The complex and highly regulated nature of the healthcare system in the United States creates a uniquely challenging – yet rewarding – environment for health insurers dedicated to delivering consistently positive experiences to customers. To live up to its member-centric aspirations, Neighborhood Health Plan of Rhode Island uses journey maps to instill customer-centric behaviors and mindsets across the organization. We sat down with Sara Brandon, the Director of Customer Experience and Communications at Neighborhood, to understand how they use this popular CX tool as an engine for cultural transformation. 

Background

Neighborhood Health Plan of Rhode Island – a not-for-profit health maintenance organization (HMO) insurance company that serves Rhode Island through a large provider network – has always prided itself on its strong member-centric mindset. Since its founding nearly 30 years ago, this 600-employee-strong organization has been deeply committed to providing healthcare for typically underserved populations. This dedication hasn’t gone unnoticed by members, most of whom are Medicaid beneficiaries. For more than two decades, Neighborhood has routinely earned high scores on the annual National Committee for Quality Assurance (NCQA) satisfaction and quality surveys, making it one of the top-rated plans nationally. 

However, Neighborhood recognized that, in order to build the types of repeatable organizational practices required to consistently deliver member-centric experiences, it needed more than just this regulatory, “once-a-year” survey data. So in 2018, Neighborhood established a customer experience (CX) team. One of the first activities the team focused on was creating journey maps of its key products, with the initial aim of identifying and quantifying existing pain points and gaps across its customers’ experiences. However, the CX team quickly realized that because journey maps can capture and communicate the state of people’s experiences with Neighborhood in a compelling, easily understood format, they provide significant benefits beyond just pinpointing problem areas.

Journey Maps Produce Multiple Benefits

The CX team started by mapping its members’ Medicaid journey . It recognized that starting with a journey so near to the organization’s heart would help introduce the concept of journey mapping through the lens of an experience people already knew and felt strongly about. Since then, the CX team has mapped the provider journey, Medicare-Medicaid Plan (MMP) journey, the Exchange journey of signing up through HealthSource RI, and the employee experience journey .

Early on, the CX team found that these journey maps not only admirably performed their intended function of helping the organization understand the current state of people’s experiences, they also provided a whole host of additional benefits that supported the team’s broader mission of building a more customer-centric culture. These secondary, yet significant, benefits of journey maps have included:

• Creating a shared definition of “customer experience.” Despite the near-universal dedication to member-centricity within Neighborhood, the practices and behaviors individuals deemed “member-centric” varied dramatically between groups. Journey maps have created a common understanding and vocabulary around customer experience that is shared across the organization. These tools have also reinforced the CX team’s message that good “customer” experience doesn’t just refer to members; it encompasses both providers (including community health centers, hospitals, general practitioners, etc.) and employees as well. Today, each of these three groups – member, provider, and employee – make up one pillar of the three-legged stool Neighborhood considers “customer experience.”
• Breaking down internal silos. Neighborhood is organized by product line, which has historically resulted in siloed groups that tended to operate mostly within their own narrow domain. Member and provider experiences, however, invariably span multiple departments and teams. Journey maps bring these different groups together to pool their insights and develop a holistic view of the paths people travel in order to achieve their goals, making them a powerful tool for overcoming these internal siloes. They have also helped reinforce to all these different product teams the interrelated nature of member, provider, and employee experiences and, by extension, the necessity of working cross-functionally.
• Engaging and empowering employees. Journey maps have also proved a valuable tool for helping employees across Neighborhood orient themselves and their work within the context of people’s broader journeys with the organization. The CX team has found that when employees can clearly see how their role contributes to the bigger picture, many of them end up feeling more energized and invested in Neighborhood’s mission and vision. And because journey maps also help employees recognize the upstream and downstream effects of their work, these tools have made employees feel more confident about identifying and implementing experience improvements within their domain. They can now channel their passion for their work within a structured framework.
• Defining on-brand experiences. Historically, the experiences people had with Neighborhood could vary significantly between teams and touchpoints. Journey maps – as well as the brand promises and governance structures that spawned from them – have changed how the organization approaches the design and delivery of experiences. Instead of each group forging its own, individual path, the CX team has used journey maps to create a standardized, data-driven set of guidelines for creating new interactions. Now, regardless of the audience (member, provider, or employee) and regardless of the product (Medicaid, MMP, Exchange, etc.), Neighborhood is working to execute consistent, on-brand experiences within the organization.
• Focusing organizational attention. Prior to journey maps, Neighborhood’s ability to inform and prioritize improvement opportunities was limited by the fact that it only had its annual satisfaction surveys as a guide. Now its journey maps – in combination with its expanding voice of the customer listening post data – act as a source of truth that people across the company can use to make the case for resources and determine how best to allocate their time, people, and budget. These maps not only help validate people’s resource requests, they also help ensure that the organization at-large is prioritizing and addressing the most severe issues.
• Aligning listening architecture. Neighborhood used to have a number of disparate listening posts scattered across mediums and products, making it difficult to surface broader issues and trends. The CX team now uses journey maps to identify where to establish listening posts. And because these listening posts are anchored within a wider journey context, it’s easier for the groups that own each touchpoint to understand the context of the feedback and make valuable connections between experience data and operational data. All of which has made the insights Neighborhood does collect more actionable and valuable.

Three Levers for Driving Culture Change

While journey maps are powerful, their existence alone is not enough to bring about all these various CX-related benefits. Rather, the CX team has to actively work to embed these maps into the organization’s everyday operating rhythms, using them as the tip of the spear for driving customer-centric culture change across Neighborhood. The team does this through three key levers:

• Learning through journey mapping. The extended process of building each journey map brings together individuals and teams from across the organization who, by necessity, have to adopt a customer-centric perspective and collaborate with one another to develop and validate each journey map.
• Aligning around brand promises. Based on common themes surfaced in journey maps, the CX team defined a set of brand promises that the entire organization now uses to shape how they engage with members, providers, and fellow employees.
• Assembling multi-disciplinary teams. To coordinate and implement all the customer-centric improvement opportunities uncovered in journey maps, the CX team established two multi-disciplinary working groups that are responsible for driving the CX initiatives forward across the organization.

Lever 1: Learning Through Journey Mapping

Since it first kicked off its CX program, Neighborhood has advanced into the third stage of CX maturity – Mobilize – which means that much of its customer experience work now relies on activating employees around its CX vision. Because journey mapping workshops allow the CX team to slowly and methodically involve groups across the organization in this customer experience vision, they have proven a potent activation lever for driving customer-centric culture change. Each journey mapping project follows a similar process:

1. Orient Walker during a kick-off meeting. The CX team brought in an external Experience Management firm – Walker – to provide expert support and guidance during the journey mapping process. Therefore, each journey mapping workshop begins with a session aimed at familiarizing Walker with the current state of the journey that the team plans on mapping. This session includes the CX team and the primary business owners of the journey in question, who together brief Walker on the existing pain points, listening posts, and relevant business objectives for the next five years.
2. Interview relevant stakeholders. Armed with this initial information, the journey team – which consists of the CX team, Walker, and the business owners – identifies which key stakeholders they want to invite into the journey mapping process. These stakeholders are senior leaders who are responsible for at least one touchpoint along the relevant journey. Those stakeholders commit to a one-hour informational interview with Walker, during which time they share survey results pertaining to the journey, performance data, internal processes affecting the journey, and any other information Walker needs to formulate a rich picture of that part of the experience.
3. Develop a journey hypothesis. Based on all the insights they’ve accumulated so far, the team creates a hypothesis of the current journey, which they capture in a draft version of the map. This initial mockup breaks the journey down into its likely phases – including the conjectured steps within each phase – as well as the current state of the experience at each touchpoint.
4. Validate draft with stakeholders and customers. The journey team then shares the journey hypothesis back out to all the stakeholders they’ve previously interviewed for their review and approval. They also share this draft with real members, providers, or employees who take this journey to verify that they’ve captured the phases, steps, and experience perceptions accurately. For example, for the Exchange journey map, the CX team sent a survey out to appropriate members, asking them to confirm their current experiences within the defined journey phases.
5. Identify workshop participants. Once everyone has approved the draft, the team maps the full experience through a journey mapping workshop . This process begins by identifying appropriate workshop participants. The goal is to assemble a collection of individuals from different groups and levels across the organization who can, together, generate a cohesive, holistic perspective on the journey being mapped. The CX team then works with each participant’s manager to ensure the participant will be able to dedicate their undivided attention to the workshop, which is either a full day for in-person sessions or several hours a day for four days if the workshop is held virtually.
6. Facilitate journey mapping workshop. Workshop participants have not yet seen the high-level draft of the journey map, so the facilitator and journey team share the outline with them and then ask probing questions to start filling in the details within each phase and step. Because participants tend to be much deeper inside the organization than the stakeholders who contributed to the draft of the map, they can provide much more specificity around the day-to-day operations surrounding each journey.
7. Socialize findings with stakeholders. After the workshop, the CX team presents the outcomes and findings from the journey map workshop to all the participants. They also share a high-level presentation with Leadership Team and, eventually, with the relevant CX working group.
8. Assign ownership. Finally, for each phase and improvement area included in the journey map, the team identifies either a single business owner or a small team of directors who are responsible for improving that particular phase. The owner(s), along with the CX team, create and maintain the final journey map files. While this person or group is ultimately accountable for driving changes and improvements, the CX team continues to offer ongoing support through coaching, metrics consultation, resource development, and more.

Lever 2: Aligning Around Brand Promises

While working on the first two journey maps – Medicaid member and provider – the CX team started noticing that consistent themes were emerging from both groups about the types of experiences they wanted to have with Neighborhood. When they dug into the results of the employee engagement surveys from the past two years, they realized that these themes were also present in employee feedback. Given all three legs of their customer experience stool – member, provider, and employee – wanted and expected the same types of experiences with the organization, the CX team decided to codify these themes into a set of six brand promises, which include statements like, “Health is our mission,” “We make it personal,” and “We empower” .

These brand promises are commitments Neighborhood has made to members, providers, and employees about the types of experiences they are going to have with the organization. Because they are rooted in genuine feedback from the people who have experiences with Neighborhood – rather than a mandate from the top – these brand promises have become immensely popular across the business. They now act as a touchstone individuals and groups can use to check themselves and their work, informing how they engage with members, providers, and one another. Since the CX team first uncovered these themes through its journey mapping work, it has leveraged brand promises to drive CX cultural transformation by using them to:

• Define “customer-centric” behaviors. While historically people across Neighborhood considered themselves “member-centric,” this manifested in different ways across different groups. These brand promises have taken that broad descriptor and made it tangible and actionable, translating it into clear behaviors (e.g., “We make it easy”) as well as the desired sentiment those behaviors are meant to evoke (e.g., “Heard and valued”). The CX team has found that employees have also started using them with each other. For example, the CX team has heard colleagues explicitly cite the promise, “We empower,” when providing each other with tools or resources. The CX team has socialized these brand promises through a number of different channels, everything from joining team meetings across the business to embedding them in the new graphics on the wall of Neighborhood’s office building to opening meetings with voice of customer quotes that reflect how the organization delivers on a particular brand promise during a certain phase of a journey.
• Evaluate journeys and moments of truth. Since its initial journey mapping workshops, the CX team has added a step into the process; it now checks the journey map against the brand promises. It uses them as a lens through which to assess the current state of the experience, highlighting where across the journey there are barriers getting in the way of the organization delivering on its brand promises. For instance, during the journey mapping workshop for the Exchange journey, participants identified places where Neighborhood failed to live up to its brand promises of “we make it personal” and “we are proactive” as key moments of truth that organization needs to prioritize improving.
• Measure the quality of people’s experiences. Neighborhood has started explicitly asking members, providers, and employees about how it is living up to these brand promises in its surveys. For example, after a contact center interaction, it now asks the open-ended question, “Did we make your day better than you expected it to be?” The CX team has found that these unstructured responses tend to be more personal, heartfelt, and – perhaps most importantly – actionable compared to previous survey questions. Given these initial successes, the team is incorporating brand promises questions into more after-service listening posts for members, providers, and employees later this year.
• Set up automatic alerts. In addition to including brand promise questions in surveys, the CX team has also created automatic alerts where, if a respondent indicates in a comment that Neighborhood didn’t live up to one of its brand promises, it automatically routes that feedback to the group across the organization who owns that experience so they can reach out to the customer and figure out how to remedy the situation. The notifications alerting ticket owners that they need to follow up also include recommendations around next best actions they can take. Historically, all these comments had to come through one CX manager, but now each team is equipped with the information they need to close the loop with these respondents within 24-48 hours.
• Justify and prioritize resource requests. Groups across Neighborhood now use brand promises as a means of justifying their resourcing requests and securing executive commitment. For example, leaders were historically reluctant to invest in Salesforce given the cost and the amorphous benefits of the product. Recently, however, the CX team was able to sit down with the executive team and effectively make the case that without this investment, the organization would not be capable of living up to its brand promises of knowing the customer personally or demonstrating empathy.

Lever 3: Assembling Multidisciplinary Teams

In addition to journey mapping workshops and brand promises, the third lever the CX team uses to propel customer-centric culture change across the organization is its two multidisciplinary working groups, one focused on member experience and one focused on provider experience . These working groups are made up of middle managers from across the business who are close enough to the frontlines to have a clear picture of the work being done, yet also retain influence over budget and strategy – a position that enables them to connect customer experience and operations in a uniquely powerful way. The two groups each meet once a month for an hour to review the current state of their relevant experiences and discuss how to drive key CX initiatives forward. To propel Neighborhood’s customer experience transformation efforts across the business, these working groups:

• Amplify the voice of the customer. Each working group session begins by sharing a quote from a member or provider that frames up the conversation for the day . These verbatims come from a recent survey or from a journey mapping exercise. The customer experience manager who pulls these quotes includes which member or provider cohort the person belongs to, which phase of the journey they are referring to, and which brand promises are relevant to the quote.
• Update existing journey maps with new activities. The working groups examine the portfolio of CX activities underway across all the different project groups and then map those activities back to the corresponding phase in the broader journey map. So while each journey phase has a specific owner or a small team of owners, these working groups are the ones who keep an eye on the overall, holistic journey to understand how the complete collection of CX activities is contributing to experience transformation for Neighborhood’s members, providers, and employees.
• Prioritize immediate actions. Based on the portfolio of CX activities currently underway, the working groups develop a list of short-term CX priorities and immediate actions that need to be taken across the organizations. They derive this list by looking at the key moments of truth highlighted in each journey map as well as current capacity and potential added value.
• Track progress towards goals. Once a customer experience project is established, the working group helps the business owner develop a suite of key metrics to track the progress of that project. During working group meetings, the business owner who is responsible for managing and monitoring a given intervention will share what actions they’ve taken in the previous month, planned next steps to move the project forward, and an update on whether they are on track or not to hit their targets. The working group also works with the business owner to identify where there may be opportunities to set up new listening posts to gather more or better metrics for that project.
• Surface continuous improvement opportunities. Because of their cross-functional perspective, working groups also identify new patterns and trends that span multiple areas and speak to deeper, more systemic issues. When these types of problems emerge, the groups map the relevant data or feedback to the appropriate journey phase and then present their findings to the business owner(s) for that phase. In addition to just calling attention to the improvement opportunity, the group will often also provide the owner(s) with recommendations for how to fix the issue and rejigger short-term priorities to free up resources to address it.
• Identify long-term projects. These working groups are also responsible for developing and maintaining a multi-year plan for how Neighborhood is going to achieve its ultimate customer experience objectives. This includes creating and prioritizing a list of future projects as well as setting future CX objectives and targets.
• Remove barriers to success. As individuals and teams across the organization inevitably hit roadblocks along their path to improving CX, the working groups can step in and – where appropriate – help remove those obstacles. This may involve using their clout as influential managers as well as sharing their expertise and fresh perspective to help find solutions.
• Securing executive buy-in and approval. Given all the complicated moving parts involved in driving the organization’s CX transformation plans forward, the working groups are the people who are responsible for understanding the holistic resourcing requirements, (including people, money, and time), making trade-off decisions about what to invest in when, and then going to the executive team to obtain their commitment to the CX roadmap and securing the resources necessary to accomplish it.

Lessons Learned

Here are some of the key lessons Sara and her team learned during their efforts to use journey maps to drive customer-centric cultural transformation, which may be relevant to other organizations looking to use these tools in a similar way:

• Be patient. Building a truly customer-centric culture takes time. Rather than take a top-down, command-and-control style approach – which may result in short-term compliance but doesn’t change people’s underlying mindsets – the CX team instead focused on building people’s CX skills and interests within the context of CX projects they were directly involved in. This strategy of “planting seeds,” as Sara calls it, has paid off. Historically the CX team had to initiate meeting requests and push insights out to groups across the organization, but today, roles have reversed and the groups are the ones inviting the CX team to meetings and proactively requesting their insights and guidance.
• Involve stakeholders from across the organization. Every single person across an organization has a role to play in creating and delivering better experiences, so don’t limit involvement in the journey mapping process only to frontline workers. Plus, the CX team has found that when people understand how their individual work fits within the context of the larger business operations, they are ultimately more dedicated to improving the whole customer experience.
• Build storytelling capabilities. Just sharing out raw data and metrics is not enough to convince people to change their attitudes and behaviors. That’s why the CX team is planning to double down on its storytelling capabilities. It is focused on speaking both to people’s minds – clearly connecting the data it’s sharing to insights users’ personal objectives – as well as to their hearts. The CX team uses the voice of real members, providers, and employees to inspire the organization and articulate why it’s so essential for Neighborhood to improve the experiences it delivers.
• Embed CX within existing business operations. In 2021, the CX team went to the executive team and made the case that the customer experience philosophy and methodology it was espousing needed to be embedded into every facet of the organization. They explained that doing CX well didn’t require more meetings or reviews; it required bringing a customer-centric lens to all of the existing organizational processes and structures. Rather than setting up a separate activity stream, Sara argued for embedding CX into the existing rhythms of the business. The executive team was convinced and – in addition to standing up the two working groups – started including the CX team into its normal operating cadence, helping them build significant traction and advocacy around the organization.
• Bring external business partners into the process. Similar to many other organizations, Neighborhood does not have full control over every single experience it delivers. Certain steps along the member and provider journey are owned by external partners or vendors. This often confuses customers, who are not aware of the entangled nature of the healthcare ecosystem. So to ensure that people have a consistent, on-brand experience – no matter who owns that touchpoint – the CX team is starting to actively bring these external groups into the journey mapping process and train them on how to live up to Neighborhood’s brand promises.