In this preview piece from the upcoming Customer Contact West: A Frost & Sullivan Executive MindXchange Chronicles eBook, Aisha Ponds shares key insights and outlines a process to help organizations map the root causes of customer service issues and develop strategies to address and prevent them in the future.


The handling of customer complaints and concerns is a challenge shared by all contact centers. But just resolving a specific issue should not be a one and done approach. Participants learned about BlueCross BlueShield of North Carolina’s process to identify root causes and how they use that analysis to develop strategies to prevent or minimize future occurrences.


  • Best practices to establishing escalation processes with your business partners
  • Fresh perspectives on how to use learnings from escalations to better train/coach your frontline staff
  • Techniques on how to creatively educate the organization (across silos) on lessons learned to make process improvements outside of your business area


Aisha opened her session by commenting that escalation is a fancy name for complaint! She also shared a true story about a big customer issue she faced at BlueCross BlueShield North Carolina. Story: I’m about to check out for Christmas vacation. We get a complaint, and it’s a big one. A family was no longer covered for a drug after a policy change. It’s a necessary $30,000 drug for their child. The family had already appealed multiple times and within multiple places. What could we do about it?

In this case, every department had done their job correctly, in line with company policy and processes. But the customer experience overall was negative, and led to a 120 day delay in the multiple appeals process. It was an urgent matter. “We do have not time for super stars; we need to get this approved asap.” Ideas included calling the pharmacy, appeals, changing the drug, etc. As Aisha noted, sometimes you have to look at all your processes holistically.

How to solve for problems like this? Map it out to gain a deeper analysis of the escalation and better inform future processes.

Why create root cause maps?

  • Deeper analysis
  • Identifies the entire cause
  • Strategic way to improve performance
  • Easy way to see failure points and opportunities
  • Can help you understand reactions leading to the problem
  • Visual chronological account of customer interaction

A strategic way to improve performance via people, method and tools

  • A visual and chronological account of customer interaction
    • BlueCross BlueShield of North Carolina captures every interaction customer has had with us
    • How many times they’ve ever called, emailed, written, visited in person

Easy way to see failure points and opportunities

  • Identify the failure points:
    • The agent gave incomplete information
    • The representative didn’t do sufficient research
    • Or, perhaps, the agent did everything right, but the handoff was incomplete
    • Say a check was not issued out — that’s not a service function, it’s a finance problem

Whatever it is, they’re able to see at what point in the process the moment of failure or missed opportunity occurred

  • Customer loyalty = Service → Support → Feedback → Quality → Satisfaction → Reward (Customer direct process)
    • Customer satisfaction indirect processes: Even indirect processes have a direct impact when talking about customer satisfaction
    • Look at instances of escalations:
      • Different kinds of escalations: formal processes, federal healthcare, social media
      • Identify failure points
      • Example: agent failed or there was incomplete information or an incomplete handoff; i.e. check wasn’t issued

With root cause mapping, companies can talk to groups who are farther and explain how they are touching the customer. For example, at BCBS of North Carolina, the finance department started taking American Express cards, but didn’t tell anyone in customer service. Through escalations, it came up that members had paid bills with AMEX…but customer service was saying, “No, we don’t take AMEX.” Oops!


  • When trigger events occur, know the process
  • Escalations are gold – they represent nuggets of opportunity to learn what you do well and what needs to change
  • Use customer feedback
  • Don’t assume that the customer is settled. Call and ask – complete the customer transaction
  • Critically analyze ‘every’ customer interaction, or a good percentage, on a monthly basis, by mapping out the process
  • Understand the customer role – planned and unplanned
  • Implement a solution for feedback


  • View failure point mapping as a gift to see what is going on
  • Assumptions from external processes have to be challenged
  • Mapping for BCBS of North Carolina has been beneficial and led to more collaboration
  • Map using the “swim lane method,” present findings, know your triggers and truths

Consider creating a Customer Loyalty Group out of the “frequent fliers,” people who often use escalation channels. Benefits include:

  • Allows you to channel the feedback of the frequent complainers, and teach them about healthcare
  • Helps to gain their buy-in and engagement and focus group feedback
  • Candid conversations with this group are mutually beneficial
  • They can come to internal meetings and you can leverage their perspectives

Understand the customer’s REAL experience (journey) with your product and services

    • Not just the experience you mapped out at the beginning
    • Don’t shy away from it
    • Improve operational efficiency and  increase exceptional experiences accordingly
      • Use learnings to better train coaches and your frontline staff
      • Educate business areas removed from CX
    • Cultivate continuous agent and leader engagement
      • De-escalation workshops
      • Coaching conferences (collaboration sessions)

Present findings via review sessions

      • Everybody walks up and looks at the maps, case by case
      • Identify service gaps and failures
      • They only do review sessions on closed cases!


The mapping technique BlueCross Blue Shield of North Carolina uses is called Swim Lane Mapping. It typically consists of a flowchart that maps out a process, decisions, and loops. This type of map places events and actions in “lanes” to delineate the person or group responsible, for a specific process. A swim lane map has three elements: time, people (or job functions), and tasks/processes.


What happened in the opening story about the family? The family was given a grant with the pharmacy. Take-away: Humanize the environment. It’s healthcare. It’s people. It’s conversations about opportunity.