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My previous article, The U Journey: Stepping into Design, introduced a key part of the Design phase—the Learning Journey. This includes developing and testing hypotheses, soliciting innovative ideas from wherever they might arise, exploring the psychological and cultural frontiers of your people and organisation, and trying on new ways of working.
The principle purpose of the learning journeys is to create conditions that reduce the anxiety associated with change so the people charged with bringing the new into the world can have a safe space in which to practice the mantra ‘fail often to succeed sooner’.
[Listen to audio version, read by David Hodes]
This is Part 5 of our series on The U Journey: Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8
The evolving trend toward design thinking demands that—whatever your imagined future reality—you pay particular attention to the people you’re hoping will use your product or service. They may be your own staff, your customers or any other stakeholder you need to influence favourably with regard to the change you are trying to bring into the world. Engaging them in its development—and inviting them to participate in its design and testing—will make all the difference to that change’s ultimate success. For it is never easy to bring about change. Most people prefer the certainty of current reality over the risk attached to stepping outside the walled garden and into the wild frontier—often with wilful disregard for how sterile or tyrannical the garden has become.
“If you’re not part of the problem,
you can’t be part of the solution.”
Furthermore, as individuals and collectively, there is often shame and pain associated with letting go of the past. Real change demands fronting up to culpability for the inevitable errors made. The road more frequently travelled has us sitting in judgement of others and failing to truthfully answer the question of how every one of us has some degree of responsibility for having got us to the place in which we find ourselves, and at least a degree of accountability for developing and executing a plan to get out. We must ask what kind of courageous leadership it will take to hold a mirror up to self, team and organisation and accept the systems thinking truism: ‘If you’re not part of the problem, you can’t be part of the solution.’
A visit to another organisation as outlined in my last article is a powerful way of escaping the gravitational pull of your organisation’s existing worldview and opening up the possibility for something new to emerge.
Communicating the work
Once you have clarity on what you want to accomplish in your exchange, think how you’ll communicate this to your hosts in advance. This may be a written document or a slide deck. Even better, you could use more innovative means now that anyone with a computer, a camera and a microphone can produce a video. At a minimum, you should cover off the following topics:
Context: Let them know as much as you’re willing to share about your organisation, the history of the initiative you are working on, the change you wish to bring about, and how you believe an exchange between you and them will add value for both parties.
Purpose: Be specific on the ‘why’ of the exchange. What is most meaningful about what you are setting out to do with them? What is the potential of the exchange if fully realised, and how much poorer would you each be if it was not to occur at all?
Outcomes: What are the specific outcomes you are looking for, such as plant tours, meetings with people from the executive suite to the shop floor, insights into how technology is being used and so on? Also, what will be the outputs from the visit? Will you take pictures and videos, do interviews, write journals, do some detailed analytics, study process differences? The clearer your desired outcomes—the more specific the better—the more likely the exchange will be a success.
Resources: Careful consideration of the resources required for the exchange will significantly enhance the chances of success. Think of logistics such as flights, local transfers, accommodation and meals. What kind of venues will you need for your exchanges? Meeting rooms, conference rooms, digital projectors, whiteboards. Also, be specific about whom you want to meet, in what kind of forum, and for how long. When it comes time to reciprocate, be sure that you have all the questions answered for the return trip.
I strongly recommend you make a single person accountable for project managing the whole exchange. They should have a counterpart in the host organisation; between them, they assign to the other participants accountability for the different aspects of the work that go into making the exchange a success.
At the host’s location
Once on site, be sure to use deep listening as a tool to hold the space of the conversation. Begin by bringing their story and yours into the room. Not simply your work story, but something of who you are, where you come from, what you studied, what the big turning points have been in your life, and what inspires you. What is meaningful about what you are trying to achieve and how the world would be poorer if you didn’t do it to the best of your ability.
In addition to the questions mentioned on the previous article, here are some additional avenues to explore:
The Big Idea: What’s your goal? What big idea are you pursuing to help you achieve it?
Strategy: By what means do you go about addressing the key strategic questions: What to change? What to change to? And how to change?
Innovation: How do you apply your organisation’s knowledge to deliver additional value and wealth?
Technology: How has all the technology you use shaped the business you are in? How could you improve the value delivered by your existing suite of technologies? What technology trends do you see having a major impact in your business and industry going forward?
People: How do you inspire and empower your people to be the best they can be in service of the greater good? What emphasis do you place on autonomy, learning and transcendent purpose as levers of motivation?
Process: What efforts have been undertaken to engineer simple standard processes? What systematic means do you have in place to ensure continuous systemic improvement?
Culture: What active steps are taken to cultivate a winning culture? What has been done to understand, codify and develop the shared assumptions and behaviours of your team to work together energetically toward a common goal?
Language: What are the verbal, written, visual, aural and bodily ways by which meaning is made in your organisation—from performance dashboards to office layouts and from project reporting to health and safety routines?
Organisation: By what means do you match accountability with authority at all levels of work, so your people can feel ownership and take pride in all that they do?
Resources: How do you know that you have the right amount of human, material, financial and information resources required to turn your intention into reality?
Operations: What constraints prevent you achieving more from your resources in and across time and place? What theories, methods and tools do you use to know that you’re right? How do you go about the business of continuous improvement?
Reflections after the visit
To capture and leverage the findings of your inquiry, conduct a disciplined debriefing process immediately after each visit. Don’t get distracted by cell phones or anything else until the debriefing is complete.
Here are a few sample questions for the debriefing, taken from Otto Scharmer’s insights:
1. What struck me most? What stood out?
2. What was most surprising or unexpected?
3. What touched me? What connected with me personally?
4. If the living system of the visited organisation were a living being, what would it look and feel like?
5. If that being could talk: what would it say (to us)?
6. If that being could develop—what would it want to morph into next?
7. What is the generative source that allows this living system to develop and thrive?
8. What limiting factors prevent this living system from developing further?
9. Moving in and out of this system, what did you notice about yourself?
10. What ideas does this experience spark for possible prototyping initiatives that you may want to take on?
Closing the loop
Be sure to share your gratitude and relevant findings with your hosts. Give them the benefit of some key insights you took away from the visit. If you suggested a reciprocal visit, be sure to honour that commitment.
As the group who had the privilege of undertaking the learning journey, convene as soon as possible to determine how you will present your findings to the broader change initiative. Get everyone on the same page so they know where you went, whom you talked to, what you did and how it has changed or reinforced your thinking.
Open the conversation from your findings into one which generates new ideas for redefining what’s possible for your own bold initiative.
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This article is Part 5 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 Jorik Kleen on Unsplash]
“You don’t learn to walk by following rules.
You learn by doing, and by falling over.”—Richard Branson
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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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