How do you mobilise a leadership team around a new way of thinking that will take the organisation to its goal? The process is the U Journey and the springboard is the Foundation Workshop. This article within a series on Theory U looks in more detail at what’s involved in the Explore phase. It all starts with the right preparation.
When you consider the future you would like to bring into being, what is the bedrock on which it rests? To use a construction metaphor, what kind of a building are you creating? How high can it go up, how long will it last and what will be the quality of experience for those building it and then living in it? A strong foundation is the basis of a confident step forward into the unknown frontier of the future you aspire to bring into being.
[Listen to audio version, read by David Hodes]
This is Part 2 of our series on The U Journey: Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8
A Foundation of Purpose
The Foundation Workshop is designed to give you the best possible chance of delivering a platform for the future growth and development of your enterprise. It involves deep dialogue around the specific problems you are trying to solve, the collective definition of your goal and the program of work needed to move the whole organisation from where you are now to where you want to be in as effective a way as possible.
In addition, the workshop acts as a practice field for new ways of being amongst the team. It also explores innovative and productive ways of working with each other and, in the fullness of time, the broader parts of the organisation you each represent in your various roles. But before you can get to that point, you need some input. This comes from the generative interviews.
In two recent assignments, I conducted 18 and 30 interviews respectively, across the leadership teams and beyond. I get the interviews transcribed, then revisit them with a colleague. Independently, we mine the transcripts for hints and nuggets that can point to systemic issues. We edit only for clarity and to maintain anonymity, aiming to maintain the authentic vernacular of the organisation. The hope is that people speak freely, knowing their views are being heard and comfortable that the specifics will not be attributed to them.
The resulting ‘verbatims’ essentially produce a ‘book’ of between 50,000 and 70,000 words with the responses grouped thematically. This becomes a rich source for the project team to assess where their own experience is in line with their colleagues. Of course, it’s also eye-opening for the overall project sponsor. This collective wisdom leads to a shared truth about what’s really going on and plays a key part in generating the Goal Tree and Current Reality Tree, both component parts of the Logical Thinking Process.
“Talking ‘as if standing in the future’
looking back is transformative.”
Everyone is asked the same set of questions. But the answers go off in very different directions. That’s the point; these are generative interviews in which we want to stimulate thinking, bring issues to the surface and articulate the possibility of generating a future grounded in aspiration. This is the set of questions:
1. Please can you tell us something of your story and bring it into the room. Where were you born? What did your parents do? What have been the most significant turning points in your life? What did you study? What have been your career highlights to date?
2. Why is the success of your organisation important to you personally? What is it about your organisation that would inspire you to turn up as the best version of yourself?
In almost all cases, these first two questions initiate a kind of alchemy, turning ‘roles’ into human beings who approach their work from a particular viewpoint, informed by their personal and cultural background as much as by their work experience and training to date.
3. What’s it like to work at your organisation today and how is it different from the past, if at all? If it has changed, why is it different and how?
Some people will have been there only a few months whilst others will be near ‘lifers’. We don’t weight opinions based on ‘time in’, but the answers here highlight some key issues around change and the underlying narrative the team are telling themselves. The comments often point to elements of the culture that are taken for granted.
4. Can you tell us in your own words what the goal of your organisation is? What should it be? How would you measure it? Specifically, where’s it going to come from – whether stopping value leakage or bringing innovations to what we do?
This is a powerful question to get a sense of what the team is aiming at and whether or not there is alignment. Most people will confuse the fundamental goal with the necessary conditions required to achieve it. Others will confuse the goal with vision mission and values. Whilst there is quite often a lead-in with something about ‘making a profit for shareholders’, more often than not there is a jumbled confusion of ideas. The point is not to correct, but rather to listen deeply and understand what work needs to be done during the Foundation Workshop to bring this vital element of organisational performance into sharp focus.
5. What do you think are the three or four critical success factors needed to achieve that goal? In other words, what are the non-negotiable, high-level necessary conditions of achieving the goal you have articulated?
6. For each of those critical success factors, can you please describe how you see the gap between what your organisation is now and what it needs to be to deliver on the goal? In other words, what do you see as current reality of your organisation in each of those domains you have nominated as being critical for goal achievement?
Many people spontaneously start tearing down siloes at this point. They sometimes surprise themselves by the importance they assign to getting the right people—retaining them, training them. What they may have considered as platitudes if cloaked in corporate ‘brandspeak’ becomes readily apparent when they’re thinking deeply about how the organisation will achieve its goal.
7. What do you think are the causes of the difference between current reality and the full achievement of your necessary conditions?
8. If you drill down to root causes, why do you think the current reality persists?
9. What are the deep conflicts or dilemmas which prevent your organisation from realising its full potential?
10. What assumptions do you think we make individually and collectively that keep those conflicts or dilemmas in play?
This whole sequence of questions, 7 through 10, inevitably opens up a can of worms, but it’s vital to dig deep and uncover at the root, the causes of current underperformance relative to the aspirational goal, the conflicts that perpetuate them and the assumptions that hold those conflicts in place.
Almost invariably, an issue revolves around people not operating at the right level of work for their position. This may be because of poor planning, a perceived lack of resources or operating discipline—or even an addiction in the company culture to the adrenaline around fighting fires.
But these effects are themselves symptoms of a universal truth that has to do with the way that governance and performance metrics are set up to optimise the parts in the false belief that a collection of highly efficient parts makes for an effective whole.
11. Changing gear, can you tell us a little about your vision for your organisation over the next 3-5 years? What do you think we will look like with respect to people, process and technology? How will the culture be different to what it is now? Please talk to these questions as if you were standing in the future and everything you deemed necessary for the transformation had already happened. The richer the rendering of that future, the better.
The request to talk ‘as if standing in the future’ looking back is transformative. People often surprise themselves with their answers which can be almost poetic in their desire to create a better working organisation, with a richer purpose and happier people.
12. Can you please give us what you think it’s going to take to get to that future state? Who do we need to be as individuals? What kind of teams do we need to create? How are we going to manage and lead this transformation? What resources and capabilities do we need? What role does your organisation and the group play?
Now, together we’re sowing the seeds for what it’s really going to take to bring into being the desired state articulated in the previous question. This is rich building-block material for the Foundation Workshop.
13. What legacy would you like to leave at your organisation?
Again, people may surprise themselves here. A self-deprecating ‘I’ve never really thought about it’ often leads into surprisingly deep, even moving, answers.
14. Thank you so much. Are there any questions you have for us?
After all that, people usually want to know how other people have been responding. In broad terms, are their answers in line with everyone else. And what happens next.
It may sound like all large organisations are the same. In a way they are, in that you must address people, process, technology and more. But the specifics of each organisation lead to its own unique solution.
Laying the groundwork
To ensure the greatest likelihood of cohesion and success in the Foundation Workshop, you need to prepare. The choice of venue is key—ideally somewhere close to nature and filled with natural light. For deep, relaxed and productive thinking to occur, it is of the essence that the participants slow down dramatically from the frenetic pace of their regular work and job.
Every piece of communication must also be carefully considered. We are setting an intent that these few days together will open the way to dramatically better results. This is a marathon, not a sprint, and the team must be given the opportunity to have an extended period of doing the deep work commensurate with the size and horizon of their role. The invitation must set the tone that this is more than ‘just another offsite’. Pre-reading must be curated. This could include anything from engagement survey results, the business plan, existing strategic roadmaps and consultants’ reports. It is advisable to circulate the verbatims in advance, but not the logic trees, as they need significant explanation and can too easily be thought of as being definitive rather than stimulatory.
You may also want to have everyone take a culture survey (such as the OCAI) or some kind of personal assessment such as Strengthsfinder, DiSC or even the Big Five OCEAN. The results provide a way in for conversation around blind spots or other perceptions of the organisation. The message is that all this is real work—hard yakka that will lead to a resolution of the core business challenges. It’s going to be tough but energising and rewarding in a way that ‘business as usual’ rarely allows.
In the next article, we’ll look at what happens in the Foundation Workshop itself. Armed with the ‘book’ of verbatims and a hypothesis of the goal and the current reality (using the logic trees), we’re ready to make substantial progress on providing answers to all the questions posed by the generative interviews.
Download the generative interviews questions sheet.
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This article is Part 2 of our series on The U Journey.
Part 1: How to change: Introducing Theory U
Part 2: Preparing for the Foundation Workshop
Part 3: Running the Foundation Workshop
Part 4: Stepping into Design
Part 5: Wisdom from outside your domain
Part 6: Retreat and Reflect
Part 7: Crystallise Intent
Part 8: Deliver
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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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[Background photo by Davide Ragusa on Unsplash]
“And so castles made of sand,
Fall in the sea eventually.”—Jimi Hendrix
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Healthcare professional jobs to be done
A clinician checking a monitor is performing an action. The job may be detecting a meaningful change in the patient’s condition soon enough to respond appropriately. A specialist reviewing a report may be trying to decide whether an intervention is suitable, rather than simply consuming more information.
This distinction matters to medical device development. A product can make an action easier while leaving the clinical job difficult or creating additional work elsewhere.
Question 1.1.4 asks how well your organization understands the jobs healthcare professionals are trying to get done. A strong answer describes those jobs from their perspective and uses evidence to identify the outcomes they need to achieve.
“The job explains why the information matters and what must happen after the professional receives it.”
Begin with what the healthcare professional needs to accomplish. Depending on the role, this may involve recognizing risk, determining eligibility, delivering treatment, explaining options or evaluating outcomes.
Keep the job statement independent of a preferred product. “Review our dashboard” describes an interaction. “Determine whether the patient requires a change in care” describes clinical progress.
Define the context and boundaries. The work may differ across acute care, routine follow-up and home monitoring. A job that includes several independent clinical purposes may need to be separated into smaller, researchable scopes.
The team should be able to explain why the professional performs the work, what constitutes completion and who depends on the result.
“HCP” covers professionals with different responsibilities, authority and expertise. A physician deciding on treatment, a nurse preparing a patient and a technician acquiring measurements may interact with the same device for different reasons.
Identify the job executor and the people who influence or support the work. Clarify who can make the relevant decision, who supplies necessary information and who acts on the result.
Do not assume that the purchaser, prescriber and daily user have the same needs. A product selected for one group’s convenience can introduce burdens for another.
Research each important perspective while retaining a clear account of the job under investigation. Differences across professional roles should inform the design rather than disappear into an average customer profile.
Clinical research combines observation with empathy interviews. Applied to healthcare professionals, it examines clinical work where it happens.
Watch how professionals prepare, locate information, make decisions and respond to interruptions. Ask them to explain recent cases and the reasoning behind their actions.
Observe the tasks before and after device use. A procedure that looks efficient may depend on extensive preparation by another team. A report that looks clear may require a clinician to reconstruct its meaning from several systems.
Discuss observations with the people involved. Familiar workarounds may compensate for a missing capability. Understanding them helps distinguish a product preference from a need that governs successful completion of the job.
Professionals often describe needs through the solution they know: another field, a different screen or a new report. These requests provide useful clues, but they still require interpretation.
An illustrative request for “all the data on one page” may reflect a need to establish whether enough information is available for a decision. The best response depends on the missing information, its relevance and the decision being supported.
Ask why the requested change matters. What uncertainty would it remove? What work would it reduce? What would the professional be able to accomplish more effectively?
Use the eight-step job framework to investigate the work surrounding the visible activity.
Treat these steps as prompts for discovery. In practice, professionals may revisit information, pause a procedure or return to preparation. The map should preserve the dependencies that make the job possible.
“Preparation and follow-up are part of the clinical job even when they happen outside the product team’s field of view.”
A desired outcome statement describes how the professional judges success. It identifies the direction of improvement, a measure, what is being controlled and the context in which it matters.
For example: “Minimize the time required to determine whether the information needed for an eligibility decision is complete.” Another might be: “Reduce the likelihood that a clinically significant change is missed during review of monitoring results.”
These are illustrative research statements, not claims of demonstrated product performance. They require validation with the professionals whose work they describe.
Avoid combining several outcomes into one statement. Speed, completeness and accuracy may all matter, but respondents need to evaluate each clearly. An outcome should also leave room for alternative ways of satisfying the need.
Clinical jobs involve interpretation and responsibility as well as information processing. Understanding the outcome does not establish that the product should take over the professional’s decision.
Clarify where the device supplies evidence, supports a task or performs a defined action. Examine what the professional needs to recognize limitations, handle exceptions and decide when additional expertise is required.
A design that reduces routine effort can introduce new review work or uncertainty. Research should capture these consequences alongside the intended benefit.
When professionals ask for greater confidence, determine what supports that confidence: appropriate evidence, clear limitations, interpretable results or a reliable escalation process. Design decisions should preserve the professional’s ability to act responsibly within the care setting.
Once qualitative research has produced clear outcomes, use quantitative research to determine their importance and how well current approaches satisfy them.
Ask professionals to rate the outcome itself, with a defined reference situation. Satisfaction should concern their current ability to complete the job, rather than whether they like a brand or presentation.
Include relevant variations in setting, experience and workload. The priorities of a high-volume specialist service may differ from those of a clinician who encounters the condition occasionally.
Opportunity assessment considers importance together with the gap between importance and satisfaction. It helps direct attention toward underserved outcomes. Apply consistent scales and interpret scores alongside the underlying evidence. Necessary safety requirements remain obligations even when survey respondents rank them differently.
Average scores can conceal important difficulties. A need may be well served for experienced users but poorly served for professionals without immediate specialist support.
Examine whether respondents cluster around different patterns of unmet outcomes. Investigate the circumstances that explain those patterns.
A group may struggle primarily to prepare the patient. Another may struggle to interpret results or coordinate follow-up. These differences can call for different product capabilities, training or service arrangements.
A target product profile connects prioritized outcomes with the Voice of Technology and the Voice of Business in one shared definition. For healthcare professional jobs, this creates a shared view of what the solution must enable.
Technical assessment examines feasibility and readiness. Business assessment clarifies objectives, resources and implementation conditions. Clinical evidence and relevant requirements shape what can responsibly be promised.
Record the important outcomes, intended users and operating context. Identify the measures and evidence that will establish whether a concept improves the job.
Use the profile to guide tradeoffs. A feature that helps one professional may transfer work to another. The team needs to assess its effect on the complete clinical activity and the patient pathway.
Concept evaluation should examine realistic tasks and scenarios with representative professionals. Ask what the proposed approach changes about their ability to achieve the priority outcomes.
Observe preparation, interpretation, exceptions and handover. Measure relevant effort or performance where the study supports it. Investigate whether support requirements make adoption practical in the intended setting.
A preference survey can identify an attractive concept, but it does not establish successful clinical use. Keep unresolved questions visible and plan the evidence needed to answer them.
Connect the results with the wider care system. The Theory of Constraints helps determine whether improving this job releases capacity or removes an obstacle governing patient progress.
“A useful concept improves an important clinical outcome of the job and remains practical within the system delivering care.”
Examine one clinical job your solution supports. Can the team state its purpose, identify its executor and show which outcomes remain poorly served?
Observe the work, validate the outcome statements and measure priorities. Then test concepts against those outcomes and their effects on patient flow. That is how Patient Centered Design connects professional insight with better products and more dependable care.
A patient may ask for a smaller device, a clearer display or an easier app. Those requests matter, but they leave a deeper question unanswered: what is the person trying to accomplish, and why does the current approach make it difficult?
Someone using a monitoring device may want to understand whether their condition is changing, decide when to seek help or manage daily activities with greater confidence. The device is one means of achieving that outcome.
A powerful question asks how well your organization understands the jobs patients are trying to get done. A strong answer connects patient research with clearly defined outcome statements that become the formal user needs your teams use to build the design history file. Outcome-based user needs are easier to validate, flow more easily into design requirements, and result in faster time to market.
“A feature request describes a possible answer. Understanding the patient’s job to be done sets your design team up to deliver a better solution faster.”
A useful job statement describes an activity the patient needs to accomplish in a relevant context. It should remain understandable without naming your product or preferred technology.
“Use our app every day” describes behavior your organization wants. “Provide a way to recognize when a change in my condition requires professional advice” describes the outcome a patient actually desires.
The distinction affects research. If the team starts with the app, it will ask how to improve screens and interactions. Starting with the job opens questions about information, confidence, timing and support. The best solution may involve changes beyond the app.
Define a scope the team can investigate. “Live a healthier life” expresses an aspiration but is too broad to guide detailed engineering decisions on its own. “Minimize the time it takes to find a solution to my health concern without needing to talk to a doctor or call someone” gives a team a direction, a measure, an object of control and contextual clarifier(s).
Journey mapping shows how people move through a particular care pathway. Job mapping examines what they must accomplish to achieve their purpose, including the work surrounding the interaction with your solution.
The two perspectives complement each other. A journey may show that a patient waits for follow-up. The job perspective asks what they are trying to understand or decide while waiting.
This matters because current processes can become embedded in the team’s assumptions. Patients may need a reliable way to recognize an important change; they do not necessarily need the exact sequence of activities currently provided.
Use the journey to understand context and dependencies. Use the job to examine whether a different approach could help the patient achieve the desired outcome more effectively.
Patient research begins with observation and empathy interviews at the Gemba, the place where the activity actually occurs.
For patients, that place includes the home and the settings in which they manage health alongside ordinary responsibilities. Ask people to demonstrate routines, explain decisions and describe recent experiences.
Observe what they do. Immerse yourself in the circumstances surrounding the activity. Engage through questions that let them explain their purpose in their own language.
A person may say that managing treatment is straightforward while observation reveals multiple reminders, improvised storage or reliance on a partner. Those arrangements can reveal effort and uncertainty that have become familiar enough to go unreported.
The aim is to understand the why your solution will win before making any decisions about what your solution will do. Customers will want your solution because of the outcomes it gives them, not because of what you made.
Patients with the same diagnosis may struggle with different parts of an activity. Differences in confidence, experience, resources and support can change how they define success.
Recruit participants whose circumstances reflect the population you intend to serve. Include relevant variations in health literacy, technology familiarity, physical ability and access to care. Are you targeting the tech savvy millennial, a busy parent trying to run a family with four kids or a retiree living in a managed healthcare facility?
Research should also examine emotional and social needs. A patient may want reassurance about managing a task alone or worry about drawing attention to a condition. Keep these needs visible alongside functional outcomes without assuming one design choice resolves them all.
The job mapping framework divides a job into eight recurring steps. These steps prompt investigation beyond the most visible interaction.
Apply these prompts to actual patient work. Some steps may recur or overlap. The map should help the team discover needs, rather than force experience into an artificial sequence.
“The most useful innovation may help a patient prepare, recognize an exception or recover confidence before it changes the device itself.”
Interviews generate verbatims: patients’ own descriptions of experiences, difficulties and expectations. Preserve that evidence, then interpret what each statement reveals about the job.
An illustrative verbatim might be, “I keep checking because I don’t know whether the reading matters.” The desired outcome may concern recognizing a meaningful change or understanding what action is appropriate.
A structured outcome statement identifies the direction of improvement, a measure, the object being controlled and relevant context. For example: “Minimize the time required to determine whether a change in a reading requires contacting my care team.”
Ask the team if there are uncovered outcomes that can set your solution apart related to how it is purchased, installed, received, set up, learned with training support, transported, maintained, upgraded, replaced or disposed.
This formulation gives research and design a clearer target. It does not establish a clinical threshold or promise that a device can safely make the decision independently, but often the features that will make your solution “easy to use” or set you apart will come from these outcome statements.
Several comments may describe the same need. One comment may contain multiple needs. Review the evidence carefully before combining it into a set of outcomes.
Remove duplication, separate distinct outcomes and retain links to the original accounts. Use plain language that patients can understand. Avoid embedding a particular feature in the statement.
Check the interpretation with participants or other appropriate reviewers. “I want fewer notifications” might mean reducing irrelevant interruptions while preserving important information. Treating it as a demand to suppress all alerts would misrepresent the need.
The output should be a coherent set of outcomes organized by job step. Completeness and clarity matter but typically it is ideal to have at least 100 and no more than 200 outcome statements for the team.
Qualitative research discovers needs and explains them. Quantitative research helps determine how widely they matter and how well existing approaches satisfy them.
Ask patients to rate the importance of each outcome and their satisfaction with their current ability to achieve it. Make the reference situation clear so respondents evaluate comparable experiences.
A high scoring importance outcome with low satisfaction deserves investigation. High satisfaction may indicate that the need is already well served so the team can use what already exists and put more time in creating innovative solutions to high importance low satisfaction outcomes. Low importance can reduce its priority, although clinical safety requirements cannot be dismissed through a popularity score.
Use a research design appropriate to the intended population. The outcome statements are easy to rate on a five point Likert scale. Choose population quantitative research in alignment with your target persona groups.
The Outcome Driven Innovation approach uses importance and satisfaction to identify underserved outcomes. Its opportunity calculation adds importance to the positive gap between importance and satisfaction.
Use compatible scales and a clearly defined calculation. Interpret the result alongside the underlying responses, research quality and the clinical context.
Examine differences between groups. An outcome that appears adequately served overall may remain difficult for patients with less support or a different level of experience.
These differences can reveal meaningful segments based on unmet needs. They help the organization avoid treating demographic similarity as evidence that patients need the same solution. Prioritization should retain enough detail to explain whose outcome the proposed improvement will change.
A target product profile brings the priority outcomes together with business goals, available technology and other relevant requirements. It helps the team agree what success should look like before committing to a concept.
Translate patient outcomes into design inputs and measurable requirements while preserving traceability to the evidence. Define which questions remain uncertain and what research or testing will resolve them.
Evaluate concepts against the outcomes they are intended to improve. Ask whether the proposed approach reduces effort, uncertainty or difficulty for the relevant patients and results in higher satisfaction scores than the baseline solution. A favorable reaction to an attractive prototype provides limited evidence unless the team can connect it with better execution of the job.
A priority patient need may involve work performed by a clinician, caregiver or service provider. Investigate those dependencies before deciding that a product change will solve the problem.
The Theory of Constraints helps identify where improvement can change the performance of the wider pathway. A better patient interaction can have limited effect if access to essential support remains constrained.
A Value Management Office can coordinate the initiatives needed to address these connected issues and keep investment aligned with patient outcomes.
“Patient insight becomes useful design evidence when the team can show which outcome matters, who struggles with it and how the solution improves it.”
Use patient jobs to be done to review one priority patient job. Can your team state it clearly, map its steps and demonstrate which outcomes are highly important and poorly satisfied?
Start with observation and patient conversations. Build and validate the outcome statements, measure priorities and test concepts against them. That discipline gives Patient Centered Design a practical foundation for better products and more lives changed for good.

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