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The Scourge Of Customer Satisfaction Surveys
All I can really say about the appointment at my kid's allergist is that it occurred. We waited weeks to get in, got some tests, received a diagnosis and a treatment plan, had a weird insurance thing that wasted our time. American healthcare took place.
Then I got a survey.
The email contained the usual set of questions. How would I rate the service I received? How likely was I to recommend them to a friend? But I've gotta say, getting asked how satisfied I was with the care provided by a pediatric allergist was baffling to me. My child received necessary medical treatment at a speed commensurate with its urgency. It was fine. What aspect of it could I possibly evaluate? I don't need to express an opinion about the chairs in the waiting room.
The whole thing vexed me enough that I started to really notice customer satisfaction surveys — and, as I'm sure you've seen, they are everywhere. It seems like every interaction I have with a money-involving organization also comes with a polite request for my feedback. A restaurant. A hotel. A shop. The insurance company that wasted my time. Every time I buy something or interact with someone: another survey. While I was pitching this story to my editor, his email dinged. A survey! How'd we do? How long was your wait time? How satisfied were you with the knowledge and professionalism of the salesperson who served you?
Most of the time I'm not asked to evaluate the quality of a product or service. I'm asked to evaluate the experience, the meta-consumption that drives our hyperactive service economy. A tsunami of surveys has turned us all into optimization analysts for multibillion-dollar companies. Bad enough I'm providing free labor to help a transnational corporation improve its share price or "evaluate" a low-paid, overworked, nonunion employee. It's more than annoying. I'm starting to suspect it's unethical.
This isn't just my imagination. We're all getting more requests for feedback. Global spending on market research has doubled since 2016, to more than $80 billion a year. More than half of that money is doled out in the United States, and a fifth of it — $16 billion! — is devoted to customer surveys.
Consider the experience of Qualtrics, one of the largest survey-data companies. In the past year, the firm has analyzed 1.6 billion survey responses. That's a 4% increase over the prior year — and responses for the first quarter of 2024 were 10% above what Qualtrics projected. Its analysis of "non-structured data," which is to say customer-service phone calls and online chatter, hit 2 billion conversations last year. This year the company projects an increase of 62%.
Why are there suddenly so many surveys? Because people have so many options today that they're not bothering to complain when something sucks. They just move on to a different, equally accessible website. A company pisses them off or disappoints them, and poof! They're gone.
"When a customer has a poor experience, 10% fewer of them are telling the company about it than they did in 2021," says Brad Anderson, the president of product and engineering at Qualtrics. "What's happening is they're just switching." So companies are using surveys in a bid to hang on to those unloyal customers. After all, it's way more expensive to acquire a new customer than keep an old one.
The tricky part is marketing research has shown that the objective quality of a product, its nominal goodness, matters less than whether it meets customer expectations. "Quality," as one research paper put it, "is what the customer says it is." Customer satisfaction correlates with profitability, with share price, with success.
Now, to get all philosophical for a moment, what even is satisfaction, anyway? People tried for decades to figure that out. Then, in 2004, a Bain consultant named Fred Reichheld came up with an answer. He called it the Net Promoter Score.
Before I tell you what that is, let me ask you a question: On a scale of 1 to 10, how likely would you be to recommend this article to someone else?
That's it. That's what the Net Promoter Score does. If you'd recommend something to someone else, it has by definition satisfied you. Mystery solved.
The NPS came along at the same time as the widening use of the internet and social media, which made it very easy to ask about. Phone calls, snail mail — that stuff is time-consuming and expensive. But surveys sent via email and text are fast and cheap.
"People don't choose based on objective quality anymore," says one marketing expert.
In American marketing, NPS became an unstoppable craze. Other metrics followed: the Customer Satisfaction Score, the Customer Effort Score, measurements of the entire Customer Experience. A survey, or monitoring calls to customer service, could reveal loyalty, intent to buy again, the specific parts of the "customer journey" that were most pleasant. "People don't choose based on objective quality anymore," says Nick Lee, a marketing professor at the Warwick Business School. "Value is added by way more than what we would call objective product features."
At the peak of the so-called sharing economy, customer surveys were all-powerful. They went both ways: Suddenly, Uber drivers and Uber riders both had star ratings to care about. Customer surveys were going to fix asymmetrical marketplace information. But of course, the whole thing was frothier than a five-star milkshake. By the late 2010s it was becoming clear that all those reviews and ratings were getting less useful over time. They were subject, it turned out, to "reputation inflation." Eventually everything gets four stars out of five.
The glut of customer surveys has created an additional problem for marketers. Email surveys are like the robocalls of old: You hit delete without even looking at them. "People receive so many survey requests that they're more likely to refuse to participate in any survey," says James Wagner, a researcher at the University of Michigan's Institute for Social Research. It's called oversurveying, and it makes people less likely to respond. Which means that, for statistical validity, companies have to send out more surveys. Which lowers the response rate even further, which means that companies have to send out yet more surveys, in a never-ending doom loop. On a scale of 1 to 5, customer satisfaction with customer-satisfaction surveys is headed to zero.
In reality, nobody's even sure these surveys are measuring the right thing. "Companies regularly collect customer-satisfaction measures, Net Promoter Scores, things like that," says Christine Moorman, a business-administration professor at Duke University who heads up a semiannual survey of hundreds of chief marketing officers. "But then the question is what do they do with it, and to what strategic ends? Most of them are doing it out of habit, not because they're thinking about the larger strategic questions they have."
Big survey companies don't just dump a giant Excel spreadsheet on their clients and send them an invoice. They offer sophisticated analyses of the data they collect. But unless those numbers are tied to possible changes the client might make, what's the point? "It's a huge arms race," says Lee, the Warwick marketing prof. "If you can give me more data rather than less data, I want more data. But the business model as to whether that data is valuable, it's sometimes questionable. Because people don't know what to do with the data, and they let the agency tell them what it says." Just because a company gets a bunch of survey results doesn't mean it knows what to do with them.
Customer surveys aren't just bad for companies. After reading the copious research on how surveys are actually used, I've come to the conclusion that they're even worse for us, the oversurveyed customers.
Any time a scientist wants to do research involving humans, it's a whole thing. That always comes with risks, from exposing people to an untested drug to simply wasting their time. To get approved by an Institutional Review Board, the potential results have to be worth the risks, to provide some benefit to humanity. That's called "equipoise." And if a proposed experiment on living things doesn't have it, you ain't supposed to do the experiment.
Perhaps customer surveys should be evaluated for "equipoise." What if they're only being used to discipline or fire employees?
Perhaps customer surveys should be evaluated for equipoise. If the companies actually use the data to improve a product or experience, that's good for us subjects. But what if it's used only to improve the company's share value or profitability? Or to discipline or fire employees? That only helps the company. And that doesn't even take into account whether I, the surveyed one, gave my consent for data I provided to be used in that way — a key to ethical research.
"Maybe we should have to pre-tell people what we're going to do with the data before we get it," Lee says. "That would be a way to stop companies from doing it indiscriminately." But he knows that's a nonstarter. "We'd be adding bureaucracy into the system. Never a popular thing to do with companies."
Worse, for vast swaths of services, you and I are the last people anyone should be soliciting opinions from. Things like doctor visits, legal services, or school classes are "pretty hard for the user to evaluate," Lee says. "We ask for customer feedback on these things all the time, but it's hard for a customer to give you immediate feedback, because a customer doesn't know what quality is yet." The college class you hated because it was hard, and at 8 a.M., might turn out to be your favorite academic memory and the foundation for your professional skill set 15 years later. Whether a visit to the mechanic was pleasant doesn't tell you how well they fixed your car. You have to drive around with your new drive shaft awhile to know whether you got shafted.
Lee has unpublished data, which hasn't been peer-reviewed, comparing hospital performance in Britain's National Health Service with surveys of both patients and employees. "It's not surprising that the best hospitals have the best patient feedback and best worker feedback," he says. But what is surprising is that worker feedback, not customer responses, correlates most closely with quality. Users, it turns out, aren't very good at telling what's what.
You know what is good at sorting through tons of data? Artificial intelligence. As email surveys get lower and lower response rates, consumer marketing companies have begun to tout their acumen at applying AI to the unstructured verbiage of online reviews, social-media posts, and call-center transcripts. Maybe these new tools, based on large language models, will be able to coax better responses from oversurveyed consumers. "It's the ability to be able to detect when there's a low-quality answer and come back and ask the customer for more data," Anderson says. "When we ask the second question, 40% of the time the customer engages and provides more data. The number of syllables in the second response increases by 9x."
Now, if I get a callback from a customer-survey robot, there's a good chance most of those additional syllables will be profane. How will I rate my experience getting interviewed by an AI? It might get more actionable data out of me than that email from my kid's allergist did. But I'm pretty sure I won't recommend it to a friend.
Adam Rogers is a senior correspondent at Business Insider.
COVID Not Linked To Increased Asthma Risk In Children: New Study
There's no proof that a child's chance of developing asthma is increased by a COVID-19 infection, according to a recent study.
Dr. David Hill, the principal study author at Children's Hospital of Philadelphia, led the study that disproves previous theories about COVID-19 and asthma in children. HealthDay reported about the pediatrics study, the first of its kind, included approximately 27,000 children who had SARS-CoV-2 PCR testing between March 2020 and February 2021. Over 3,100 were virus-positive.
To the experts' surprise, COVID-19 positivity did not increase the chance of a new asthma diagnosis in children. The study found that childhood asthma risk variables like race, food allergies, hay fever, and preterm delivery increased asthma risk.
Dr. Angela Hogan, a pediatric allergist and immunologist, said that the study's findings match her clinical experience, suggesting that COVID-19 may have caused fewer asthma exacerbations in children than previously thought.
The dynamic nature of novel viral variations may constrain the study's findings, and the distinctiveness of the study period makes replication difficult, according to Hill. More research is necessary to determine COVID-19's long-term impact on asthma development across age groups, as the study only examined youngsters.
"This may have been a unique time and opportunity to do this study and make this observation," Hill added.
However, the study reassures patients and their families that COVID-19 infections may not cause asthma in children.
COVID-19 Smell Loss Can Be Cured by Anti-Inflammatory MedicationsMeanwhile, another recent study reveals that early COVID-19 treatment with corticosteroids may help people restore their sense of smell.
Researchers, including neurobiologist Nicolas Meunier, found that COVID-19 had caused almost 27 million people to lose smell or taste. Most virus-induced olfactory impairment heals within 2-4 weeks; however, some people endure symptoms longer.
The study examines SARS-CoV-2 infection and smell ideas. One theory indicates direct injury to olfactory nerve cells that send odor information to the brain. The prevalent belief is that the infection impacts nasal cavity cells by allowing innate immune cells to persist even after the virus has vanished.
Read Also: FDA, CDC Warn Against Fake, Mishandled Botox Injections
Meunier and his team examined how anti-inflammatory corticosteroids affected olfactory recovery in COVID-19 patients. Two days after infection, researchers administered dexamethasone to SARS-CoV-2-infected hamsters. They assessed viral load, weight loss, food consumption, and olfaction.
Meanwhile, researchers highlight the enduring problems of COVID-19 survivors, particularly those with severe disease. Two-thirds of severe COVID patients still have physical, mental, and cognitive issues a year later, according to a new study.
Dr. Anil Makam, lead researcher and associate professor of medicine at the University of California, San Francisco, emphasizes the problems millions of COVID survivors face.
TechTimes previously reported the study that examined 156 severe COVID patients who needed long-term acute therapy. These patients were mostly healthy 65-year-olds. Many patients needed mechanical ventilation; therefore, specialist institutions helped them recover and rehab.
Nearly half of the patients had health issues, with many still needing oxygen. Long-term hospitalization caused bedsores and nerve damage, worsening their ailments.
Many COVID survivors recovered partially, returned home, and resumed work, but the study emphasizes the need for multimodal rehabilitation to address long-term deficits in severe COVID survivors.
The National Institutes of Health reports that the SARS-CoV-2 virus, which produces COVID-19, can permanently damage mitochondria in the heart, kidneys, liver, lungs, and lymph nodes. An acute SARS-CoV-2 infection can block mitochondrial genes, causing long-term organ damage.
Related Article: Study Shows Fitness Trackers, Smartphones Effective in Monitoring Multiple Sclerosis Progression
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Asthma Attack: Allergies, Rising Costs Impacting Patients
April 17, 2024 – Across the U.S., warmer days have beckoned an earlier spring, and with that, an earlier pollen season and worse seasonal allergies. Pair that with an ongoing respiratory virus season – particularly influenza A and B – and insurance and regulatory issues that have created barriers for patients to get inhalers in 2024, making this a tough time of year for those who struggle with allergies and asthma control.
In Chicago, for instance, adults and kids appear to be having an uptick in allergy and breathing concerns related to the warmer weather, said Juanita Mora, MD, a doctor and CEO at Chicago Allergy Center and a national volunteer medical spokesperson for the American Lung Association.
"Climate change is making allergy seasons longer, with a median of about 20 days longer around the country, which leads to increased carbon dioxide levels, more pollen and environment triggers," she said. "With pollen levels rising, you really want to get started on nasal steroids and antihistamines, as well as preventive and maintenance inhalers for those who use them."
Some people with asthma have faced challenges, in particular, because GlaxoSmithKline discontinued Flovent inhalers at the start of this year. Although authorized generic versions have replaced the popular corticosteroid, patients have expressed concerns about what to do, especially if their insurance doesn't cover the generic version sold by GSK.
In March, three companies – GSK, Boehringer Ingelheim, and AstraZeneca – announced a $35 monthly cap on out-of-pocket costs for their inhaler products, which begins June 1. Mora calls the move "a game-changer," especially for patients with large deductibles. But until then, patients are keeping a watchful eye on changes with their medications as seasonal flares happen and potential formulary updates are announced.
"The generic isn't always available, and paying out-of-pocket costs can be difficult for families as well," she said. "Patients need access to their medications to keep their asthma under good control, which is extremely important at this time of year."
In Chicago, flu cases remain elevated, Mora said, noting that patients can still receive a vaccine, even though it's not the typical season for influenza. People who recently traveled for spring break or to see the eclipse, for instance, may have gotten the virus and brought it home, and it could continue to spread at schools and gatherings. As graduation season, Mother's Day, Memorial Day, and other spring and summer celebrations approach, people should continue to take precautions, she advised.
"You can do environmental control with allergens as much as you can, such as driving with the windows closed or taking a shower after being outdoors," she said. "You can also speak with your local allergist about identifying triggers and considering allergy shots or immunotherapy to remain under good control."
Addressing Regulatory and Insurance Challenges
The U.S. Faces unique challenges in meeting global standards for asthma management, which recommends the use of an inhaled corticosteroid plus formoterol (called ICS-formoterol) for SMART therapy (or single maintenance and reliever therapy). The idea is for a single inhaler to contain medication for both fast relief from a steroid and a long-acting bronchodilator for the lungs to help with maintenance.
Although recommended by the National Heart, Lung, and Blood Institute and the Global Initiative for Asthma, the FDA hasn't approved ICS-formoterol for acute asthma relief or SMART therapy, and in turn, insurance companies won't pay for enough ICS-formoterol inhalers for SMART therapy use. These barriers make it difficult for U.S. Doctors to prescribe this treatment to patients, according to a recent editorial published in The Journal of Allergy and Clinical Immunology: In Practice.
"The research and guidelines are clear that being able to use specific inhalers – which combine a lung opener and a steroid – have better outcomes when you're experiencing symptoms," said Nonie Arora, MD, an allergy and immunology fellow at the University of North Carolina at Chapel Hill. Arora co-authored the editorial with colleagues in Maryland and Michigan, who were inspired by their firsthand experiences with patients.
"Right now, it's hard for us to prescribe these inhalers in a way that's affordable for patients," she said. "There are challenges with FDA approval and insurance companies being willing to pay for the inhalers, which makes it more expensive."
Plus, the struggles related to the Flovent stoppage have hit patients hard. Although people with asthma tend to do well once they switch to an option that works for them, Arora said, it may take weeks or months for them to get used to it, which isn't ideal at this time of year. The burden has also increased for medical practices, which are fielding dozens of requests.
"While the cost caps are an important first step, more can and should be done. Because of our complex health care system, the changes will only apply to some patients," said Melanie Carver, chief mission officer of the Asthma and Allergy Foundation of America.
"AAFA urges other manufacturers to address the high cost of their asthma medications," she said. "We also call on all stakeholders in the drug pricing ecosystem (drug manufacturers, pharmacy benefit managers, insurance companies, employers, and federal policymakers) to take action. Cost is the primary barrier to treatment for many people with asthma."
Some medical offices may have support staff to help with these changes, but many don't. At the University of Alabama at Birmingham's Asthma Clinic, staff make a point to discuss insurance changes and patient assistance programs with those who need financial help.
"We are making note of any changes and trying to get patients switched over to what they need, which takes a lot of intention and attention," said Miranda Curtiss, MD, an assistant professor of medicine who specializes in pulmonary and allergy care medicine and immunology and co-runs the clinic.
"We've made major progress in getting patients into assistance programs, but we still see patients in the hospital with flares who have trouble with affording their inhalers," she said. "In spite of everything you try to do to help, people are still having problems where they have to choose between filling heart failure medications or asthma inhalers, and those are horrible choices to have to make."
Having Allergy and Asthma Control Plans
As the weather, air quality, and pollen sources continue to change this year, people can check pollen and air quality forecasts to understand what may affect them in their location, Curtiss said. Grass pollens begin to spread before the grass turns green, for instance, so she recommends that people use their inhalers or allergy medications year-round and create a plan for their use.
Current events may also shift that plan, so it's important to remain aware and talk to your doctor about how to respond, she said. During the summer of 2023, for instance, wildfires across the country led to more particulate matter and spikes in air quality levels, and asthma patients used their rescue inhalers more often.
"Certain seasons lead to more triggers, whether allergies, viral infections, or irritants such as smoke," Curtiss said. "Patients are likely aware of their own susceptibilities and can prepare."
Later this year, ragweed pollen is forecasted to be higher than usual and last longer, according to the Asthma and Allergy Foundation of America, and that has become a problem for patients in some Northern states who aren't used to it. In Minneapolis, for example, ragweed season has expanded by 2.5 weeks – the greatest jump nationwide.
And in Charleston, tree pollen counts have been pronounced so far this year, and mold allergens have been higher than usual due to low humidity, said Kelli Williams, MD, an associate professor of pediatrics and section chief of pediatric allergy at the Medical University of South Carolina.
"This season has really affected people, who are used to allergies being bad for 1 or 2 weeks and then being able to come off their emergency medications, but we've been going for over a month, which is problematic for those who have allergic asthma," she said. "That makes it pretty uncomfortable – and sometimes dangerous – for people to enjoy things outside if they don't know the fluctuating pollen counts."
Patients should have both a regular asthma/allergy action plan and an emergency asthma/allergy plan, Williams said. For kids, she uses a stoplight analogy, with green, yellow, and red, to help patients remember what they should do daily, when symptoms, such as a dry cough, begin and how to react with an immediate plan.
Williams also recommends stocking up on over-the-counter medications for allergies, viruses, and other triggers, noting that drugmakers often offer coupons that can help reduce costs. Online platforms such as GoodRx and Cost Plus Drugs may help as well.
"Most asthma can be managed by adhering to a good asthma plan, and if you have one you understand and feel comfortable with and can adhere to, it's the best way of preventing attacks," said Jonathan Gaffin, MD, an assistant professor of pediatrics and director of the Severe Asthma Program at Boston Children's Hospital.
"It's important to make sure you have your medications on hand," he said. "If you have concerns about whether your medications will be available or covered, connect with your doctor or pharmacist sooner than your last puff."
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