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Customer relationship management (CRM) appears in the Oxford English Dictionary as an example of the compound noun “management-speak”, citing a 2002 Boston Globe article defining it as “jargon” for “getting the most from existing customers”. But how is CRM software redefined for industries that do not have, in a commercial sense, customers?
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Users of healthcare and higher education – patients and students – have relationships with providers that tend to be deeper, longer-lasting and more complicated than those between customers and sellers.
Such relationships also include a duty of care by the provider, which is unsurprising given that healthcare and education aim to change their users’ lives, whether by curing them or educating them.
As a result, the specialist CRM systems used by the two industries do more to support two-way communication than standard ones. Both use their own terms: healthcare calls CRM-like software “patient relationship management” or “patient engagement”, while higher education prefers “constituent relationship management” or “student lifecycle relationship management”.
“The term ‘customer’ is contentious,” says Simon Whittemore, a partner at education technology consultancy Cetis and formerly of the UK’s shared education IT service Jisc.
Most higher education providers are not businesses and have multiple aims and purposes, including helping all parts of society. This can mean a CRM-type system is used to analyse student demographics to find under-represented groups so a university can put more effort into encouraging people from those groups to apply, says Whittemore.
He adds that many universities struggle to bring in CRM across the organisation as this means integrating with legacy software, such as student administration systems. As a result, many have brought it in for one purpose, such as retaining students already on courses.
According to Whittemore, universities should take a more holistic approach. “Institutions need to understand and identify what business function they want such a system to serve, and what business problems they seek to address,” he says.
Analysing the student lifecycle
Higher education’s relationship with students has a third act after both recruitment and their student life, which US supplier Ellucian calls “advancement”.
“It’s mainly about gifts,” says senior vice-president of product management James Willey. “The data structures are all built around donor cultivation.” This reflects the importance of alumni donations to US universities, although those in the UK and elsewhere are increasingly tapping former students for cash.
Willey says Ellucian, which is built on Microsoft’s Dynamics CRM and has users in nearly 50 countries, treats each of the three periods of student lifecycle differently although all use common data on individuals, which saves staff time in having to enter data on the same people into different systems.
In recruitment, it can encourage people to complete an application – something which the company says can increase applications by as much as 80%.
The “advisement” phase, which deals with students at a university, uses familiar CRM-style functions for different purposes. Many universities try to minimise drop-out numbers by looking at data for warning signs, such as not attending classes.
But Willey says analytics can also be used to support students in general. “It’s not just to keep them, it’s to keep them on-track,” he says.
Ellucian’s system supports two-way communication, allowing students to book time with university advisers and make initiative queries that are handled through a helpdesk-style case management function.
Willey says the key benefit of a sector-specific CRM provider such as Ellucian is the specific analytical models it offers to higher education staff covering recruitment, student life and alumni.
“A classical analytics model would be, ‘Here’s a tool, go off and build the stuff you want to build’,” he says. “In each area, we’re pre-building analytics for those users who are operating in those business processes.”
TargetX similarly provides specialist software for higher education institutions, primarily in the US, although it also counts the London School of Economics (LSE), University of Roehampton, Canterbury Christ Church University and the Royal Agricultural University in Cirencester as customers.
Sasha Peterson, chief executive of TargetX, says higher education uses different language and has significantly different processes to sales-driven organisations.
“If you’re in a sales organisation in a company, you talk about leads, revenue and quotas,” Peterson says, whereas higher education talks about students, tuition and enquiries.
“There are specific needs that exist in industries – education in particular – that wouldn’t exist elsewhere,” he adds.
He contrasts processing an order with the complex decision over whether to admit a student – to support the latter, TargetX offers specific tools to handle the data, documents and processes involved.
The London School of Economics is using TargetX’s Salesforce AppExchange apps to manage email marketing, event management and information requests, for projects that aim to widen participation and for online applications and paperless decision-making.
Mike Page, head of the academic registrar’s division systems and business process, says: “More generally, we are looking to leverage this functionality across a number of different examples across the school as part of an enterprise CRM programme being explored.”
Page adds that use of TargetX has led to greater click-through rates on email campaigns, higher attendance ratios at events, swifter turnaround times for widening participation applicants, and more efficient processes.
LSE is also using some of Salesforce’s higher education software, including for helpdesk case management. “We get to pick and mix and therefore get the best of both worlds. The traditional restrictive box of a sector-specific solution melts away,” says Page.
TargetX also offers prospective students a mobile app called Schools App, which works with Facebook accounts to link them to others locally who have been offered a place.
For some universities this has boosted yields – the proportion of students offered a place who accept it – significantly, with Embry-Riddle Aeronautical University seeing an increase of 43%.
Having noted that some students continued to use the app when at university, TargetX is adding features such as the ability to search for study groups.
Healthcare similarly uses its industry-specific equivalents of CRM to improve communication with patients.
OSF HealthCare, an 11-hospital provider in Illinois and Michigan, uses US supplier HealthLoop’s software to link patients preparing for and recovering from spinal, hip and knee surgery to its team of virtual health coaches, each of which handles around 100 patients.
“This gives us much better and more consistent communication with the patient,” says Matthew Warrens, OSF’s vice-president of innovation partnerships.
“We’re communicating more often with the patient, which makes me realise that patients probably had these needs or questions before and just weren’t given an outlet to address them.” The fact they now are doing this means they are providing better care and that patients should see better outcomes, he adds.
Most queries from patients involve non-clinical questions such as what time they need to arrive and where to park, and the fact that these are handled by specialist staff has meant clinicians generally welcome its introduction.
“We’re not adding anything to your workload,” says Warrens. “Secondly, we’re going to engage your patients better. No surgeon is going to say, ‘No, I don’t want that’.”
Three-quarters of those patients offered the system are using it, although Warrens adds that they are not obliged to do so. “We’re not turning off the other ways you engage with us, [such as] phone calls,” he says.
HealthLoop sees itself as patient engagement platform, rather than a partner relationship management (PRM) or CRM. Chief executive Todd Johnson says most of its customers find that patients often ask basic logistical questions, and as a result recommends that they use non-clinical staff to provide responses.
There are financial and clinical reasons for providing better support to patients, Johnson says. Through automatically sending questions to patients after procedures, HealthLoop can spot those who are suffering adverse effects earlier, allowing them to be treated for this quicker – which, as well as being better for patients, is usually cheaper for the provider.
“Instead of bringing the patient into the emergency room, we can bring them into the clinic,” says Johnson. By offering patients a secure messaging channel, HealthLoop can also reduce the number of phone calls they make, again saving money.
Jellyfish Health, another US supplier, also focuses on specific episodes of care, in particular handling appointments and managing waiting times. As well as offering reminders, directions and other instructions, it also allows patients to check in remotely for an appointment, and uses an algorithm to estimate how long they will wait when they get there.
“We use that data in a communication mechanism to be able to push information to the patient, just like you’re tracking a package,” says chief executive Dave Dyell, adding that this helps patients to plan whether they can pick up children from school or attend a meeting afterwards.
“Telling that patient what’s happening and bringing them into the process gives them a better insight into what’s going on,” he says.
This has benefits for providers, such as fewer missed appointments, as patients who know how long they will wait are less likely to give up.
Managing patient health
David Harse, Cerner vice-president and general manager for consumer and patient engagement, says the company works with third-party companies on integrating what they supply in this area.
Harse says patient engagement work is particularly common in the US, where providers have to put effort into acquiring and retaining patients in a way that is less common in other countries.
According to Harse, the aim once you form a relationship is to “get [patients] to participate in care management or coaching, in a protocol that the care team is establishing”. This means patients play a part in designing their own long-term care, and the care evolves “around the patient being a member of that care team”.
Justin Whatling, Cerner’s vice-president of population health, adds that engagement with patients can work in a different way when a provider is responsible for the health of everyone in an area, such as NHS organisations.
“That drives quite different questions around patient and citizen engagement. You’re trying to find the unmet need that’s out there and deal with it, rather than just optimise the people that are being managed in your list,” he says.
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