This is Part Three of our series on the ‘Explore’ phase of The U Journey to guide an organisation through a transformation.
This is Part 3 of our series on The U Journey: Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8
In Part One we looked at how to set up the Foundation Workshop for success. We considered its purpose, where it fits in the overall U Journey and some social processes required to have the kind of rich conversations which support powerful movement towards the desired future. Now we dive into the activities themselves.
The Foundation Workshop works best when run over two nights and three days. Starting immediately after lunch on day one, the first order of business is to get everyone deeply present in the room. This is helped enormously by careful consideration of the venue. Being close to nature and filled with natural light serves the intention best. 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. As the first activity, a guided meditation provides a useful means of delivering this outcome.
A paired dialogue walk around the gardens can have a similar effect, especially if the pair are sent on their way with powerful questions such as: ‘Why is this workshop important to you? What is the biggest contribution you are hoping to make?’ Ten minutes outbound with one of the dyad talking and the other listening, and ten minutes back with roles reversed is enough to shift the expectation that this will not be a workshop conducted exclusively in the head. Heart and hand must also be present.
The opening circle
When everyone has come back together, it’s time to sit in the round and invite each participant in turn to talk into the centre of the circle about who they are, why they are at the workshop and what’s alive in them—meaning what emotions are animating their being.
These simple steps create a real difference in how the later conversations will be characterised. A good analogy is to think of conversation as being electrically charged. Your aim should be to create a positively charged field that allows both ideas to flow freely and deep listening to occur—the empathetic kind of listening that comes from the listener standing in the shoes of the person doing the talking.
The World Café
A very powerful social process I use extensively in the Foundation Workshop is the World Café, which encompasses seven design principles:
1. Set the context
2. Create hospitable space
3. Explore questions that matter
4. Encourage everyone’s contribution
5. Connect diverse perspectives
6. Listen together for patterns and insights
7. Share collective discoveries
A number of people from the group are nominated as table hosts, each table ideally seating four people. Thus, in a group of 24 people, there would be six tables. Each host is equipped with a powerful question, the design of which is often more important than the answer, on the basis that ‘more than half of a good answer is a powerful question’.
The hosts facilitate the conversations around the question at their tables for 10-15 minutes, using beautiful artist-grade coloured wax crayons and good quality flipchart paper. At the sound of the gong, the hosts instruct their groups to break apart, sending them as ‘ambassadors’ to three other tables, to apply their best thinking to the range of questions being asked. At the end of a round of questions, the whole group assembles to hear the hosts talk about what they heard at their tables, how the conversations evolved, what ideas were weak and fell over, and which gained traction and carried the conversations forward.
This whole process has several advantages, including:
• Everyone has a chance to be heard in a conversational ‘café style’ format
• No one can grandstand and ‘hog the floor’
• Everyone takes a turn to be the host and thus gets to practice their facilitation skills at drawing out the best from their colleagues, who usually have diverse career, academic and experiential backgrounds
• Good ideas are captured and built upon whilst weaker ideas are left behind
• There is fruitful crosspollination of ideas from people coming from different parts of the organisation with differing perspectives
• The participants are invited to access the creative part of their minds by encouraging them to draw their ideas onto the paper in front of them
• The outputs of each round represent the collective learning and wisdom of the participants. When hung up around the walls of the venue, they provide a source of energy for all to move deeper and further into the direction of the goal and show visual evidence of the progress being made.
A useful, evergreen question to get people used to the whole process is, ‘What question, if answered, would provide us with the most forward momentum towards our goal?’
The individual and the collective: Personality and Culture
Equipped with the results of a personality survey Strengthsfinder, DiSC or even the Big Five OCEAN, as well as, for example, the OCAI culture survey, we take a step into exploring the diverse personalities in the room and how this group of people rate the existing culture of the organisation, as well as what they would like it to be. This is a useful way to break the ice before commencing the more arduous work of scrutinising the logic trees. It also provides a way to get people used to the process of the World Café.
The Goal Tree and Current Reality Tree
The draft logic trees are printed out in A0 size, one for each table. Participants are given a brief introduction to the Logical Thinking Process and how to use it to scrutinise the logic of both the Goal Tree and the Current Reality Tree.
I recommend starting with the Goal Tree as this lays out the aim of the collective. It also makes more sense to understand current reality insofar as it diverges from the goal rather than as some abstract expression of a collection of bitches and moans. The work around the Goal Tree is usually very positive, as it is quite easy for people to get carried away with the enthusiasm they have for a future they have not yet earned, and which doesn’t pay too much attention to the unvarnished truth of where we are starting from.
Good ideas are captured and built upon
whilst weaker ideas are left behind
Scrutiny of the Current Reality Tree is usually quite draining as people come to realise the deeply systemic nature of the root causes (there are usually several) constraining them and their organisation from accomplishing what is contained in the Goal Tree. One of the constant themes I find is that the leadership regularly works at the wrong level of work. They are locked in the minutiae fighting fires rather than thinking about what systems and processes have to be put in place to eliminate the need for firefighting. The process of scrutinising the trees—interrogating the cause and effect connections—reminds the leadership team of the level of work appropriate to their role in the organisation. They also start to take ownership of the language used in the trees, adopting or adapting phrases as they see fit. This exercise also reinforces the idea of the Foundation Workshop as practice field for the future.
Creating a Vision for the Future
Having spent several hours in the proverbial woods, the team is ready for a change from the heavy use of left-brain thinking. We revitalise the team with a fun exercise in envisioning the future. I usually kick off this activity with a video by conducting maestro Ben Zander called ‘Leadership and the Art of Possibility’. In his inimitable way, Zander brings to life the idea of the future being a possibility to live into—rather than an expectation to live up to—and introduces useful concepts such as ‘Shining Eyes’, ‘Rule #6 – don’t take yourself so *!&% seriously’ and the like.
I then invite each of the tables to imagine themselves 3-5 years into the future, their goal now accomplished. I tell them that the most senior executive layer of their organisation has asked them to present what happened. I provide a list of prompting questions and instruct them to draw their vision, using the pastels provided. That way, when they present, they speak naturally rather than reading off bullet points. A bonus benefit comes when we hang these drawings on the walls of the workshop room, bringing to external life what was until that point invisible.
Intermediate closing circle
As important as the opening circle is the closing circle. Rather than simply dismiss the participants at the end of the day and leave them alone in their thoughts and feelings, it is best to provide an opportunity for them to share together what they have learned and what they believe is the work that still needs doing. This is helpful for the facilitators, too, as it provides some feedback into any course correction that may be required. It also provides a useful indicator as to what points have landed.
Planning the work
Through the activities undertaken in scrutinising the logic trees and developing a shared vision, there should by now be a strong enough alignment to explore—at a high level—the work of the coming days, weeks, months and years. Once again, using the World Café as social process, the planning of the work can take place. What is the program of work the transformation demands? What are the vital workstreams that align with the critical success factors of the Goal Tree, or solve the issues in the Current Reality Tree?
I recommend you make the potential leaders of these workstreams the hosts of the tables. Once the team has agreed a set of criteria to determine how different initiatives will be scored, the table hosts are asked to collate the list of all initiatives currently underway so that the team can examine their relevance, timing, resource requirements, benefits and governance. You’re not expecting definitive answers to these questions. At best a rough first cut will do. A key benefit of doing the exercise is to determine the scope of the projects to be released into the execution pipeline, and the sequence in which they will flow. No less important is for the team to realise what they must stop doing in order to release capacity for the prioritised projects. They will also start to think about how this prioritising will be governed.
Communicating the change
Once you know what the work is and why it is being done, it becomes essential, as a part of effective change management, to spend time determining the communication strategy for the change. This aspect of the program should help the Foundation Workshop team develop a deeper insight into the fundamentals of communications. This includes the development of an aligning narrative, use of brand principles for change management, development of key communication artefacts, and the rhythms and routines of communications. And, of course, how to make all of this relevant for all stakeholders—from the shop floor to the board room.
The final closing circle
The distance travelled over the course of the Foundation Workshop is enormous—both cognitively and emotionally. The end of the Explore phase of the U Journey is, to steal a line from Churchill, ‘the end of the beginning’. Before launching into the Design phase with the Learning Journeys, the team needs to reflect on what has happened. All around the room, and contained in all the documents brought into the Foundation Workshop, is a representation of the past and future of what they are set to change. It is worth asking again, and having each share in their own way, ‘What have you learned about yourself, your team and your organisation?’ And: ‘Starting tomorrow, what is your work?’
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This article is Part 3 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 Sweet Ice Cream Photography on Unsplash]
“Define your ‘change goal’ in terms of the specific problem
you’re trying to fix, not simply as ‘culture change’.”—Edgar Schein
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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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