Why does our productivity rarely meet our own expectations? When planning our work, most of us make a reasonable effort to estimate how long we’ll need. While any given task seems perfectly doable on its own, when we string together a sequence of them we rarely achieve our target.
If we were as productive as we planned, we wouldn’t need to work overtime or sacrifice our weekends. So how can we get more done in the same time and be able to knock off work with no guilt or digital tethering to the office?
[Listen to audio version, read by David Hodes]
A major destructive force of productivity is multi-tasking. We imagine we’ll save time by juggling tasks along with the random demands placed on us by email, instant messaging, phone calls and interruptions from well-meaning colleagues. But this switching between tasks takes a major toll on our effectiveness.
In his book, Your Brain at Work, executive coach David Rock lays out some insights from neuroscience about how our brain really works. For example, the part of our brain responsible for executive function—that is, planning, reasoning and decision-making—is the most evolved, but also the most taxed. Found near the forehead, the pre-frontal cortex is likened by Rock to a theatre stage–and a very small one at that, even in the best and brightest amongst us.
“The part of our brain responsible for planning
is the most evolved, but also the most taxed”
Every time we think of something, it’s like calling someone up on stage from the dark recesses of the theatre. This effort of mental setup is highly energy intensive from a pure physiological perspective, requiring regular glucose refuelling just to keep up. Rock also makes the point that one of the most taxing activities of all is that of planning.
Why is this? Planning requires us to hold a whole series of thoughts in our minds at once while we flip between various combinations, like mentally playing out various scenes of a play. Only when we’ve made our decision do we send the audience backstage again, reducing our mental effort and returning our brain to a more steady state.
With this in mind, is it any wonder that the more interruptions we have, the more we need to do mental setups? And the more mental setups required, the less productive we become? We get less done and become more tired in the process, creating a vicious cycle that makes it ever more difficult to achieve what we have set out to do in a reasonable amount of time. How do we get into such a bind?
We’ve all had the experience that we are often more productive on the tasks that add the most value once everyone has gone home. Or that we choose to work from home because of too many interruptions at the office. That, surely, is a signal that something in our workplace needs fixing.
Our own worst enemy
The opposite of all this multitasking is the psychological state coined by renowned psychologist Mikhail Csikszentmihalyi—‘flow’. In flow, our work is challenging enough to stimulate us but not so difficult that we become anxious about our ability to do the task. We become engrossed and lose track of time. We can dramatically improve our output and feel satisfied as we do so. Yet even when we’ve experienced this enjoyable state, many of us sabotage our own ability to reach it.
In recent years, we’ve essentially trained ourselves to become addicted to the tiny packets of dopamine released when we feel our phone vibrate or hear an email or social media alert. We convince ourselves we’ll ‘just check this one’ but look up 20 minutes later—a different kind of losing track of time. (And, make no mistake, that time is lost.) Worse, research estimates that it takes us 18 minutes to fully return our attention to the deep state we were in before the interruption. The very things that were designed to make us more productive, such as instant messaging, are sapping our energy levels.
In short, while we may really want to engage deeply with a task, honing our mastery of complex problem-solving, we achieve that flow state all too fleetingly. What’s the solution?
There are really four core problems preventing us from working in flow:
The challenge is that we conflate them—colleagues ping us on IM, or we procrastinate by ‘checking the news’ before we’ve allowed ourselves to enter a flow state, when the real root cause is being overwhelmed and unsure where to start. It’s too easy to think it’s just the way things are. But they don’t have to be.
Know the work
Start with the system. If we’re talking about work, we should have a shared vision and aligned objectives. The requirement for a coordinated set of priorities at all levels of work sits at the heart of Theory of Constraints (TOC), especially through Critical Chain project management and Drum Buffer Rope production management. TOC acts as a systemic synchronising engine, taking explicit account of load (expressed as work-plans) and capacity (expressed by the pool of resources available).
We should therefore be starting from an explicit understanding of what is reasonable and possible to achieve given the available resources. Further, through the use of buffer management, everyone gets to know which chains of work are most under pressure, as well as which task and resources are required to relieve that bottleneck on any given day.
When we know the most important tasks to work on, we can make a ‘to do’ list that puts those tasks at the top. New York Times journalist and author Charles Duhigg offers good advice about putting stretch goals at the top of the list and making lower-order tasks SMART (specific, measurable, achievable, realistic, timebound). We not only know what’s next but have criteria against which we can weigh random interruptions: is that sudden meeting request going to help you with your stretch goal? If not, maybe pass on it.
David Rock suggests we do as much planning as we can before we start our work, doing it first thing in the morning if possible, when we have maximum energy. Others, including Mr Duhigg, recommend a slightly different approach and suggest planning your work the evening before. That way, when you sit down in the morning, you know exactly where to start and can use your energy most productively. My advice is to experiment and find what works for you.
Institutionalise ‘flow time’
We want our colleagues to respect our focus and wait for an appropriate time to have their questions answered, without barging into our mental workspace and forcing a new setup of the pre-frontal cortex once they have departed. So how can you make ‘flow time’ a reality for your team?
First, you need to decide for yourselves that you’ll all work smarter if you work in flow. So start by declaring ‘flow time’ as an inviolable part of the day or week when email and IM alerts are switched off, along with your phone. Your colleagues, regardless of rank, know this is a time for quiet, steady, task-engaged work and that they are forbidden from interrupting. If they know a time will come later in the day when they can ask whatever questions they want of whomever they want, they are more likely to honour the new way of working.
“Start by declaring ‘flow time’ as an inviolable part of the day”
Furthermore, they will begin to see one of two things happen: their seemingly urgent needs will be resolved by alternative means, or they will get a far higher quality of attention from the constrained resource once they have their full and undivided attention.
It shouldn’t be beyond the ken of your team to figure out a designated ‘flow time’ that respects local requirements and colleagues across time zones. Changing ingrained work habits is not that easy, but neither is it too difficult—the secret is to gradually wean ourselves off the multitasking, whilst simultaneously experiencing the joys of being able to apply ourselves to being fully present to the work at hand.
In my experience this has worked best by starting with, say, just half-day a week. So, for example, we could declare that from 8.30-13.00 on a Tuesday is ‘flow time’; meetings are banned and all electronic forms of communication switched off. (If you must work on emails, do so in offline mode.) Everyone respects the sanctity of doing his or her own work while letting others do theirs.
As the team gets used to this way of working, you can expand the proportion of flow time in any given week. It is practical wisdom to know that you cannot expect to work in flow the whole time you’re at work, but it should be possible to make it manage 50% of it in most instances. Also, when there is a system-level constraint, the team not working on it should do everything possible to subordinate to its needs of , leaving the constraint to do that which, at that moment, only the constraint can do.
Know thyself
We’ve looked at knowing which task to work on and how to institutionalise flow time. That leaves technology and self-sabotage. If you follow the flow-time rule above, you’ll quickly feel the benefit of ‘unplugging’ from alerts. It’s a small step to move from a block of time that everyone respects to chunks of extra unplugged time that work for you. You may feel obliged to keep IM channels open (although those usually have a ‘do not disturb’ sign) but why not turn email off as your default and only check, say, three times a day? You’ll find you can quickly despatch the short emails in one go where, previously, each one would have been an interruption. Some may no longer need answering at all!
Even after all this, we’re only human. We’re frazzled by the news or by events at home or with colleagues. The Pomodoro technique is useful here. That’s when you set a timer (originally a tomato-shaped kitchen one, hence the name) for 25 minutes and tell yourself you’ll only focus for that length of time. Usually, though, once you pick just one task and focus you’ll almost feel your brainwaves lengthen from the choppy, frenetic alert-driven state to a more relaxed state. Don’t be surprised if you find yourself losing track of time and continuing happily on. Be aware, though, that we tend to hit diminishing returns around the 90-minute mark.
To wrap up, here are our key learnings:
Do all this and you will significantly increase the quantity of what you get done, the quality produced and the joy you get from doing your best. You’ll then find that allowing yourself a break—whether for a walk or even surfing the web—becomes not self-sabotage but a way to enter a different state again that’s good for diffuse thinking. But that’s a subject for another day.
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What’s next?
The change from standard thinking to Theory of Constraints (TOC) is both profound and exhilarating. To make it both fun and memorable, we use a business simulation we call The Right Stuff Workshop.
We’d love to run it with you. To learn more:
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Pomodoro image: Francesco Cirillo (CC licence)
“If you change the way you look at things,
the things you look at change” —Dr Wayne Dyer
Healthcare professionals are central to the patient’s progress from awareness of a therapy to successful long-term use. They identify risk, interpret evidence, diagnose conditions, discuss options, perform procedures, provide training and monitor outcomes.
Yet many medical device development programs treat healthcare professionals primarily as users to be trained or customers to be persuaded.
HCP-Centered Design takes a wider view. It examines the work healthcare professionals must perform, the system in which they perform it and the constraints that limit their ability to move suitable patients through the care pathway.
“If patient flow depends on a healthcare professional, that professional’s available capacity may determine how many patients ultimately receive the therapy.”
A medical device patient journey commonly depends on several healthcare professionals:
Each professional governs a transition in the flow of patients.
If one transition lacks sufficient capacity, information or clarity, the whole pathway slows. More marketing, sales activity or production capacity will not compensate for a shortage of specialist time or a burdensome diagnostic process.
This is why HCP-Centered Design is not simply about making an interface easier to use. It is about enabling the system of care to perform.
A healthcare professional’s work depends on information and actions supplied by others. They may rely on referrals, patient histories, pathology, imaging, electronic records, clinical guidelines and the availability of equipment or trained colleagues.
After reaching a decision, they may need to explain it, document it, arrange authorization, coordinate treatment and prepare the next person in the pathway.
A technically strong solution can still create difficulty if it:
The relevant design question is not merely, “Can the HCP use this product?”
It is, “Does this solution improve the HCP’s ability to complete important clinical work within the conditions in which care is actually delivered?”
“HCP” is not one persona.
A general practitioner, specialist, interventional physician, nurse, technician and clinical administrator encounter different stages of the pathway. Each has different responsibilities, authority, expertise and exposure to risk.
Even within a profession, context matters. An experienced specialist in a major hospital may approach the same task differently from a professional who encounters the condition infrequently or works without immediate specialist support.
Useful HCP personas distinguish factors that influence work:
These personas clarify who performs each job and what support each person requires.
The HCP journey often begins before the visible clinical procedure.
It may include receiving a referral, gathering information, forming an initial view, ordering investigations, interpreting results, deciding whether the patient is eligible, discussing treatment, obtaining authorization, preparing for the procedure, delivering care and arranging follow-up.
At each stage, ask:
The resulting journey map should distinguish processing time from waiting time. A decision may require only minutes of specialist attention while patients wait weeks to access that attention.
This reveals the practical relationship between HCP capacity and patient flow.
The Theory of Constraints directs attention to the factor limiting the performance of the entire system.
In some pathways, the constraint may be the number of qualified interventional specialists. In others, it may be diagnostic capacity, physician confidence, authorization effort, operating room access or the time required to train patients.
The constraint may also be hidden inside the HCP’s working day.
A specialist supporting a therapy must still manage other clinical duties, administration, meetings, documentation and urgent cases. The question is not simply how many specialists exist. It is how much of their usable capacity is available for the activities upon which patient flow depends.
“The scarcest resource may not be the healthcare professional. It may be the few hours of focused capacity available for the critical work.”
Improvement away from this constraint can make performance worse. Sending more referrals to an already overloaded specialist increases the queue. Adding information may increase cognitive burden. Creating another approval may consume the capacity required to treat patients.
HCP-Centered Design seeks to protect and expand the capacity that governs flow.
Policies and procedures describe how clinical work should happen. Observation reveals how it actually happens.
Healthcare professionals routinely compensate for missing information, awkward interfaces and unreliable handovers. These workarounds may become so familiar that nobody reports them as problems.
Gemba research should examine:
The purpose is not to judge the healthcare professional. It is to understand the system surrounding the work.
“A workaround is often evidence that the system has failed to support the person doing the work.”
Healthcare professionals do not simply use devices. They use them to make progress in clinical work.
An HCP may need to identify risk, reach a confident diagnosis, select an intervention, perform a procedure safely, explain options, monitor progress or recognize deterioration.
A structured job map divides this work into eight stages:
This wider view prevents the product team from concentrating exclusively on the procedure.
The greatest value may come from reducing preparation, improving decision confidence, clarifying an exception, simplifying documentation or improving the handover to follow-up care.
Comments such as “the interface is difficult” or “we need better information” indicate dissatisfaction, but do not provide sufficient direction for design.
They should be translated into measurable outcome statements, such as:
“Minimize the time required to identify which clinical information is missing before making a treatment decision.”
Or:
“Reduce the likelihood that a clinically significant change goes unrecognized between scheduled reviews.”
A broader population of healthcare professionals can then assess the importance of each outcome and their satisfaction with their current ability to achieve it.
Highly important and poorly satisfied outcomes provide a rational basis for prioritizing innovation.
“Adoption follows when a solution makes important clinical work safer, clearer or easier to complete.”
The five-step FOCUS process creates a practical improvement cycle.
Find the constraint. Determine which HCP activity or resource currently limits patient flow.
Optimise for it. Protect the constraint from avoidable work, missing information, interruptions and rework.
Collaborate around it. Align upstream and downstream teams so patients, information and resources arrive when required.
Uplift it. Add capacity, redesign responsibilities, improve technology or remove restrictive policies.
Start Again. Identify the new constraint once flow improves.
This approach allows the organization to distinguish activity from value. It also turns HCP engagement into an ongoing management discipline.
HCP-Centered Design must connect clinical reality with patient needs, technology, regulation and business strategy.
A Value Management Office can help coordinate these perspectives across the product lifecycle. Its role is to ensure that projects, resources and stage-gate decisions remain connected to patient flow and business value.
The organization should be able to show:
The goal is not simply a device that healthcare professionals can operate. It is a solution they can confidently incorporate into care and a delivery system capable of getting that solution to more patients.
Use the HCP-Centered Design assessment to determine how well your organization understands clinical work, HCP capacity and the constraints governing patient flow.
The resulting evidence should guide product design, process improvement and investment toward better products, delivered faster, with more lives changed for good.
Medical device companies devote enormous skill and investment to developing safe, effective products. Yet a technically successful device changes no lives while suitable patients remain unable to reach it.
Between a patient becoming aware of a therapy and receiving its intended benefit lies a pathway of referrals, consultations, diagnostics, approvals, procedures, training and follow-up. Every step consumes time. Between the steps, patients wait. At some points, they become confused, discouraged, ineligible or lost to the process.
Patient Centered Design must therefore address more than the design of the device. It must improve the performance of the entire system through which patients reach, receive and live successfully with the solution.
“A life-changing therapy changes no lives while patients remain trapped in the pathway leading to it.”
A typical medical device journey may include:
Companies often manage these stages as separate functions. Marketing works on awareness. Medical affairs supports clinicians. Market access addresses reimbursement. Sales works with specialists. Clinical teams gather evidence. Training teams support adoption.
The patient, however, experiences one journey.
From the patient’s perspective, a delay between two organizational functions remains a delay. A repeated test remains repeated work. An unclear handover creates uncertainty regardless of which department owns it.
Patient Centered Design begins when the organization sees and manages this journey as a connected system.
Every step contains some necessary processing time. A consultation takes time. A diagnostic test takes time. An authorization must be assessed. A procedure must be performed.
The patient’s total lead time, however, also includes the waiting between these activities.
A consultation may take 30 minutes, but the patient could wait six weeks for it. A diagnostic test may take an hour, followed by another delay before a specialist reviews the result. Prior authorization may require little actual work while adding weeks to the pathway.
This distinction matters because organizations often improve processing time while leaving the larger queues untouched. Saving five minutes during an appointment produces little benefit if the patient waits months to reach it.
Patient Centered Design therefore asks:
The answers reveal the true performance of the patient system.
Theory of Constraints teaches that the performance of any system is limited by a constraint. Improving a part of the system that is not constraining flow may create more activity without increasing results.
If diagnostic capacity is the constraint, generating more awareness may simply produce a longer queue for diagnosis. If specialist capacity is the constraint, accelerating authorization may move patients more quickly into another wait. If training after first use is inadequate, increasing procedures may produce poor experiences and avoidable follow-up demand.
“More activity at a non-constraint creates work in process. More capability at the constraint improves the system.”
The constraint is not always a physical resource. It may be a policy, an eligibility rule, missing evidence, a fragmented handover, an information delay or the cognitive burden placed on the patient.
The most important question is therefore not, “How do we improve every step?”
It is, “What currently limits the flow of suitable patients to successful use of the therapy?”
Numbers show where patients are lost. Patient research helps explain why.
Two patients with the same diagnosis may respond very differently. One may actively seek new treatment options. Another may delay action until symptoms become severe. A third may want help but lack confidence in navigating the healthcare system.
Meaningful patient segmentation considers characteristics that influence behavior:
These differences affect whether patients enter the pathway, remain engaged and successfully adopt the solution.
The Gemba is the place where work actually happens. For patients, this includes the home, clinic, hospital and all the places where they manage their condition between formal encounters.
Interviews alone may miss important evidence. People normalize inconvenience, forget workarounds and simplify their past decisions. Observation allows the development team to see what patients actually do.
Good research combines three activities.
Observe. Watch how patients obtain information, prepare, use the solution and respond when something goes wrong.
Immerse. Understand the physical, emotional and practical conditions surrounding the experience.
Engage. Ask open questions that allow patients to describe their goals, fears and frustrations in their own language.
The purpose is to discover the patient’s reality before asking them to evaluate the organization’s preferred answer.
Patients rarely want a medical device for its own sake. They want the progress it may enable.
They may want to recognize deterioration earlier, preserve independence, reduce pain, avoid repeated visits, return to work or prevent a disease from controlling daily life.
A useful job map examines eight recurring stages:
This reveals opportunities beyond the immediate use of the device. The most valuable improvement may involve helping patients prepare, confirm readiness, recognize an exception or understand what happens next.
Stories create understanding, but investment decisions require structured evidence.
Patient observations and comments should be converted into outcome statements that identify:
For example:
“Minimize the time required to recognize that my condition has changed sufficiently to require clinical help.”
Patients can then assess the importance of each outcome and their satisfaction with their current ability to achieve it.
Highly important and poorly satisfied outcomes represent genuine opportunities. This prevents teams from prioritizing attractive features that do not materially improve the patient’s life or progress through the pathway.
“Innovation becomes valuable when it improves an outcome that matters and remains poorly served.”
The Patient Centered Design pathway can be improved through a repeating discipline:
Find the constraint. Identify what currently limits patient flow or successful use.
Optimise for it. Make the best possible use of existing constraint capacity.
Collaborate around it. Align functions and partners so their actions support the constraint.
Uplift it. Add capability, remove restrictive policies or redesign the pathway.
Start Again. Once the constraint moves, identify and address the next limiting factor.
This prevents improvement from becoming a collection of disconnected initiatives. It directs scarce resources toward the factor that most strongly governs the result.
Patient insight should influence more than early product design. It should shape clinical evidence, regulatory strategy, reimbursement, manufacturing, education, market development and post-market support.
The organization should be able to show:
The goal is not simply to place the patient at the center of a diagram. It is to organize the enterprise around delivering better products faster, so that more lives can be changed for good.
Use the Patient Centered Design assessment to determine how well your organization understands its patient journeys, priority outcomes and constraints to patient flow.
The result should be more than another collection of patient opinions. It should provide evidence that directs strategy, investment and execution toward the changes that matter most.
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