The EEG: Expectation-Experience Gap

Why The Expectation-Experience Gap Is Important Healthcare

The World Has Changed

Whether we like it or not, and regardless of our current level of awareness here in the lucky country, there are two major changes that have already had a big impact on healthcare funding in the US and Europe, and whose influence will only grow and will eventually start to impact Australia. These twin forces are the disruptions of Customer Experience (CX) as an increasingly essential business competence; and Value Based Health Care (VBHC).

The society wide inflation of customer expectations around product and service experiences has been triggered in part by our exposure to (and enthusiastic uptake of) new global highly digital businesses (examples include Uber, Apple, Netflix, Google, Amazon). These organisations are architected around a seamless, delightful customer experiences[1], usually encompassing both product & service. Whether we are conscious of it or not, they are moving the goalposts of what we think of as ‘normal’ customer experience in any industry vertical. Hoping that the expectations of payers and patients in the healthcare industry hasn’t changed along with these, is like trying to hold back the tide.


Value Based Healthcare & Patient Experience

Value Based healthcare on the other hand really started to get traction over a decade ago in the US. It has grown and been accelerated in the interim by US pressure to control spiralling healthcare costs, and more importantly, a need to get better value for the (considerable) money spent[2]. An important legislative agenda of reform in the US around reimbursement has cemented outcomes-measurement as well as input cost tracking, transparency and continuous sampling of the patient experience within this value model [3]. Europe is also enthusiastically tracking down this path although with varied adoption speeds, but essentially the same model, and certainly the same philosophy [4].

Value in this model, is defined is defined as outcomes important to the patient. To say the implications of this are enormous for healthcare providers all around the globe, is perhaps an understatement. In the US, the patient experience, (as rated by the patient), is currently impacting reimbursement levels, something many providers in Australia might perhaps find unfathomable. The world has changed, and our world will change with it. The question is how to respond.

Clearly, because of varied leadership responses, as well as different organisational capacity to change, there will be both major winners and losers from these changes, with market share and profitability changes amongst providers, but perhaps also viability impact.


Customer Expectations

In all purchases, buyers of products and services have a mental model, conscious or unconscious, of what they expect the experience to be like. Even if they claim no particular expectations, we as buyers of many items have some sense of how we like to be treated and what politeness we expect to be afforded. Sellers on the other hand, usually have very little idea of what buyers are expecting, because no one has routinely asked or enquired of the buyers what they expect or want. We instead try to infer from sales volume, complaint numbers and other blunt instruments. Cultural & language differences further widen this dearth of real customer insight.


Expectations: Experience Framework

We have found the Expectations: Experience framework below, outlined by Howard Tiersky [5], a useful tool to consider the different perspectives, and especially where there are significant differences detected between the service experience and the lived reality as experienced by the customer. The framework outlines the two major axes of where these Expectations:Experience gaps can occur – either along the Execution Gap Axis (we intended X, but Y actually happened), or along the Insight Gap axis (we didn’t realise the customers actually wanted something other than the Z that we provide).

The Customer Experience Execution Model, from Howard Tiersky, 2017

Clearly without systematic & continuous measurement of the customer experience, organizations will mostly be in the dark about the reality of the experience they provide for customers from a user perspective.


Insight Gaps & Execution Gaps

The solution to the Insight Gap is qualitative user experience research about the customer, and the jobs the customer is trying to get done. The solution the Execution Gap is detailed probing of the culture, staff, systems and touchpoints that underpin the current experience and an experience strategy developed to decide where changes will bring the largest impact in closing these Execution Gaps.


Data As Insight Currency

Data and particularly experience data is partly what enables Uber, Apple, Netflix and others to design and develop such remarkable experiences. In their solutions, the customer & their feedback is essentially part of the solution. It is impossible to manage a continuous improvement cycle without a constant stream of data from customers and operational sources about the actual lived experience as it occurs.

This is the gold that allows continuous iteration of the services and is also a source of potential new initiatives that could improve the experience for customers. These data sources come from both quantitative & qualitative research tools. Unfortunately many healthcare providers currently have no systematic customer experience sampling methodology / system. In other organisations even when something is present, sometimes the tool has not been sufficiently well designed or resourced so that high participation and completion rates result, making the data thus representative and useful. Development of a data source that is sufficiently low friction that it is mostly free of bias and is sustainable is key.



The quantitative tools range from simple “Smiley” sampling at certain customer touchpoints, through Visual Analytic Scales (VAS) scores (Rate satisfaction 1-10), to well characterised tools such as the Net Promoter Score system [6]. The qualitative research tools such as Jobs-Top-Be-Done mapping [7] Customer Value Proposition design [8] and more formal User Experience (UX) research tools are based on interviews, observations and a variety of research techniques to generate significant insights about what customers really want and need, in their own words and actions.

If you’d like to close some of the Execution or Insight Gaps in your organisation, contact us to learn more.



1. McKinsey guide to CEO’s on Customer Experience

2. Porter et al, Value Based Healthcare; Harvard Business School.


4. VBHC in Europe – BCG Economist

5. Howard Tiersky

6. Fred Reichhield, Net Promotor Score system

7. Christenson, Clay

8. Otserwalder et al, Customer Value Proposition design Ostewalder

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