“It only takes a second to fill out,” the x-ray technician told me cheerfully after an MRI I had yesterday. He was explaining that I would soon receive a survey in the mail asking about the service he provided, and he mimed checking off the boxes: “You just go down the list, five, five, five, five…”

Five, as you may have guessed, is the top satisfaction score.

Now, this was a community hospital affiliated with the University of Chicago Medical Center (which is a client of ours). But it’s an example of how all kinds of educational and cultural nonprofits could be thinking about the relationship between customer feedback, staff performance, and the bottom line.

At first it rubbed me the wrong way. My colleagues and I pride ourselves on being rigorous researchers, and we’ve criticized (here and here) survey processes that are less than scientific and objective. The whole point of social and market research is to get a true picture of how people think, feel, and act. You’re not allowed to coach them to give you high marks; you’re not supposed to influence them in any way.

But there was something else going on here, and it made me look more deeply at the role this kind of satisfaction research plays.

My tech’s name was Leo, which he wrote on the card he gave me so I would be sure to put it on the survey. Unprompted by any questions from me, he explained that the survey was a big part of the culture at the hospital. “We strive for five” is a staff mantra. At weekly meetings in each department, workers who received good survey ratings or comments are recognized. This presumably factors into their promotion and salary trajectories.

He even told me that the insurance companies link their reimbursement amounts to those patient satisfaction scores. I don’t know whether this is true or how much of the hospital’s revenue might be at stake in the formula. But what’s important is that Leo and his colleagues see the financial performance of the institution as dependent on the quality of the experiences it provides to individuals like me. ...