The latest in our series that uses the ‘book review’ format as a springboard into a wider conversation about the world of work—and how to do it better.
Leaders and Misleaders by Andre van Heerden
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Most of us can recall those few gifted teachers who really made a difference in our lives. I was lucky to have Andre van Heerden as my history teacher. For the first two years of high school, he taught me everything from Hammurabi to Napoleon and his way of teaching made any era come to life—in fact, he made learning come alive. Back then, while he was teaching and I was learning, we were both enduring a civil war that saw the end of the racist regime of Ian Smith in what was then Rhodesia and what is now Zimbabwe. One of the great pleasures of 2017 was reacquainting myself with Andre.

Having said that, I am always skeptical of books on leadership, as they are so often filled with platitudes and absent themselves from the context within which their leadership is exercised. I am a firm follower of Elliott Jaques and his injunction to see ‘managerial leadership’ as an inseparable word pair. Paraphrasing Jaques’s analogy, you cannot say the stick is either brown or six inches long—they are both qualities of the stick. This implies that the context within which a leader manages is of central importance. A priest, academic, civil servant, politician or businessman may all be leaders, but what and how they manage is very different.
Thankfully, Andre’s book, subtitled ‘The Art of Leading Like You Mean It’, goes far deeper than the standard management texts. He argues convincingly that you cannot, to quote him, ‘lead like you mean it’ if you don’t ask deep questions about the power of integrity, thinking for yourself and the compelling need for education and personal growth. Andre’s book is thus a provocative and penetrating exploration of the historic and philosophical roots of the postmodern leadership crisis. He takes us into the very foundations of understanding human nature and the development of character.
‘Leadership inspires people to be the best they can be in mutual pursuit of a better life for all’
In Andre’s definition ‘leadership inspires people to be the best they can be in mutual pursuit of a better life for all’. And with his long history of reading and teaching history and philosophy, Andre gives us his views on leadership from Napoleon to Washington, from Lincoln to Hitler and from Cincinnatus to William the Conqueror. His vision of leadership is one that liberates—and the values he portrays are timeless. There are no fads in his work, no blind obedience to our digital zeitgeist and with it our seemingly endless, and unexamined, need to go ever faster into the abyss it has created.
Once he has introduced us to his definition of leadership, his subsequent chapters take us through the following ideas:
Personal integrity – genuine leadership can only be built on this
Daily reflection – leaders must think for themselves
Ongoing education – understanding the world and the leader’s part in it
Respect for human potential – getting the best out of ourselves and others
Trust and character – understanding attitudes and emotional intelligence
Creativity and strategy – leadership means finding a better way
Empathy and compassion – leadership is about people, people, people
Confidence – where there is no hope, there is no leadership
What was so appealing about Andre’s book is the breadth and depth of his reading—from history to philosophy and from psychology to theology. Andre’s worldview is steeped in the heritage of our Western Civilisation, but he is no triumphalist of that cause and takes a deeply moral stance without coming across in the least bit self-righteous or sanctimoniously pious. At the centre of his worldview is the idea of the sovereignty of the individual. Not as the ego-ridden loner of the ‘me generation’, but one who is equal to all others—whether king or pauper—is divinely endowed with the power to reason, and who finds their deepest meaning in service to family, community and the world.
Liberally sprinkled through the book are gems of quotes from famous people I have heard of and some more obscure. On my mission to bring more Just Work into the world, I loved this one from the Spanish writer Jose Ortega y Gasset in The Revolt of the Masses:
An unemployed existence is a worse negation of life than death itself. Because to live fully means to have something definite to do—a mission to fulfill—and in the measure in which we avoid setting our life to something, we make it empty. Human life, by its very nature, has to be dedicated to something.
Seeking the truth
Andre’s core belief is that at the root of our God-given gifts is the power to reason. We are made to seek and know truth through our reasoning faculties, and we do this by thinking for ourselves. He clearly articulates the impediments to thinking for ourselves under the sometimes-provocative titles, such as the postmodern mindset, relativism, the demise of education, political correctness, the media mushroom, information overload, specialisation, trust in formula, fatalism and victimhood. But Andre doesn’t just leave it there. He provides a way out—how to overcome the obstacles to sound thinking including traps to avoid which, as any well-trained rhetorician would know, include ad hominem, petitio principii, loaded words, emotional appeals, poisoning the well, and argumentam ad numeram.
In his appeal to find a better way, Andre calls on us to look at history:
History provides some spectacular examples of a better way for people to use their rational faculties to find answers to the issues that confront them. The Socratic dialogues recorded in the works of Plato, and the scholastic disputation of the Middle Ages offer models for reasoned discourse that is based on disciplined thinking, which ailing postmodern democracies badly need.
The passion Andre brings to the chapter ‘Education and Personal Growth’ reminded me why I loved him as my teacher. At the start of the section where he defines education, he poses the age-old dilemma of education:
…[is] the purpose of education the acquisition of knowledge by a learner, or the development of the learner’s character? (For the ideologue it is neither of these, of course—it is for control of the learner’s mind for the ends of the state, the party or the cause—for misleadership.)
There can be no doubt where Andre stands on the topic. In quoting Josef Pieper in Leisure: The Basis of Culture, there was a powerful resonance with my own views on systems thinking:
Education is concerned with the whole: whoever is educated knows how the world as a whole behaves. Education concerns the whole human being, insofar as he is capax universi ‘capable of the whole’, able to comprehend the sum total of existing things.
When I read Andre’s book, it made me lament how shallow our education and lifelong learning has become. Current trends in leadership development seem for the most part to cover the knowledge necessary for transactional success in a mechanistic view of the modern workplace. Why, it left me wondering, would time not be set aside in the workplace to put on a Shakespearean drama, or explore with an expert the great books of our rich but barely alive heritage? What could Dante teach us that Myers-Briggs has got no chance of reaching?
Andre calls on us to examine eternal verities about truth and reason, and in his final chapter invites us into the question: quo vadis? Where are you going? This is an important book to better equip us to answer that question. But for our benefit, earlier in the book, Andre nails his flag to the mast by putting forward ten essential books for leaders:
1. The Bible
2. Plato’s Republic
3. Aristotle’s Politics
4. Virgil’s Aeneid
5. Livy’s Early History of Rome
6. Shakespeare’s Julius Caesar
7. Swift’s Gulliver’s Travels
8. Dostoyevsky’s The Devils
9. Bruce Catton’s The Hallowed Ground
10. Jacques Barzun’s From Dawn to Decadence
If I’m looking to get even a pass grade from this exemplary teacher of mine, I had better get reading.
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You can buy Andre’s book Leaders and Misleaders. It’s beautifully written, thought provoking and, as yet, not widely known.
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 Aaron Burden on Unsplash]
“You need virtue in your organisation.”—Andre Van Heerden
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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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