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The U Journey: Retreat and Reflect

David Hodes

It is paradoxical, but true, that even the most deeply systemic changes start because an individual wills such a change into being. This is not to say that the individual alone can make the change happen. Nor is it only the individual leader who has to go through a personal transformation.

Everyone on the team will need to undergo a mindset shift and find their own connection with the need for change and where the organisation is headed. What’s the story you will tell yourself?

[Listen to audio version, read by David Hodes]

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

On our U Journey, there comes a time when the learning journeys are coming to an end, the scenarios you have developed have been tested and the initiative is poised for scaling. Decisions must be made on what has worked and will be further developed, as well as what has failed and should be abandoned. You could think of it as being similar to a team of architects coming to the end of their conceptual design phase. They are settled on the form and aesthetics of the new building, they would have considered how it is going to meet its functional requirements and will have engaged a variety of stakeholders to ensure a good fit for its purpose.

But you are not building a building—you’re transforming an organisation to address its most pressing problems and seize its most profitable opportunities. There cannot be change of the order you are looking for without profoundly affecting the relationships between people, the processes they use and the level of anxiety they would likely have when they wonder what the changes could mean for them. What will it do to their status? Will they be good enough? What of their shortcomings and vulnerabilities? Will they be on parade for all to see? How will they continue to render the vision of what they are trying to achieve when they have to take their proposed solution to a much bigger, more sceptical and often more cynical organisation at large?

For each of the core members of the transformation team, it is important to retreat from the whirligig of the project as usual and go deep into a quiet place to connect with purpose and make sense of all the changes and how they will ultimately affect the way people think, feel and act.

Standing over the abyss
The conscious and deliberate act to retreat and reflect occurs at the bottom of the U in our U Journey and is the equivalent space of the abyss in the classic Hero’s Journey. It is a place for death and rebirth and is symbolically the threshold into a new way of being. On your way down the left-hand side of the U, you will have crossed two other thresholds. The first would have been to overcome the voice of judgement—that is, the voice in your head that relentlessly tells you you’re not good enough, you don’t know enough, and that you’re going to get found out. Diving deeper down you have to contend with your voice of cynicism as well as that of your team and organisation. The cynic doesn’t believe in transformation or indeed progress of any sort. The cynic in you ascribes base motives to any advocates of change and can’t wait for the moments of failure so the voice can pipe up: ‘I told you so’.

“On your own, in nature, you have no rivals, no point to prove”

We all have this voice in our personality and it acts as a shield against our vulnerable selves. Seems like a good bargain; become more cynical and cauterize yourself against any emotions associated with trying and failing. But there’s a heavy price to pay. That cauterization acts as a barrier to any positive emotions and the rewards that arise from having a go, securing some success and most importantly, connecting deeply with your colleagues as you try and achieve something meaningful.

The Retreat and Reflect series of activities is in fact a wilderness retreat. A place is carefully chosen that is at once safe, has the usual workshop facilities and is close enough to primal nature that each individual can partake in a solo experience in a part of that wilderness. There are three distinct phases: preparation for the solo, the solo itself and the dialogue after the solo.

Why, you may ask, do you need a solo? And why is it desirable to have it in nature? The ‘solo experience’ is a means by which each of the participants accesses their deeper sense of knowing, their connection to the work of the transformation and to the members of the team charged with crafting the vision and bringing it to life. It happens in nature because that is where we can truly switch off all distractions and connect with our own beating heart and true inner voice. On your own, in nature, you have no rivals, no point to prove and no judgements being made by anyone other than the voice in your head. Being all one in nature provides the field in which whatever it is that ails you can be healed.

Thus, the whole Retreat and Reflect process needs to be facilitated by people who are well equipped in keeping people safe in nature, have a heightened capacity for holding deep conversations and who are deeply empathetic towards leaders on a quest to make a difference to the environmental, economic and social wellbeing of our organisations.

There are two fundamental questions to take with you into the Retreat and Reflect process: Who are you? And why are you here? The ‘who are you’ question is not asking about your name, where you live or what your job title is. It is sometimes referred to as the capital W ‘Who are you?’ That is, what is at your core? How do you define yourself when everything other than your essential essence is left? There is an exercise you can do to help get closer to answering this question, developed by Michael Ray—the man who gives the most popular course on creativity at Stanford University. You can find that exercise here.

The ‘why are you here?’ question invites you to go deep into who your large ‘S’ Self is—the way you make meaning out of your life, the contribution you want to make and what you’ll be remembered for. Put another way, it’s the answer to the questions: ‘What difference would it make if you weren’t here at all? What would the world be missing if you hadn’t acted in it, with a deep sense of purpose?’ In the words of the philosopher Martin Buber:

The free man is he who wills without arbitrary self will. He believes in destiny, and believes that it stands in need of him. It does not keep him in leading strings, it awaits him, he must go to it, yet does not know where it is to be found. But he knows that he must go out with his whole being. The matter will not turn out according to his decision; but what is to come will come only when he decides on what he is able to will. He must sacrifice his puny, unfree will, that is controlled by things and instincts, to his grand will which quits defined for destined being.

This idea of sacrificing ‘his puny, unfree will, that is controlled by things and instincts’ is what is facilitated by the process. Equipped with these two questions—and having completed both the Foundation Workshop and the Learning Journeys—you will likely have a much clearer vision of what it is you want to bring into the world as well as what you need to let go of that’s no longer useful to you. On the shortest of the Retreat and Reflect events, it takes four days to go through the transformational process which occurs at the bottom of the U.

It works best when everyone arrives around lunchtime on Day One, with the most senior facilitator inviting everyone in turn to talk about their journey so far, and particularly to focus on what they have learned about the two questions above: ‘Who are you? Why are you here?’ That evening a meal is prepared together and, if possible, the group should sit around a fire and continue the conversation. There is nothing quite like sitting around a fire and telling stories to connect you with a deeper sense of your own being. It is also valuable to do some quiet contemplative practices such as meditation, yoga, Tai Chi and the like.

Time to explore alone
On Day Two, the participants are briefed on what to expect on their solo, their individual sites are prepared, usually with a tent or swag, and around lunchtime, are sent out to those sites to be alone—or ‘all-one’ as John P Milton, my own teacher in these matters, would say. There is something extraordinary about going into nature on your own and, however temporarily, removing yourself from all elements of human culture. Just think for a moment—when was the last time you did that in a deliberate way, and for a period of two days and two nights?

Just as the caterpillar turns to goo before it transforms into the butterfly, so too are you able to let go of the structures and narrative that brought you to this place and discover the possibility of connection to your highest future self. Surrendering to the experience of the wilderness gives you a glimpse into the connections between inner, outer and true nature. It makes the pain and loss associated with the death of your old self bearable. By deeply connecting to who you truly are and what you are on this good earth to do, you emerge greatly strengthened, with a grand will opened to a full expression of what’s possible.

Somewhere around 10am on Day Four, the participants come out of the solo and are skilfully assembled in a dialogue circle to share their experience.

For millennia, people and nature were not separate—one was the context for the other. Natural places serve as sanctuaries for connecting to the Source of our own being, to life itself, and for expressing our highest form of creativity. ‘The collective unconscious,’ wrote Carl Jung, ‘is identical with nature herself.’ You may be wondering just where all this is going with regard to the transformation in your organisation. That’s where we’ll go next as we Crystallise Intent.

____________________________

This article is Part 6 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

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    [Background photo by Andrew Deslauriers on Unsplash]

    “Men have become the tools of their tools.”
    —Henry David Thoreau

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  • 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.

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