S2 EPISODE 3 | Change That Binds

How to Listen When Customers Don't Speak

SERIES 2 EPISODE 3

The Illusion of Listening

Most organizations are good at tracking complaints through well-established escalation processes that allow them to respond when customers have simply had enough. These processes matter. They help organizations recover relationships, resolve immediate issues, and identify operational breakdowns. However, these recovery processes are only the beginning of listening well.

When organizations listen primarily to the loudest customers, who represent only a fraction of the customer base, they are reacting rather than learning. They become highly skilled at responding to symptoms while remaining disconnected from the conditions that created them. The opportunity to examine, validate, and apply what they learn to the broader population is often missed.

Why does this matter? Because the loudest customers shape the agenda while the quiet majority remains largely invisible. Within that silence may be information that is more systemic and consequential than any individual escalation. Yet organizations can become so focused on determining which department or individual is responsible for a failure that they lose sight of the people they exist to serve. When assigning blame becomes more important than understanding the conditions that produced the failure, the organization has matured its ability to respond, but not its ability to learn.

The Silent Majority Is Not Neutral

Silence is often misinterpreted as satisfaction. In many cases, it may signal that the effort required to provide feedback outweighs the perceived benefit, that customers lack confidence their concerns will matter, or that unfamiliar processes make engagement difficult. Sometimes it signals something more concerning: customers have simply lost faith in the organization's ability to make life easier for them. Of course, silence can also reflect satisfaction or an absence of immediate need. The challenge for leaders is learning to distinguish among these possibilities rather than assuming that no complaint means no problem.

These signals are particularly consequential in healthcare, where the cost of confusion can extend well beyond inconvenience to delayed treatment, worsening health outcomes, and avoidable financial burden. Members navigating their benefits are frequently managing illness, financial uncertainty, caregiving responsibilities, or fear. Many do not have the time, language, confidence, or energy to call, wait, explain, and escalate. As a result, some delay care, skip preventive services, or make decisions that unintentionally compromise their health and financial well-being.

Consider diabetes management. Evidence summarized in the American Diabetes Association's Standards of Care demonstrates the importance of ongoing monitoring, preventive interventions, and effective management in reducing the risk of complications, including kidney disease and cardiovascular events (American Diabetes Association, 2022). When members encounter barriers to accessing these services, the consequences can extend far beyond an unresolved benefits question.

The same concern is evident in maternal health. Black women in the United States continue to experience substantially higher maternal mortality rates than White women (Centers for Disease Control and Prevention, 2023). Likewise, Black women experience higher mortality rates from breast cancer despite lower incidence rates than White women (American Cancer Society, 2024). These disparities reflect complex and persistent inequities involving access, quality of care, treatment, and broader social conditions. They remind us that the absence of a complaint cannot be interpreted as the absence of need, particularly among populations whose experiences may be poorly represented in traditional feedback systems.

The Vision We Cannot Lose

For payer organizations, the strategic role of the contact center must be larger than resolving interactions. It is to help members fully utilize their health benefits to achieve their wellness goals for themselves and their families. That responsibility extends beyond helping the member who calls. It requires identifying patterns across thousands of interactions to uncover where plan design, benefit language, billing explanations, prior authorization requirements, provider access, or network complexity create barriers that may affect the broader membership.

The true value of the contact center is not simply its ability to answer questions. It is its ability to reveal where the system itself is creating them. When leaders use cumulative insight to identify and address recurring barriers, they improve the experience for members who call and create opportunities to improve access for those who never reach out. Complaint resolution remains essential, but it should contribute to a larger purpose: understanding how well the organization is fulfilling its promise of care.

The Organizational Bias Toward Noise

Most organizations are designed to respond to what is visible: complaint volumes, escalation rates, speed of response, and service recovery metrics. Unintentionally, they create a feedback loop in which the loudest signals receive the greatest attention. Over time, customers may learn that persistence and escalation are effective ways to obtain resolution, while organizations continue allocating resources toward managing complaints rather than eliminating their root causes.

This creates an unintended consequence. Customers who understand how to navigate the system and are willing to advocate for themselves may be better positioned to overcome barriers than those who do not. Research on health literacy demonstrates an association between limited health literacy and poorer access, understanding, and health outcomes (Berkman et al., 2011). Those facing the greatest challenges may also have the fewest resources to navigate complex processes. What begins as an experience issue can quickly become an equity issue.

A well-functioning system should not require persistence, escalation, or expertise on the customer's part to access a benefit, especially for those who are most vulnerable. Kaiser Permanente offers an example of a more proactive approach through its integration of care delivery, clinical information, and population health management. Research within Kaiser Permanente has demonstrated how electronic health records and organized outreach can support preventive screening and the identification of gaps in care. The larger lesson is that organizations can design systems to identify unmet needs rather than wait for customers to report them.

Listening as a System, Not an Event

Real listening is not episodic, nor is it confined to surveys or post-call questionnaires. It is an organizational capability that reflects an institution's capacity to learn, adapt, and improve. A mature listening system integrates behavioral data that reveals what members do, structured feedback from surveys and targeted outreach, unstructured insights from call transcripts and agent notes, and frontline intelligence from employees who observe where customers struggle and processes break down.

When organizations triangulate these sources across the customer journey, they gain a more complete understanding of how members experience the system and where leadership may need to intervene. Research by De Haan et al. (2015) demonstrates that different customer feedback measures provide distinct predictive information, reinforcing the importance of understanding what individual measures can and cannot reveal. For healthcare organizations, the greater opportunity is to connect contact center intelligence with utilization patterns, care gaps, and other appropriate operational and clinical information, while maintaining the privacy and governance necessary to use that information responsibly.

The goal is not simply to collect more data. It is to develop a more complete understanding of the experience the organization is creating, including experiences that never generate a complaint.

Finding the Signals That Aren't Obvious

Listening to customers who don't speak requires asking different questions. Leaders should routinely ask who is not utilizing preventive care and why, where members abandon important processes, which populations remain under-engaged despite high need, and whether issues identified during an interaction were ultimately resolved. These questions shift the conversation from understanding only those who contacted the organization to examining the needs of the broader membership.

This is particularly important in areas such as benefits, claims, appeals and grievances, and prior authorizations. Patterns emerging from customer questions may reveal confusing plan language, inconsistent explanations, or processes that are difficult to navigate. Those patterns provide hypotheses about barriers that may also affect members who never call. By comparing contact center findings with broader membership and utilization data, organizations can test those hypotheses, distinguish isolated issues from systemic problems, and identify opportunities for improvement.

The distinction matters. Call data alone cannot tell us what every silent member is experiencing. But it can reveal where leaders should look, what they should question, and which assumptions require validation. In this way, the contact center becomes an important source of organizational intelligence rather than merely a record of completed interactions.

Owning the Outcome, Not Just the Interaction

Most contact centers are designed to optimize the moment. Leaders focus on Handle Time, First Contact Resolution, and Customer Satisfaction. While these measures matter, they provide an incomplete picture because they primarily assess the interaction rather than what happens afterward. A member may receive an accurate answer, express satisfaction, and still encounter barriers that prevent access to needed care.

The more important question is whether the member's situation actually improved. Did they receive the care they needed? Do they understand what to do next? Were they able to act on the information provided? These questions require organizations to look beyond the immediate interaction and consider whether the customer journey produced the intended result.

Owning the outcome requires a shift from transactional thinking to journey accountability, from siloed functions to shared ownership, and from closing interactions to addressing gaps in care. This does not mean that contact center employees become responsible for clinical outcomes beyond their authority or expertise. It means that leaders establish the relationships, processes, and accountability necessary to ensure that information about barriers reaches the functions capable of addressing them.

The benefits of this approach may not be immediately visible in traditional service-level metrics. Improvements in preventive care engagement, reduced confusion, stronger trust, and more effective navigation often emerge over time. This is more difficult work than managing daily performance measures, but it is also the work most closely aligned with the broader mission of a healthcare organization.

Building a Culture That Listens Deeply

Let me be clear. Listening at this level is not a tool. It is a discipline, and it begins with leadership. If leadership focuses exclusively on complaints, accuracy, and service levels, the organization will naturally direct its attention toward those measures. If leadership expands its focus to include missed opportunities, unmet needs, and the experiences of members who rarely engage, the organization begins to develop a different understanding of performance.

Leaders must create the conditions for continuous learning by examining non-engagement alongside escalations, elevating frontline observations into strategic conversations, and rewarding prevention as well as recovery. This requires a willingness to question established processes and consider whether recurring customer difficulties are evidence of individual failures or organizational design problems.

A culture that listens deeply also changes the employee experience. Rather than spending their days compensating for problems they did not create, employees have meaningful opportunities to contribute what they know about the system and participate in its improvement. Their observations become a source of intelligence, and leadership assumes responsibility for acting on what the organization learns.

Listening as a Change That Binds

Becoming good at listening to customers who do not speak is a strategic capability that requires discipline, structure, and a willingness to look beyond what is easy to measure, especially when the system is under pressure. In healthcare, where access, understanding, and trust influence how people engage with care, the ability to learn from those who never complain may be one of the most important capabilities an organization can develop.

The organizations that will thrive in the coming decade will be those that move beyond responding effectively to complaints and become equally capable of learning from the experiences those complaints do not represent. When contact centers become engines of organizational learning rather than simply centers of resolution, they help create systems that are more equitable, effective, and responsive to the needs of all members. That is what service integrity looks like.

Ultimately, the goal is to help members, whether they ever call or not, access, understand, and fully utilize the benefits designed to support their health and the well-being of their families. When organizations learn from the voices they hear and become curious about those they do not, they strengthen trust, reduce unnecessary barriers, and create systems capable of continuous improvement. That kind of learning creates change that endures, and that is a change that binds.

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🎧 This essay is part of our quarterly conversation on Customer Experience in Real Life. Listen to the companion podcast episode.

References:

American Cancer Society. (2024). Cancer facts & figures for African American and Black people 2024–2026. American Cancer Society.

American Diabetes Association. (2022). Standards of medical care in diabetes—2022. Diabetes Care, 45(Supplement 1).

Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine, 155(2), 97–107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005

Centers for Disease Control and Prevention. (2023). Maternal mortality rates in the United States, 2022. National Center for Health Statistics.

De Haan, E., Verhoef, P. C., & Wiesel, T. (2015). The predictive ability of different customer feedback metrics for retention. Journal of Service Research, 18(4), 466–483.