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Customer Satisfaction MeasurementLiterature Review

30 June 2014

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Contents

Executive Summary....................................................................................................31. Introduction..........................................................................................................52. What is customer satisfaction measurement?.....................................................53. Why is measuring customer satisfaction important?............................................6

3.1. Engagement and empowerment tool.............................................................63.2. Service improvement tool...............................................................................73.3. Performance management tool......................................................................8

3.3.1. Accountability and compliance................................................................83.3.2. Customer feedback and benchmarking tool............................................93.3.3. Tool to support funding proposals.........................................................10

4. Application of customer satisfaction measurement processes...........................105. How is customer satisfaction measured?...........................................................12

5.1. Key drivers or determinants of satisfaction..................................................125.2. What does the drivers or determinants of satisfaction literature tell us?......16

6. Methodological considerations...........................................................................186.1. Timing..........................................................................................................186.2. Sampling bias..............................................................................................196.3. Customer benefit..........................................................................................196.4. Confidentiality..............................................................................................206.5. Customer expectations and experiences.....................................................206.6. Social and cultural background of customers..............................................216.7. Capacity to respond.....................................................................................226.8. Carer involvement in assessing satisfaction................................................226.9. Response bias.............................................................................................23

7. Conclusion.........................................................................................................23Endnotes...................................................................................................................25

4 / 30 June 2014 Customer Satisfaction

Executive Summary

This paper reviews the existing literature on customer satisfaction measurement and provides the theoretical background for the development of a number of tools to help the community services industry in Queensland measure customer satisfaction.

In the context of community service delivery, there are a range of issues to be considered when designing and using satisfaction measurement tools. There is a growing expectation, in the literature that individuals and their family should be at the centre of service design, delivery and review. Tools and processes for measuring satisfaction need to accommodate individual needs and preferences around literacy, timing and form. There is also an expectation that people who have contributed to such processes will receive information on the broader outcomes from their feedback and ideas.

At a broader policy level, contestability and a move to self-directed and in some cases, self-managed funding means the people who use services may be doing so under market or market-like conditions. This requires that people shift from being consumers to “discerning customers” which will bring challenges and opportunities for both organisations and the people who use their services.

The paper begins by outlining a brief definition of customer satisfaction measurement drawing on the extant literature. At the most basic level, customer satisfaction measurement involves assessing the difference between a customer’s expectation of a product or services and a customer’s experience of a product or service.

The paper investigates the main reasons why measuring customer satisfaction is important. Through the review of the literature it is shown that customer satisfaction measurement provides a means to better understand the needs of social service customers and to empower customers by creating customer-centred services. It is also argued that customer satisfaction measurement provides a means of creating ongoing service improvement by identifying areas of improvement. Lastly it is argued that customer satisfaction measurement provides a performance management tool that can be used to generate data to meet compliance and reporting requirements, provide customers with information about service performance and provide evidence for future funding proposals.

The paper also discusses how customer satisfaction is measured by analysing the literature on key drivers or determinants of satisfaction. This section of the report demonstrates the importance of understanding satisfaction from the point of view of the customer. It argues that the drivers or determinants of satisfaction will differ in different service contexts and discusses the importance of including service customers in the design of customer satisfaction surveys. Doing so, ensures that customer satisfaction processes are able to accurately reflect the needs and values of customers and can be effective in driving service improvement.

The final section reviews a number of methodological considerations. This includes discussion of the impact of timing, sampling bias, customer benefit and confidentiality on participation and the impact of customer expectations and experiences, social and cultural background, intellectual disability and mental illness and response bias on participation and response quality. As it is noted it is useful to gain direct feedback from customers about how they would prefer customer satisfaction surveys to be administered, as this can have a significant impact on participation and on the quality of responses.


The paper provides a starting point for social service organisations in developing more rigorous customer satisfaction processes and will be augmented by the development of tools that can be used to assist in the measurement of customer satisfaction. As part of the development of these tools, QCOSS will be undertaking consultation with the social service sector to ascertain current practice and capacity. This will include consultation with customers to better understand how customer satisfaction measurement processes can be engaged in the development of customer satisfaction processes.


1. Introduction

This paper examines a range of existing national and international literature on the development and use of customer satisfaction measurement. It suggests that customer satisfaction measurement is potentially a useful mechanism for identifying and verifying customer needs and preferences which can, in turn, inform product and service design and improvement. It begins with an overview of why customer satisfaction is important as both an engagement and service improvement tool, and where it can contribute to performance management and meeting compliance requirements for organisations. It explores the relative merits of a range of approaches and discusses a range of methodological issues associated with the administration of customer satisfaction measurement processes.

This paper uses the term ‘customer’ to refer to the various populations and contexts in which satisfaction is measured. In some instances people using public or social services may be more appropriately referred to as ‘patients’, ‘consumers’, ‘users’, ‘citizens’ or ‘clients’ depending on the type of service being offered. Much work has been undertaken, for example, to empower ‘clients’ by reconceptualising them as ‘consumers’ in the mental health and disability service areas. We acknowledge that the use of the term ‘customer’ can be problematic as it refers to a situation of empowered choice that does not necessarily reflect the reality of people using many public services, some of which are not voluntary. We use the term ‘customer’ for simplicity acknowledging that it may be more appropriate to use more specific terms when referring to specific groups or populations.

2. What is customer satisfaction measurement?

While there are many different models used within the literature to conceptualise customer satisfaction measurement, at its most basic level customer satisfaction measurement involves an assessment of the difference between a customer’s expectation of a product or service and a customer’s experience of a product or service.

Quite simply, customer satisfaction measurement involves the collection of data that provides information about how satisfied, or otherwise, customers are with a service.1

In general, customer satisfaction measurement utilises quantitative questionnaires to elicit information from service users about the level of satisfaction with aspects of the service experience. This can involve structured survey questions where service users are asked to rank their levels of satisfaction using predetermined scales or open-ended questions where a respondent can provide rich detail about their satisfaction with various aspects of a service experience.

At a more advanced level, customer satisfaction measurement is part of a service improvement process. The act of administering a customer satisfaction survey is only one part of a larger process in which a service provider uses data collected from service customers to refine and improve the experience of the customer.

Customer satisfaction measurement draws on insights and tools grounded in academic theories of customer satisfaction and service quality from the fields of business, marketing


and management. One of the more widely adopted theories is the disconfirmation model, which conceptualises satisfaction as the relationship between expectations and perceived performance2,3.

Given that customer satisfaction measurement emerged in the fields of business and marketing it has become well established as a tool within the commercial sector. In competitive markets, customer satisfaction measurement is a key marketing tool used to understand and drive business performance. In marketing, customer satisfaction is viewed as the ultimate goal of any business because satisfied customers are more likely to become repeat customers and to recommend a business to other potential customers.

While customer satisfaction measurement processes were developed originally for use in competitive markets, they are increasingly being applied to public sector settings as a means of monitoring performance and improving service quality. Customer satisfaction measurement is being more commonly used in a range of public sector areas, including transport, health and disability, to measure performance in a range of customer service settings.

3. Why is measuring customer satisfaction important?

There are a number of reasons why it is important to measure customer satisfaction:

As an engagement and information collection tool, customer satisfaction measurement provides service delivery organisations with a structured means of collecting information from service users to better infuse the needs and values of the customer into their organisation.

As a service improvement tool, customer satisfaction measurement provides a means of assessing what the main drivers of satisfaction or dissatisfaction are and focusing efforts on improving customer experience as part of an ongoing cycle of service improvement.

As a performance management tool, customer satisfaction measurement provides a means of meeting reporting requirements for funding, demonstrating effectiveness when tendering for new funding opportunities and providing potential customers with information about performance.

3.1. Engagement and empowerment tool

Customer satisfaction measurement provides a structured means of engaging with and collecting information from customers, which can be used to infuse the voice of the customer within an organisation. As Rapp and Poertner (1987) have argued, a key challenge for service managers is adopting a more customer-centred approach to service delivery4. Seeking input and ideas from customers creates a more customer-centred intervention5. Customer satisfaction measurement focuses an organisation on the needs of the people it serves to better position them at the centre of the service delivery experience.

In this regard, processes to assess customer satisfaction are not just about gaining information from customers, they can also be an effective tool to promote customer empowerment6. Empowerment is particularly important for parents and children marginalised


as a result of statutory interventions, such as those associated with child protection. Processes that empower parents to participate in the planning, delivery and evaluation of family preservation programs, for example, serve to enhance the strengths and competencies of parents7.

The literature on customer satisfaction measurement emerging from the United Kingdom Government, for example, views customer satisfaction measurement as a means of focusing on the customer and the customer experience8. As such, the process of customer satisfaction measurement can be viewed as a method for reflecting upon the needs of the customer.

While service based organisations involve intensive interaction with customers on a daily basis this does not mean that information about customer needs and values are automatically absorbed into the service operation and culture. Customer satisfaction measurement provides a structured tool for actively engaging with customers; seeking out information about how they view the services being offered to them; and enabling them to have input into the delivery of these services. This includes the involvement of customers in the process of designing the methods used and the questions asked to elicit information from customers.

3.2. Service improvement tool

The measurement of customer satisfaction provides a means of creating broader service improvement. Organisations armed with the right information about customer satisfaction can use it to better target services to their customers’ needs or better manage customer expectation by improving the way program benefits are communicated. This information also allows organisations to improve those aspects of service delivery which are most important to customers9, focusing time and resources more effectively.

It is important to note that the measurement of customer satisfaction is not the same as measuring overall service quality but one distinct part of an integrated framework for analysing service quality and efficacy. A broader quality improvement framework would likely include methods and processes to measure unmet service demand, customer outcomes, evaluation of external programs impacting on customers and support for continuous quality improvement10.

While customer satisfaction measurement at its most basic level generally involves some form of survey to elicit this information about customer satisfaction, this is only one part of an ongoing service improvement cycle. It should be seen as a means to an end, in which the measurement of customer satisfaction forms one part of an ongoing process of ‘insight, measurement and improvement’11.

There are a number of examples of attempts to conceptualise customer satisfaction measurement as part of an ongoing service improvement cycle. One useful example is a guide developed for public services in King County in the United States. In this guide, the service improvement cycle is viewed as consisting of a number of clear steps12:

• defining and reflecting about the service and its customers • gathering existing customer-related data


• measuring customer experience • analysing data and developing insights • developing an action plan and communicating about that plan and • taking action to improve the service.

According to this example, it is critical to conduct initial scoping and research before undertaking satisfaction surveys in order to understand what is valuable to measure from the perspective of the service and the customer. While it may be easier to develop a survey based on staff knowledge of the program and the customer group, it is useful to gauge customer’s own level of understanding to ascertain expectations about what they may view as being most important to them.

Equally, it is critical to take steps to develop an action plan that guides the process of service improvement ensuring the information gathered from customers is actually put to use. As a cycle this process would be repeated to learn the impact that improvements have on customer satisfaction and to continue the service improvement process over time.

3.3. Performance management tool

Aside from providing a structured tool for engagement and information gathering and acting as part of the process to promote service improvement, customer satisfaction measurement is also a useful tool for performance management. It provides a method for collecting useful data that can be used to meet contract reporting and accountability requirements, provide customers with information about service performance, create opportunities to compare and contrast performance and demonstrate effectiveness when tendering for new funding.

3.3.1. Accountability and compliance

Customer satisfaction data is also commonly used as an accountability and compliance tool. The collection of information about the level of satisfaction with a particular service is commonly used as a performance indicator by government to demonstrate the performance of funded activities. There are a number of examples of the data being used in this way.

In health care, one of the motivations for administering patient surveys in hospitals in Australia was the need to meet accreditation guidelines under the Australian Council on Healthcare Standards (ACHS). ACHS accreditation requires all public and private hospitals to undertake patient experience and satisfaction surveys13. In health, performance data has historically been used as an internal accountability and quality control tool but is increasingly reported publicly to stimulate quality improvement and cost efficiency and empower consumers with knowledge to navigate the health system14.

Compliance with quality standards has also driven the uptake of customer satisfaction measurement in the human and social services. Human service organisations delivering services to the community on behalf of the Queensland Government are required to demonstrate service quality as a part of their contract arrangements. Customer satisfaction surveys are one of the methods that can be used to demonstrate continuous improvement under the Human Services Quality Framework (HSQF)15.


Satisfaction data has also been used as a performance indicator for the delivery of services to people with a disability in Queensland. Data from service user satisfaction surveys is routinely collected by the Department of Communities, Child Safety and Disability Services and reported in departmental budget statements and annual reports as a means of demonstrating performance16.

The use of customer satisfaction as a performance management tool has resulted in activities to harmonise survey methods across jurisdictions. In 1998, the Productivity Commission conducted a review of satisfaction survey approaches used in disability services for the purpose of developing a survey to provide nationally comparable information on satisfaction with disability services. Further, in 2005, the Productivity Commission conducted a review of patient satisfaction and experience surveys used in public hospitals for the purpose of measuring quality across Australia. The review identified points of commonality and difference in these surveys and assessed the potential for creating a minimum national data set on public hospital patient satisfaction or patient experience17.

It is important to disentangle customer satisfaction from outcomes measurement as these can often be confused. LaSala (1997) has noted that customer satisfaction may be a ‘worthwhile and valid construct to consider in evaluating outcome’18. While evidence suggests that the outcomes experienced by customers have an impact on the level of satisfaction felt by customers and on customer choice, they are not the same thing19. In the delivery of health care, for example, satisfaction has often been treated as an ‘outcome’ measure based on the assumption that improvements in health status are logically linked to a patient’s satisfaction. While outcomes do have an impact on patient satisfaction, satisfaction is best thought of as a ‘process’ measure or a measure of the way that the service was delivered20.

In complex services, such as those delivering human service interventions, it is hard to separate out the process of delivering the service from the outcome. Keeping the focus on the process rather than the outcome requires an understanding of the customer’s experience and careful survey design21. While it may be tempting to ask a customer if they received the outcome they wanted as the only satisfaction measure, this would not enable organisations to understand the level of satisfaction with various parts of the service process and therefore would not know what actions could be taken to improve the quality of the service.

3.3.2. Customer feedback and benchmarking tool

The data collected though customer satisfaction measurement can provide useful information that can be used by customers to assess the quality of a service offering. This is especially useful if benchmarking allows comparison between organisations offering similar services.

The impetus for customer satisfaction has been driven in part by moves to create greater choice for consumers. In the United States the Hospital-Consumer Assessment of Health Plans Survey (H-CAHPS) was initiated as a direct result of requests from the Centres for Medicare and Medicaid, which saw patient surveys as a means of encouraging greater accountability and choice for consumers22. The development of standardised instruments to measure patient satisfaction in the United States is said to have reinforced the use of quality assurance methods in health care settings23.


Customer satisfaction measurement can also be used as a tool to compare performance at different scales and across a range of service settings. Customer satisfaction data can provide insight into the performance of a whole organisation, a specific program, a work unit or an individual working within a service. When done consistently, customer satisfaction measurement can elicit data to compare performance across different services, geographic areas and customer groups.24 By administering surveys with common or standard questions and methods across different organisations, this can enable organisations to benchmark against each other to drive performance25. As it is noted later in this report, this has led to the identification of common drivers of satisfaction in the public sector in Canada and the United Kingdom.

3.3.3. Tool to support funding proposals

Customer satisfaction measurement is a useful tool for eliciting information that can be used in developing funding proposals. The measurement of customer satisfaction can demonstrate to a potential funding body if a service is meeting the expectations of customers. When used as part of a service improvement cycle it demonstrates to potential funding bodies the organisations commitment to ongoing service improvement.

4. Application of customer satisfaction measurement processes

There are many examples of the different ways that customer satisfaction measurement is being applied in the public and community sectors, both nationally and internationally. Describing these provides an opportunity to gain a clearer picture of the different contexts in which satisfaction measurement has been applied; a better understanding of the different ways that customer satisfaction can be collected and communicated; and more information about the different reasons customer satisfaction measurement is pursued.

The UK Government has encouraged customer satisfaction as a means of showing how government departments and agencies are improving the experiences of customers of services as part of the cross-government Service Transformation Agreement initiated in 2007. This has resulted in the development of a guidance document to discuss the role of satisfaction measurement in service transformation and a toolkit to provide ‘service owners’ within government to undertake effective customer satisfaction measurement. The toolkit presents customer satisfaction measurement as part of an ongoing Service Transformation Cycle26,27.

Internationally, several organisations have become experts in managing the delivery of formal patient surveys and have developed patient satisfaction tools that can be used to assess the performance and quality of care provided in various health care settings. The Picker approach has formed the basis of the UK’s National Health Service patient survey and adapted for surveys in Australia28.

In Australia, patient surveys are becoming well established as a means of collecting feedback about satisfaction in various health care settings. The Queensland Government, for example, has administered an Emergency Department Patient Experience Survey since 2011 to monitor the performance of hospital emergency departments across Queensland29.


The impetus for the survey was to ‘identify areas of excellence and areas for improvement’ and to ‘inform the development of initiatives to improve the patient experience’30.

In the UK and Australia the Patient Opinion website provides patients of various health services with an opportunity to post comments about their experience online and have these comments sent to staff in the hope that this will result in positive changes to practice or reinforce existing good practice. Patient Opinion is a subscription service which operates on funds from participating health service providers. Initiatives, such as Patient Opinion, provide a novel approach to collecting and communicating customer satisfaction and feedback using web based technologies31.

Victoria developed its first mental health consumer and carer satisfaction surveys in 1996. Following a review of national and international practice, stakeholder consultations and the administration of a pilot study, a new survey was implemented in 2003-04. This survey shifted from measuring satisfaction to measuring perspectives on service quality to better reflect the quality of care provided and to more readily facilitate quality improvement.32

The Queensland Government have also conducted regular surveys of consumers (and carers) of disability services funded by the Department of Communities, Child Safety and Disability Services since 1999. The Department has collected information about consumer and carer satisfaction with services delivered by non-government organisations as part of requirements to monitor the quality and performance of funded services. Surveys were initially conducted through the administration of a centralised survey and more recently by aggregating the data collected from surveys administered by individual service providers. One of the impetuses behind the measurement of consumer and carer satisfaction in this context is to meet a range of annual reporting obligations, such as is found in the Service Delivery Statement (SDS) Budget Paper 533.

Satisfaction surveys have also been used by community service organisations providing a range of family support, drug and alcohol and aged care services. For example, Mercy Community Services (MCS) in New South Wales have conducted regular customer satisfaction surveys to ascertain the level of satisfaction with a range of programs. The survey is administered to clients receiving alcohol and other drugs counselling, parenting support or aged/disability support across the Newcastle, Lake Macquarie and the Lower Hunter regions34.

Similarly, Anglicare Victoria has undertaken a survey of customer satisfaction encompassing a range of disparate services offered through various locations. This whole-of-agency process sits alongside existing formal and informal feedback mechanisms35. While large scale satisfaction surveys are administered by external organisations both the MCS and Anglicare Victoria surveys were developed and administered in-house using staff and volunteers as a means of reducing the cost of contracting in specialised providers.

In Tasmania, Baptcare has undertaken post-interaction, a survey of users of the Disability Gateway Services which is one part of a single state-wide entry point for community intake, assessment and planning into disability and family services. The survey forms part of an evidence base to demonstrate positive outcomes for those who engage in the services and the effectiveness and efficacy of the Disability Gateway model. The survey was developed using a mixed method approach including initial focus groups with users of the gateway to identify issues, explore themes and contribute to the identification of the questionnaire36.


A national survey was developed in 2003 to gather information about customer satisfaction with emergency accommodation services provided through the Supported Accommodation Assistance Program (SAAP). The survey was administered by an external organisation as part of a broader evaluation process. It was developed on the basis of recommendations made in a preliminary report, which highlighted a number of considerations for the development of customer satisfaction processes and outlined the conditions under which customer satisfaction measurement should occur37.

As this brief summary of some examples of customer satisfaction measurement indicate, customer satisfaction measurement is becoming widely adopted in the public sector in a wide variety of service settings. It also shows customer satisfaction is being used as a key tool for understanding customer needs, behaviour and motivations and as a basis for improving customer experience. The examples presented also show that customer satisfaction has emerged from the need to monitor the performance of public sector services to demonstrate accountability to the wider public.

The examples also demonstrate the variety of ways that customer satisfaction is applied from the more traditional use of surveys to the more novel use of web based technologies. It also highlights that customer satisfaction measurement can be administered by organisations internally or, where the resources permit, can be outsourced to dedicated organisations with expertise and skills.

5. How is customer satisfaction measured?

A large part of the customer satisfaction literature is preoccupied with understanding the key drivers or determinants of satisfaction in different service contexts. The following section discusses the literature on the key drivers or determinants of satisfaction before moving on to discuss the implications this preoccupation has for developing customer satisfaction measurement processes.

5.1. Key drivers or determinants of satisfaction

One of the key considerations in the customer satisfaction literature is identifying aspects of a service which are most important in determining a customer’s overall satisfaction. Because customer satisfaction is defined by the questions used in the surveys38 it is important to ensure that these reflect what customer’s think is most important. If not it is likely the data will not give an accurate indication of satisfaction. As Johnston (1997) has noted ‘the identification of the determinants of service quality is necessary to be able to specify, measure, control and improve customer perceived service quality’39.

The identification of the key drivers or determinants of customer satisfaction enables organisations to focus on what is most important when assessing customer satisfaction from the perspective of the customer. Unfortunately, there is significant variance in the drivers of service quality and limited agreement on what are the key dimensions of satisfaction40. This, it is argued, requires appropriate methods for eliciting customer satisfaction information, particularly in the area of human services, where the services offered and customer served have specific characteristics.


Customer satisfaction measurement in the delivery of health services is relatively well advanced. Criticism that traditional patient satisfaction surveys ignored what was important to patients resulted in a shift in approach from measuring patient satisfaction to patient experience. This shift involved at its core an assessment of what patient’s value and consider unacceptable in the delivery of health care. In general, this has been facilitated by the development of various survey tools to capture patient experiences and resulted in the identification of key dimensions of patient care which can be used to better reflect patient satisfaction. Research conducted by the Harvard Medical School, for example, identified eight key dimensions of patient-centred care from qualitative research into patient experience41. These are:

• access to care• respect for patient values, preferences and expressed needs• coordination and integration of care• information, communication and education• physical comfort• emotional support and alleviation of fear and anxiety• involvement of family and friends• transition and continuity.

This model has been widely adopted in a number of health and patient care surveys, including the National Health Service patient survey in England42.

In the field of marketing, a number of attempts have been made to define the determinants of satisfaction that can be applied across service types. One of the more well known of these is the SERVQUAL/RATER instruments developed by Parasuraman, Zeithaml and Berry. Initially, Parasuraman et al developed a list of 10 determinants of service quality as a result of focus group studies with service providers and customers43. The 10 determinants of service quality have since been refined to five key dimensions, which are used to structure the process of understanding customer satisfaction and improving service quality. The five key dimensions of the refined RATER instrument include44:

• reliability (ability to perform the promised service dependably and accurately)• assurance (knowledge and courtesy of employees and ability to convey trust and

confidence)• tangibles (appearance of physical facilities, equipment, staff and communication

materials)• empathy (caring and individual service to customers) • responsiveness (helping customers and providing prompt service).

It is argued that these determinants of service quality apply to a range of service types and that, regardless of the service being studied, reliability is the most important dimension in predicting overall customer satisfaction, followed by responsiveness, assurance and empathy, with tangibles being of least concern to service customers45. From these dimensions Parasuraman et al have developed a set of standardised survey questions, which are used to determine if a customer is satisfied with a particular service.

It is important to note that there is significant conjecture about the validity of the SERVQUAL/RATER dimensions, not least the contention that the instrument is applicable to a range of service settings46. It is also vital to acknowledge that other approaches exist which


identify drivers or determinants of service quality. Another similar study by Johnston (1995), for example, has proposed an alternative set of 18 determinants of service quality, including47:

• attentiveness/helpfulness• responsiveness• care• availability• reliability• integrity• friendliness• courtesy• communication• competence• functionality• commitment• access• flexibility• aesthetics• cleanliness/tidiness• comfort• security.

Given the conjecture about the applicability of generic instruments for assessing customer satisfaction to different service settings, it should be noted that attempts have been made to develop frameworks specifically for public services. According to research conducted in the UK into customer satisfaction in the public sector, there are five key drivers of satisfaction and dissatisfaction, which account for 67 per cent of variation in overall satisfaction48. These include:

• delivery • timeliness• professionalism• information• staff attitude.

In Canada, the Institute for Citizen-Centred Service is the custodian of The Common Measurement Tool (CMT), which is used by Canadian public service organisations to measure customer satisfaction. A number of key drivers of service quality have been identified through a national survey, which are said to account for the overwhelming majority of variance in satisfaction amongst users of public services. While these have gone through refinement over time, the key drivers of satisfaction have been relatively stable and currently include49:

• timeliness• ease of access• outcome • staff performance.


Amongst this list of key drivers, timeliness was found to be the single most important driver across all public services in Canada. As with the SERVQUAL/RATER instrument a set of commonly worded questions have been developed which elicit information about satisfaction relating to the key drivers of satisfaction. Because the CMT provides users with standard questions that can used by different organisations it offers organisations an opportunity to benchmark their performance against peers over time.

Other generic tools for examining customer satisfaction which are more specific to the social services setting include the Client Satisfaction Questionnaire (CSQ-8), the Reid-Gundlach Social Service Satisfaction Scale (R-GSSSS) and the Client Satisfaction Inventory (CSI).

CSQ-8 provides a standard set of eight questions originally developed to use in mental health programs but is now applied in a variety of social service areas. R-GSSSS includes 34 items made up of three subscales and was designed for use in social work, however it has had limited application and questionable validity. CSI consists of 25 items and a short-form version (CSI-SF), which includes nine items and is designed to be useful in a variety of services by a range of clients50. The downside to these three models is that they must be purchased, which may make their use financially restrictive.

There are a number of examples of attempts to identify the drivers or determinants of customer satisfaction for specific social service settings or interventions. This has occurred as part of academic studies or in large organisations or large programs where economies of scale are more amenable to use of complex research processes required to elicit an appropriate level of data.

Kapp and Vela (2004) developed the Parent Satisfaction with Foster Care Services Scale (PSFCSS) to assess the satisfaction of parents who had a child removed from their care. As part of this research the authors undertook psychometric testing to determine which of the factors within the PSFCSS best predicted overall satisfaction. These include:

• the worker was working within them to get their child back• the worker had clear expectations of them• the worker prepared them for meetings• the worker stood up for them in meetings• the worker respected their cultural background• the agency had realistic expectations of them• willingness to recommend their agency to others• willingness to recommend worker to others.

Kapp and Vela claim that these predictors can be used to focus resources and craft quality interventions and greater levels of satisfaction for parents of children in foster care51.

Essex et al (1981) developed a satisfaction survey for consumers of mental health services, which they argue could be applied to a range of mental health settings. The research identified four factors which correlated with overall satisfaction. These include:

• satisfaction with services• acceptability of clinician• impact of services• dignified treatment.


The authors contend that it is important to isolate the key determinants of satisfaction as this will result in shorter questionnaires that are less burdensome for survey respondents52.

A review of satisfaction surveys for people with disabilities conducted by the Productivity Commission in 1998 has found that satisfaction with services is multi-dimensional and best measured using questionnaires that address different determinants. Nevertheless, the report claimed that consumer satisfaction was likely to be primarily influenced by staff interaction with a consumer.53 The importance of the client / therapist relationship on satisfaction has also been found in satisfaction studies of mental health treatment54; in studies of family preservation programs55; and research into the satisfaction of parents of children in foster care56.

Research conducted into the development of satisfaction measurement processes for the Supported Accommodation and Assistance Program (SAAP), for example, elicited a number of key determinants of satisfaction. Through consultations and pilots it was found that four main factors underpinned satisfaction and should be the focus of surveys with service users. These included:

• the quality of information communication,• the quality of engagement and support by staff • the helpfulness of support programs offered • the standard of accommodation and other facilities.

In another study, undertaken by Relationships Australia, research identified that the factors impacting on overall satisfaction in the delivery of relationship counselling services differed by gender. Research showed that women are more influenced by the nature of the experience, whereas men are more influenced by the outcome57.

5.2. What does the drivers or determinants of satisfaction literature tell us?

The literature presented above raises a number of key issues for the development of tools to measure customer satisfaction. As it can be noted by examining the lists of key drivers, despite the preoccupation with determining common sets of drivers or determinants of satisfaction there is clearly significant variation in the types of drivers impacting overall satisfaction across different service settings.

There is a significant difference in the key drivers between private sector and public sector services. Because public and private sector services differ, this can make customer satisfaction models designed for the private sector less than optimal. Models aimed at increasing consumption or maintaining loyalty are not necessarily relevant in a situation where a customer has little choice, as it is with many public sector goods and services. In some instances, customer satisfaction may be optimal when the level of consumption of or contact with public services is actually minimised58. Equally, there is a significant difference between the various services delivered by publicly managed institutions and those delivered by non-government organisations on behalf of government. In essence, what this shows is that the number and the type of drivers of satisfaction relate to the particular service being offered59.


The critical factor to take away from this review of the literature on drivers of satisfaction is the importance of accounting for the specific features of an individual service in the development of customer satisfaction measurement processes. This is particularly important in social services where customer / service provider relations are fundamentally different from those in the commercial and even the public sector.

While there have been some attempts to develop generic customer satisfaction survey instruments specifically for the human services, these tools may have limited use for organisations with limited resources to purchase the licences to use them. Furthermore, there are obvious limitations in using generic tools, even if they have been developed specifically for a social service context, given the wide variance in service settings within the social services.

This has been noted by Hsieh (2012) with regard to the development of satisfaction survey tools in the social services. Many of the studies of customer satisfaction in the social services are not context specific, instead they use generic survey instruments, which are not able to account for the unique nature of specific service settings. This, it is argued, leads to the collection of overall satisfaction scores, which provide limited guidance on how to improve services because they do not pinpoint the sources of satisfaction or dissatisfaction.60

While the various dimensions noted above can provide a useful starting point for developing surveys and questionnaires used to measure customer satisfaction, a level of adaption is required to ensure that customer satisfaction surveys are relevant for specific service contexts. Essentially work must be undertaken to ascertain, from the point of view of service customers, the dimensions of service delivery that most contribute to satisfaction.

Fostering the participation of customers in research processes, such as those involved in developing customer satisfaction surveys, provides an opportunity to base any service improvements on insights of everyday practice61. The use of participatory and emancipatory research methods as tools for increasing the inclusion and empowerment of disadvantaged and marginalised people is well developed in the field of disability research62. As Nind (2011) has argued with regard to research with people with a disability, participatory research should, at the very least, involve research participants in the development of research questions63.

The inclusion of customers in the process of developing customer satisfaction questionnaire tools is commonly used in academic studies and the development of larger scale surveys. Kapp and Propp, for example, used focus groups with parents to develop and test a satisfaction survey for parents of children in foster care. The development of options for measuring customer satisfaction in SAAP services involved steps to elicit input from service users through focus groups and pilots64.

The need to make customer satisfaction measurement surveys and questionnaires applicable to a specific context and reflective of the experiences, values and views of service customers poses significant problems for non-government organisations with limited resources. It is likely that some social service organisations would find it difficult to follow a rigorous and inclusive process to determine the key drivers of satisfaction, because this is time consuming, technical and costly. Many organisations develop and administer basic customer satisfaction surveys and questionnaires based on the knowledge of staff with


limited input from service users because of the lack the resources required to undertake more thorough processes. This undermines the capacity of customer satisfaction processes to provide feedback to assist in developing meaningful change in practice.

Despite these constraints it is clear from the discussion above that the development of processes to collect customer satisfaction data requires consideration of the specific context and input from customers to ensure that methods used to collect satisfaction data are tuned to the issues of importance for the specific customer group.

6. Methodological considerations

There are a number of tools, which can be used to gauge customer satisfaction. These range from informal conversations with customers during service activities, complaint forms, formal written questionnaires, face-to-face and telephone interviews and focus groups amongst others. There are a number of issues to consider when choosing the most appropriate methods for eliciting feedback about satisfaction from customers. These include the timing of the administration of a survey, sampling bias, customer benefit, confidentiality, customer expectation and experiences, social and cultural background, capacity to respond, carer involvement and response bias.

These factors can affect either actual participation in customer satisfaction surveys or influence the way that responses are given by participants. While this provides some guidance to service operators in developing customer satisfaction processes and tools that maximise participation and response quality, it is preferable to gain input from customers about which satisfaction measurement methods work best for customers. Doing so can have a positive impact on participation and ensure that responses more accurately reflect customer sentiment.

6.1. Timing

The timing of the delivery of a customer satisfaction questionnaire or survey can influence whether a customer chooses to provide feedback to an organisation.

Delivering a survey to customers at the point of contact can significantly reduce the costs associated as there is no need to pay for mail outs or to employ external consultants to administer a survey on behalf of the organisation.

Some organisations choose to administer satisfaction surveys at the point of service delivery at a set time to provide a sample of responses that can be used as a proxy for overall satisfaction over a longer period. Anglicare Victoria, for example, administer a survey to all people accessing services across a range of programs and program areas over a one week period in September, which is designed to be able to be administered at any point of a service intervention, not just at the end. In doing so, Anglicare Victoria hoped to reduce the burden of administering the satisfaction survey on staff65.

Unfortunately, there are drawbacks in administering surveys at the point of contact with the customer. The delivery of a survey to customers at the point of contact may not be the most customer friendly or appropriate method. This is particularly so if the customer has low-


literacy skills, a cognitive impairment or if the survey is written in a language, in which the survey respondent is not proficient. While this can be overcome by having a staff member administer the survey with the customer, this may reduce the capacity for negative feedback to be collected, especially if the survey is asking questions about the staff member’s performance.

Administering a customer satisfaction survey at the point of contact may also be problematic in certain situations or contexts. While it may be practical, for example, to ask customers to participate in satisfaction surveys at the point of first contact, this may be inappropriate when they have immediate crises issues to deal with, such as when accessing accommodation services. In such situations it is preferable not to attempt to gain satisfaction information or consent at this time but to administer surveys at a later point in time using mail or telephone survey techniques66.

6.2. Sampling bias

Another interconnected issue is the problem of sampling bias. Any kind of research, whether it is measuring customer satisfaction or otherwise, can suffer from a bias in results because the sample of survey respondents inadequately reflects the population being investigated67. According to Harris and Poertner (1998) customer satisfaction data is plagued by low response rates, which calls into question the representativeness of satisfaction results and the ability of the results to be generalised to the rest of the population.

Baker (2007) has noted, with regard to child welfare clients, that sampling bias can occur as a result of the timing of the administration of surveys. If a satisfaction survey is administered on exit or using a point-of-time methodology this can over- or under-represent participants based on the length of time in the system. This can be problematic because length of participation may be correlated with satisfaction, such that customers who continue to be engaged in a service are more likely to be satisfied with the quality of that service. This could result in a bias towards higher levels of satisfaction in survey results, which may not reflect the whole population68.

Sampling bias can also occur because of the method adopted to elicit responses from customers. While mail and telephone surveys overcome the issue of sample bias from using exit or point-of-time methods because they can include customers that exit the service prematurely these can have a response rates as low as 40 per cent for mail and 43 per cent for telephone surveys69. This low response rate is problematic because evidence suggests that those who choose not to respond may be more dissatisfied with the service they have received than those who are willing to respond, biasing the outcome of any satisfaction survey70,71. Both service providers and funders should be cognizant of the implications this has for achieving a representative sample of customer satisfaction72.

6.3. Customer benefit

Customers may choose not to participate in satisfaction surveys simply because it is not in their interest. Participation in surveys requires time and effort and often the only reward for


participation is the promise that their responses will be taken seriously and result in positive changes to future practice.

To overcome this constraint to participation, services can offer inducements to reward a potential participant. Anglicare Victoria, for example, offered participants in its annual survey the chance to win a $500 shopping voucher as a potential reward for participation73. Given that the response rate for the survey was estimated to be only 12.1 per cent, it is difficult to ascertain if the inducement had an impact on participation or whether other factors associated with the method of administering the survey reduced the capacity of the inducement to encourage participation.

Without any inducement to participate in customer satisfaction surveys, organisations rely heavily on the knowledge that feedback from customers will result in service improvements as a means of encouraging participation. It is difficult to get people to respond to surveys if they feel that doing so is futile. Potential participants must be convinced that the information that they provide will result in a change to the system otherwise they are less likely to bother74. This may be difficult where there are ingrained beliefs based on past experiences or social norms.

6.4. Confidentiality

Confidentiality is a significant issue, which can have important ramifications for participation. Baker has argued that collecting feedback in sensitive areas such as child welfare, for example, requires both confidentiality and efforts to convince survey participants that there will be no way for their responses to be linked to them otherwise they may be unwilling to participate75.

Confidentiality concerns can make it difficult to gain the consent of some customers. It is possible that customers willing to participate in satisfaction surveys may be more satisfied, in part because those that are most unsatisfied are sceptical that their input would be kept confidential or would indeed change anything76. This could skew the results of any satisfaction survey and provide an overly positive assessment of the service.

6.5. Customer expectations and experiences

As it was noted earlier customer satisfaction is determined by measuring the gap between expectations and perceptions of performance. This raises a number of important considerations when undertaking customer satisfaction research.

It is possible that a constellation of influences on a customer outside of the service interaction may have significant influence on their expectations and perceptions of performance. Expectations are complex in that they emerge not only from direct experience but are also informed by a number influences. For public institutions it has been argued that this includes77:

• a client’s past experiences, • word-of-mouth communication, including family, friends, colleagues and the media • the personal needs of the client


• explicit communications made by the service, staff and written in literature • implicit service communications such as those associated with the physical

appearance of the service setting• a client’s values and beliefs• a client’s views about government.

As Johnston (1995) has duly noted a customer’s overall feeling of satisfaction with a service could in truth be influenced by a customer’s personal disposition on entering the system78 and therefore largely be beyond the influence of the service provider.

A service provider should be cognizant of the fact they may not view the service in the same way that the customer does. This is important, because the way that the customer defines the service, shapes their expectations, their experience and ultimately the level of satisfaction. If a customer needs something specific, for example, that the service simply cannot deliver then this will ultimately lead to a lack of satisfaction. Equally if a customer disagrees with the focus of an intervention, for example child-centred versus family-focused, this may result in higher levels of dissatisfaction79. It is important, therefore, that the ‘customer defines the ‘service’ in the same way as the organisation’80.

With this in mind it is important to recognise what can be done to align expectations with reality. While it is impossible to control customer expectations, an organisation can control how it communicates about itself through staff and in promotional literature. This includes communicating accurately the type and level of service provided by the service without making any undue promises about what can be obtained or provided.

Because the measurement of customer satisfaction relates to a customer’s expectation and experience of a service, it is also important to acknowledge that the process of measuring customer satisfaction has the potential to raise or lower customer expectations. As organisations use customer satisfaction processes to improve service delivery and to communicate the positive aspects of the service, this invariably raises future expectations. This phenomenon is viewed in the literature as a task without an endpoint because customers are never completely satisfied81.

6.6. Social and cultural background of customers

Another important consideration is the impact that a customer’s unique social or cultural background has on the way that customer satisfaction is measured. These differences may influence how satisfaction is measured, data is collected, results are interpreted and actions are taken to improve service quality.

Both the age and socio-economic background of survey respondents can affect the way that a person responds to survey questions. Research into patient satisfaction in health care has shown, for example, that older patients are generally more satisfied with their hospital experience than younger patients.82 Similarly patients from lower socio-economic backgrounds have been shown to be more likely to be satisfied than wealthier patients.83

Another important consideration is the capacity of customers from culturally and linguistically diverse (CALD) backgrounds to participate in satisfaction surveys and questionnaires which are in English. It is beneficial to have customer satisfaction surveys administered in the


preferred language of the service user as this will not only increase the response rate for people from a CALD background, but will also reduce any embarrassment that may occur as a result of a person’s capacity to comprehend questions in English. It is also preferable to administer surveys in the preferred language of respondents because when this is not done it produces survey results that differ if the survey was provided in their native language84.

Equally, though, consideration should be given to the literacy level and communication style of the survey respondent. It may be inappropriate to administer a written questionnaire when survey respondent’s literacy or numeracy levels are low85 or if oral communication is a preferred means of communication. Consideration should also be given to the issue of acquiescence bias, which can result in survey respondents only providing positive feedback. As one report has noted, standard satisfaction surveys may not be useful when administered to some CALD respondents because they may elicit positive feedback even though they have had a negative experience of the service86. Each of these considerations will have important implications for the choice of survey method, which will in turn impact on the cost of collecting customer satisfaction data. Face-to-face interviews are also useful for respondents with literacy and numeracy problems87.

6.7. Capacity to respond

Apart from language, there are other instances where the choice of survey methodology may impact on the capacity of a customer to respond. Traditional survey methods using numbered Likert scales may be inappropriate for people with different competency levels.

Survey methods need to be adapted to ensure that people with an intellectual disability, for example, are able to participate in customer satisfaction processes. To ensure this, it is important that survey processes and questions are developed based on feedback from customers before they are administered. This can be done by holding focus groups and by conducting pilots and trials to get advice and feedback from customers

This might require the development of different approaches to asking questions, which are better suited to the customer. As it has been argued in a Productivity Commission report it may be better to measure satisfaction by using direct questions rather than satisfaction ratings, for example do you wish to move house or change your job88.

6.8. Carer involvement in assessing satisfaction

Another consideration is the involvement of significant others in the process of collecting information about customer satisfaction.

While satisfaction surveys administered in the disability area generally collect information about carer satisfaction, it has been argued that it is not appropriate to use the responses of family members and carers as a proxy or substitute for collecting satisfaction directly from people with a disability89.

Similarly, in studies of family and significant others who play a role in supporting clients receiving mental health services it was found that there are differences in reported


satisfaction indicating that clients and significant others use different factors or emphasize different aspects when evaluating satisfaction90.

6.9. Response bias

It has been well noted in the literature that satisfaction surveys tend to be biased towards positive results. Surveys relying on self-reporting have a tendency to elicit positive responses from survey respondents due to a reluctance to express negative opinions of services or service providers. This is defined in the broader customer satisfaction literature as social desirability or courtesy bias. Social desirability bias is particularly acute when information is gathered at the site of the service or using face-to-face methods91.

In a study of customer satisfaction of a family planning clinic in Africa, the issue of courtesy bias was overcome by designing a survey methodology that focused on areas for improvement rather than levels of satisfaction. This was done by asking yes / no questions about whether a service user was satisfied or unsatisfied with an aspect of the service and then selecting those aspects where a high proportion of dissatisfied responses exceeded a predetermined threshold for improvement92.

Even something as simple as the wording used in the survey can have a significant impact on the results from a customer satisfaction survey. A similar issue with surveys is the tendency for respondents to respond in the direction of the question. This acquiescence bias may skew reported levels of satisfaction in the direction of the wording, such that negatively worded questions induce a negative response and positively worded questions are more likely to induce a positive response93.

The difficulty getting honest responses from service users can also occur as a result of the fear that there may be repercussions if negative or critical responses are provided. Justice and McBee (1978) have argued that people receiving treatment for mental illness may have a tendency to express satisfaction with services for fear that these service may be withdrawn now or in the future94. This is also the case in child safety, where clients may perceive extreme power imbalances due to the removal of children, which make them reluctant to provide negative feedback for fear of reprisal95. This same fear has been reported amongst clients receiving crises accommodation and support96. In each of these cases it is critical that the people involved in collecting satisfaction surveys be viewed as impartial and create a safe space for eliciting honest responses without fear of retribution97.

7. Conclusion

This paper has provided an overview and introduction to customer satisfaction measurement through an examination of a range of literature, including academic peer reviewed studies and organisational and project reports. It has shown that customer satisfaction measurement, at its heart, involves assessment of the difference between a customer’s expectation of a service and a customer’s experience of a service. But it has also shown that customer satisfaction measurement can be a complex and involved process in which organisations use customer satisfaction surveys as part of an ongoing service improvement cycle.


The paper has also discussed the importance of using customer satisfaction measurement to better understand the needs of social service customers and create more customer-centred services. Through the analysis of the literature it was shown that the drivers or determinants of satisfaction, those elements which customers see as most important as contributing to overall satisfaction, vary in different service contexts. This has exposed the importance of working with customer groups in specific settings when developing customer satisfaction instruments, such as surveys and questionnaires, to ensure that the questions asked reflect the needs of customers. Failure to do so, may result in customer satisfaction processes which are meaningless and give little or no guidance to service providers on how to improve service quality. As it was also found, it is important to gain feedback from customers about how they would prefer customer satisfaction surveys to be administered, as this can have a significant impact on participation and on the quality of responses.


Endnotes


1 HM Government 2007. Promoting Customer Satisfaction: Guidance on improving the customer experience in Public Services. http://www.tns-bmrb.co.uk/uploads/files/iips-insight-customer-satisfaction-guidance.pdf

2 Buttle, F. 1996. ‘SERVQUAL: review, critique, research agenda’ in European Journal of Marketing. 30,1, pp. 8-32.3 Clinton, A. and Wellington. T. A Theoretical Framework of Users’ Satisfaction/Dissatisfaction Theories and Models. 2nd

International Conference on Arts, Behavioral Sciences and Economics Issues Dec. 17-18, 2013 Pattaya (Thailand) http://psrcentre.org/images/extraimages/1213003.pdf

4 Rapp, C. and Poertner, J. 1987. “Moving Clients Center Stage Through the Use of Client Outcomes” in Administration in Social Work, 11, pp. 23 – 38.

5 Baronet, A-M. and Gerber, G. 1997. ‘Client Satisfaction in a Community Crises Center’ in Education and Program Planning. 20, 4, pp. 443 – 453.

6 Northern California Training Academy 2009. The Importance of Family Engagement in Child Welfare Services. Davis, CA http://academy.extensiondlc.net/file.php/1/resources/LR-FamilyEngagement.pdf

7 Kapp, S. and Propp, J. ‘Client Satisfaction Methods: Inputs from Parents with Children in Foster Care’ in Child and Adolescent Social Work Journal. 19, 3, pp. 227 – 245.


9 HM Government 2007. How to measure customer satisfaction: A tool to improve the experience of customers. http://www.ccas.min-financas.pt/documentacao/how-to-measure-customer-satisfaction

10 Australian Federation of Homelessness Organisations. 2003. Measurement of Client Satisfaction in the Supported Accommodation Assistance Program (SAAP). http://www.dss.gov.au/sites/default/files/documents/05_2012/saapclientsatisfactionreport0306.pdf


12 King County 2007. Measuring Customer Satisfaction: Improving the experience of King County's customers http://www.kingcounty.gov/~/media/CustomerService/files/1101CustomerSatisfactionGuide.ashx

13 Productivity Commission 2005. Review of patient satisfaction and experience surveys conducted for public hospitals in Australia. A Research Paper for the Steering Committee for the Review of Government Service Provision http://www.pc.gov.au/__data/assets/pdf_file/0016/62116/patientsatisfaction.pdf

14 Deeble Institute for Health Policy 2014. Can we improve the health system with performance reporting? Deeble Institute Issues Brief no. 6 http://ahha.asn.au/sites/default/files/publication/18885/deeble_issues_brief_no_6_partel_k_can_we_improve_the_health_system_with_performance_reporting.pdf

15 Department of Communities, Child Safety and Disability Services 2014 Human Services Quality Framework User Guide http://www.communities.qld.gov.au/resources/funding/human-services-quality-framework/user-guide.pdf

16 Department of Communities 2011. Disability Service Users and Carers Satisfaction Survey 2011: Key Findings http://www.communities.qld.gov.au/resources/disability/community-involvement/satisfaction-survey/documents/consumer-satisfaction-survey-2011.pdf


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an exploratory study. http://www.adhc.nsw.gov.au/__data/assets/file/0005/241664/51_Measuring_outcomes_in_community_care_report.pdf



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