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The U Journey: Deliver

David Hodes

The ultimate prize promised by Theory U is the kind of transformational improvement that self-perpetuates. While even the most dynamic systems will eventually succumb to entropy, the Theory U approach is one possibility of creating an organisational shift that embeds a deep culture of learning and continuous improvement.

Change demands a step into the unknown. The fear of how things might turn out often trumps the sure knowledge that those very same things cannot continue as they are—regardless of how compelling the case. The image of a strong steel spring being held in the open position comes to mind.

[Listen to audio version, read by David Hodes]

This is Part 8 of our series on The U Journey: Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8

It has a natural memory of being coiled, and unless held open, or permanently bent into a new shape, will revert to its original form as soon as the countervailing force is removed. So too with any attempt at introducing new ways of working. The memory of how work has been led and managed is like that strong spring. Often, it has taken many years to give it form and you cannot readily expect that the new ways will be sustainable without significant effort.

The dance of change
In his classic book The Fifth Discipline, Peter Senge promoted his theory about how to develop a ‘learning organisation’. Ten years later, in The Dance of Change, he reviewed how his ideas had fared in practice across a range of organisations. He identified some of the limits to scaling change from the laboratory of the initiators to the organisation at large:

• There’s not enough time
• There’s not enough money
• There’s not enough help, and we don’t know what we’re doing
• It’s irrelevant
• The leadership is not walking the talk, so why should I?
• I’m not sure if I’m able
• Can these people be trusted?
• Can I trust myself?
• Why is it taking so long?
• I don’t want to be part of a new religion
• What they’re doing is a complete mystery to me, and I’m anxious about showing my ignorance
• Who’s in charge?
• The old guard won’t give up the power
• We’ve seen all this before
• Where is all this heading?

Whilst I do keep looking, I’m yet to find an organisation with a leadership capable of voluntarily undertaking deep transformational change because they want to go from good to great. Far more often, they only seek change from a place of deep trouble where the anxiety associated with having to learn new ways of working has been outweighed by the anxiety associated with going out of business altogether. Nothing quite focuses the mind on overcoming Senge’s list than the prospect of bankruptcy. In cases where the case for systemic change isn’t immediately evident, it therefore takes real courage to put a safe job at risk and call to attention what most colleagues do not want to hear. Not if it means having to learn new rhythms and routines, relate to old colleagues in new ways, and embrace new colleagues with different and often competing ideas to yours.

If the people you seek to influence were not part of your initial phases of the U Journey—the Generative Interviews, Foundation Workshop, Learning Journeys, Retreat, and Crystallising Intent—there is a strong chance they’ll see you as, at best, misguided in your understanding of their issues and, at worst, as a self-serving promoter of the shiny new thing, arguing that your motive is tainted because of how heavily invested you are in understanding and communicating the benefits of your ideas to others.

The Innovation Workshop
Your opportunity to address, head on, all of these issues has now arrived. The Innovation Workshop is similar to the Foundation Workshop but larger in scale. It is designed to give a ‘whole system in the room’ experience to all the participants and has a mini-U architecture. The participants must include the upper ranks of the organisation, including executives and senior managers. The purpose is to give those who have been leading the transformation journey thus far the opportunity to share their learnings, have them tested by the expertise assembled in the room and gain acceptance on a formal program of work required to standardise and scale the most valuable insights gained during the U Journey to date.

By design, the workshop should ideally run over two days in a relaxed and inspiring venue close to nature. As with the Foundation Workshop, establish the workshop’s social field in such a way that deep dialogue can take place. Allow time for walks in the woods and make extensive use of social processes such as Appreciative Inquiry and the World Café.

The people who have been running the learning-journey phase as stream leads are asked to prepare an immersive experience for those they are looking to influence into adopting the best of what they have discovered. Whilst it is important to present facts and figures, nowhere is it mandated that this should be in the ditchwater-dull tones of an endless PowerPoint presentation. It is worth investing in professional help in the arts of communication to provide compelling visual design, graphics, video, writing and storytelling. Pay as much attention to selling your best ideas as you would if you were about to launch an important new product or service into the market.

“It takes real courage to put a safe job at risk and call to attention what most colleagues do not want to hear.”

Over the last few years, I have had the pleasure of working with people who have deep roots in branding. I am now convinced that the approach that masters in branding take to build trust and belief in their client’s product or service is perfectly suited to delivering large-scale change within organisations. Good brand work always asks questions about vision, mission and values and is able to communicate the resulting purpose in aesthetically and cognitively arresting ways that engage the organisation.

Up the capability ladder
So, what is it we’re actually trying to achieve? In the diagram below is a representation of an ascent up the ladder of capability maturity. By committing to the hard work of building process capability within a structured framework of the development of organisational maturity you develop a better way to do better work.
Capability Maturity

 

 

Note how the delivery time initially pushes the target deadline back [1-2]; reality bites as you account for what’s actually going on with your current processes. As you proceed up the capability ladder [3-5], the way of working changes winding in the target date with it. It all adds up to more successful projects, on time, in less time—every time.

As the saying goes, ‘you campaign in poetry but govern in prose’. For us, the left-hand (downward) side of the U Journey is the poetry and the rising right-hand side the prose. It is advisable to check in on who will form the core team and hence lead the streams of work associated with the newly envisioned organisational future. There’s a definite shift towards leadership by the competent and conscientious administrators rather than the creative innovative dreamers. They have the skills and temperament to bring order, repeatability and scale to the new way of thinking. The more open creative types need to remain deeply engaged in the process, if for no other reason (and there’s always another reason) than to be the jealous guardians of the spirit of change dreamed of in the earlier phases of the journey.

It is essential to convene all decision-makers for the Innovation Workshop. Its power and magic lie in the fact that the hard work of developing and testing prototypes has been done. The wheat has been sorted from the chaff and it’s time to decide which initiatives are going to be given the nod and in what order. Decisions on matters such as the process of governance, the allocation of resources, which products, services and markets will be pursued, which technology platforms will be used, how the organisational hierarchy will be designed, what the learning curricula will comprise and what methods are used to run operations. Having all decision-makers in the room means that anyone can mount their case for their point of view, debate its merits with their colleagues and understand, and hence accept, why any given decision went the way it did.

The important point coming out of the Innovation Workshop is not that everyone agrees on every decision, but rather that there is strong alignment behind the decisions taken. The energy and momentum that’s built around a leadership team aligned around a mighty purpose is inspiring to the troops and serves to strengthen the relationships and bonds of trust within the leadership. The Innovation Workshop works best when people empowered by the crystal clarity of their intention feel inspired to do meaningful work with people with whom they share a vision. They know in their bones that the world would be a poorer place if they and their colleagues had not committed to making this contribution.

____________________________

This article is Part 8 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

____________________________

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:

  • download the brochure (no email required)
  • schedule a call

    ____________________________


    [Background photo by William Ander ]

    “Design is not just what it looks like and feels like.
    Design is how it works.”—Steve Jobs

    ____________________________

  • Uncategorized

Understanding the jobs healthcare professionals need to accomplish

David Hodes

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.”

Define the clinical purpose behind the interaction

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.

Identify who performs each job

“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.

Study the work in its actual setting

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.

Separate current behavior from the desired outcome

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?

Map the complete clinical job

Use the eight-step job framework to investigate the work surrounding the visible activity.

  1. Define. Establish the intended clinical result and the decision or action required.
  2. Locate. Obtain the evidence, equipment and resources needed.
  3. Prepare. Arrange the patient, environment and supporting work.
  4. Confirm. Verify readiness and determine whether proceeding is appropriate.
  5. Execute. Perform the assessment, procedure or other clinical activity.
  6. Monitor. Evaluate progress and recognize deviations from the intended result.
  7. Modify. Change the approach within the professional’s authority when necessary.
  8. Conclude. Document, communicate and prepare for the next episode of care.

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.”

Convert clinical experience into measurable needs

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.

Preserve judgment and accountability

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.

Establish priorities through importance and satisfaction

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.

Look for hidden differences between groups

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.

Bring clinical needs into the target product profile

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.

Test concepts against the work they should improve

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.”


What comes next

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.

READ MORE

  • MedTech

Understanding the Jobs Patients Need Doing

David Hodes

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.”

Define the job from the patient perspective

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).

Distinguish the job from the journey

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.

Study daily life where it happens

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.

Recruit for differences that affect the job

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.

Examine the complete job

The job mapping framework divides a job into eight recurring steps. These steps prompt investigation beyond the most visible interaction.

  1. Define. Establish what the patient needs to achieve and the circumstances that matter.
  2. Locate. Establish how the patient will find the information, materials or support required, including your solution.
  3. Prepare. Uncover how the patient will arrange the environment and resources for the job to be done.
  4. Confirm. Understand how the patient will make the decision to go forward with your solution and determine whether everything is ready for the intended next action steps.
  5. Execute. What outcomes matter to the patient as they get your solution and start using it. Often this is the ONLY job step the team looks at.
  6. Monitor. How will the patient assess and know for sure your solution is progressing successfully.
  7. Modify. Rarely do things work perfectly on the first try. Identify outcomes that are important to the patient when adjustments to the approach are needed when conditions or results require it.
  8. Conclude. Complete the set of outcomes by understanding how the patient completes the activity or prepares to repeat it.

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.”

Turn patient language into outcome statements

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.

Preserve meaning as you organize the evidence

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.

Measure importance and satisfaction separately

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.

Identify opportunities within patient segments

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.

Connect outcomes with development decisions

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.

Keep patient progress connected to system performance

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.”


What comes next

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.

READ MORE

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