8%) patients for abdominal CT or ultrasonography

At least 1 vascular phenomenon was evidenced in 235 patients (47.3%) and consisted of embolism (in 224 patients [45.1%]) (Table 2), intracranial hemorrhage (in 29 [5.8%]), mycotic aneurysm (in 19 [3.8%]), and Janeway lesion (in 8 [1.6%]).

Immunologic manifestations were ob- served in 58 of 487 patients (11.9%) and included glomerulo- nephritis (in 11 of 473 [2.3%]), Osler nodes (in 13 of 484 [2.7%]), Roth spots (in 3 of 439 [0.7%]), and positive rheu- matoid factor (in 35 of 129 [27.1%])

Transthoracic echocardiography was performed for 497 patients (100%), and transesophageal echocardiography was performed for 437 (87.9%). A major echocardiographic criterion was present in 460 patients (92.6%): 435 (87.5%) had vegetations (in 148 of the 348 patients [42%] whose vegetation size was recorded, vegetations were $15 mm long), 80 (16.1%) had an abscess, and of the 104 patients with a valve prosthesis, 19 (18.3%) had prosthesis dehiscence

n the 66 patients with intracardiac stimulation devices, IE was located on leads only in 26 (39 .4%), on tricuspid valve and/or leads in 21 (31.8%), on leads and left heart valves in 2 (3.0%), and on left heart valves only without evidence of lead involvement in 13 (19.7%); the location of IE remained uncertain in 4 patients (6.1%)

Causative microorganisms were identified in blood cultures for 451 of 497 patients (90.7%)

In patients with negative blood culture results, the causative microorganism was identified by valve culture for 5 patients, by lead culture for 3, by culture of synovial fluid for 2, by PCR of valve material and/or blood for 8, by serology for 1, and by both serology and PCR of valve material for 1.

Eventually, 26 patients (5.2%) had no microorganism identified.

Table 3 shows that S. aureus was the most frequent single species among IE-causing microorganisms, accounting for .25% of all cases

According to the mode of acquisition, streptococci overall, as well as oral and group D streptococci individually, were more frequently responsible for community-acquired IE, whereas both S. aureus and coagulase-negative staphylococci were more frequently responsible for healthcare-associated IE.

Indications for surgery were hemodynamic for 142 patients (63.7%), uncontrolled infection for 100 (44.8%), and embolic for 116 (52.0%).

The overall in-hospital mortality rate was 22.7% (113 pa- tients)

The mortality rate among patients with prosthetic valve IE was not significantly higher than that among patients with native valve IE

In the subgroup of patients with community-acquired IE, results remained essentially similar to those observed in the whole population: S. aureus as the cause of IE (HR, 2.82 [95% CI, 1.72–4.61]; P 5 .0001), the development of cerebral com- plications (HR, 2.38 [95% CI, 1.45–3.93]; P 5 .0007), and a greater age (HR, 1.04 [95% CI, 1.02–1.06]; P 5 .0001) were the 3 most significant prognostic factors

By contrast, in the sub- group of patients with healthcare-associated IE, S. aureus was the only factor associated with a higher risk of in-hospital death (HR, 2.54 [95% CI, 1.33–4.85]; P 5 .005)

The 2 most important results of this study are that (1) S. aureus has become the predominant species responsible for IE in France and (2) healthcare-associated IE now represents .25% of all cases of IE

These figures clearly illustrate the dra- matic change of paradigm in IE: within a few years, this dis- ease shifted from an infectious disease mostly of dental origin to mostly a healthcare-related infection, as previously high- lighted by other studies [16, 22–25]

A total of 11.4% of all healthcare- associated cases of IE were nonnosocomial; this proportion was lower than that in the United States but higher than that out- side the United States, as determined in the ICE S. aureus IE study by Fowler et al [6]