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What’s your story?

David Hodes, Founder

Stories are how we make sense of the world. They also stir our emotions in powerful ways, often persuading our audience more effectively than any reasoned argument. If we’re trying to inspire change, we should use them. This three-part series explores how.

I sometimes imagine the first humans with conscious thought, looking across the African savannah, gazing at the infinity of the night cosmos above. When did they start asking the eternal questions: ‘Who am I? Why am I here? What’s going to happen when I die?’ What stories did they tell themselves?

This is Part 1 of our series on our Storytelling series:
Part 1 | Part 2 | Part 3

Stories are what make us different as a species. I can hardly imagine animals thinking they are not satisfied with their lot. Do lions bemoan their ‘lion-ness’, aching to try something different for a while? Can they transport themselves into an alternative point of view? Do they have any knowledge of what is good and evil? What do they think about living and dying? What do we think, when our thoughts turn to the inevitable?

Our most deeply held truths are simply stories

Read the book of Genesis and you get one story of how the world began. Listen to the scientists talk about the Big Bang and Darwin’s theory of evolution and you get some others. Science itself is still only a story—an imperfect model of reality. It was only a little under 100 years ago that the awe-inspiring idea was born that the creation of all the known universe emerged from the nothingness of the singularity. Now there’s a story—something arising from nothing.

Our senses don’t equip us to perceive the fullness of reality. Stories help us understand the world around us and our journeys within it. They have driven emperors and kings—and the people who overthrew them—echoing down the ages long after the civilisations they inspired turned to dust. Unlike the other animals, we can sacrifice this moment’s gratification for a larger prize down the road. They cause us to dream about horizons beyond our grasp.

As my favourite writer, Joseph Campbell, put it, ‘Life is like arriving late for a movie, having to figure out what was going on without bothering everybody with a lot of questions, and then being unexpectedly called away before you find out how it ends.’ At the risk of labouring the metaphor, the truth is we can be the hero of that movie, and author the script. Even in the most desperate of situations, as Victor Frankl discovered, no one can rob us of our ultimate freedom—the choice of our response to any circumstance. It turns out we have agency in how the movie turns out.

What story are you telling yourself?

I can’t imagine a circumstance where our storytelling doesn’t act as the compass of our lives. It can point to an affirming idea and help overcome obstacles on the way to the goal. Conversely, when the voice of judgement gets a say, we may create a negative story that puts imaginary obstacles in our way. Hamlet told us ‘there is nothing either good or bad, but thinking makes it so’. If that’s true, then what we think has consequence, and the way we think is in stories.

Inspiring, understanding, connecting

We should be intentional about the use of stories in our business settings. My communications director uses the simple model above to show the core benefits of stories: to understand, to connect and to inspire. He notes they are not mutually exclusive, either; a good story can do all three.

I often run workshops where I teach the methods and tools of the Theory of Constraints. While it’s important to know your technical chops, it adds so much to understanding and learning when these new ideas are grounded in a good story. There’s a human connection made when you relate what happened in that other situation—the one that’s like their own, but not the same. The imagination steps in to fill the gaps as the story’s lessons are drawn out from the specifics of my story to the general principle, and then back into the specifics of their situation.

A good story inspires when those learning hear how people, just like them, wrestled with the particulars of their situation, overcame obstacles on the path, and courageously willed themselves to succeed. The story they tell is that if those others can do it, then why not us? If not now, when? And, the story creates the connective tissue which defines ‘us’.

Being part of the tribe

Ed Schein, a doyen of organisational culture, observed that within most businesses, there are three tribal subcultures: executives, managers and operators. In a large organisation, the executive’s implicit story is: ‘I set the course, you manage the project, they deliver the work’. But is this the reality? It probably feels more like: ‘I expect results; you promise me a deadline, they’re late again’. In the manager’s version of the story, it might sound like: ‘I plan the work, you (my team) wreck my plan, he (my boss) promises miracles’. While the operator’s story goes something like this: ‘I do the work, you (my manager) get in my way, he (the boss) is clueless about what it takes’.

From these different perspectives, everyone is trying, everyone feels squeezed—and it’s always someone else’s fault. Instead of a well-orchestrated performance, it’s more like three groups playing different genres of music in different keys and time signatures. No one grasps the whole story and the work is often a grind, wasteful and unjust. What’s the remedy? Tell a bigger story—an aligning narrative which allows the hearing of every voice. A vision so compelling that individuals find themselves willing to sacrifice their desires to something bigger than themselves. To have the possibility of living into a more meaningful future self, amplified by committing, as individuals within a collective, to the extraordinary.

“Stories help us understand the world around us
and our journeys within it.”

The language we use affects the story we internalise. Consciously or not, we are all well versed in the use of metaphor and turn to it when we want to provide the necessary emotional charge to what we are trying to communicate. On a recent assignment, a very distraught senior manager, who had been with the business from its inception 30 years ago, talked of his plant having ‘cancer’ from the repeated neglect of necessary maintenance. Of course, a machine cannot have cancer in the way we know it, but he was able to convey in a visceral way how the neglect had affected his team and destroyed the pride in their work.

My area of specialisation, the Theory of Constraints is also a story—one that aims to simplify the messy complexity of our organisations and focus where it counts. When I’m introducing the concepts, I say there’s no way that TOC can be what Eli Goldratt, its physicist inventor, wanted it to be—a grand theory of everything. Life and its experiences are far too complex to be reduced to a single idea. However, I tell the story that you don’t need to know quantum mechanics to drive a car around a corner; Newton will do just fine.

You don’t have to understand the absolute truth to have order gain a victory over chaos. As Goldratt himself put it, ‘I would rather be approximately right than exactly wrong.’ The idea of allowing ourselves to fail, learn from the experience, and try again. That’s a story we can tell yourselves. And if enough people share it, the culture changes.

What story are you telling your team?

Real leadership doesn’t happen by fiat; it comes because people want to follow. As a leader, it’s your job to create the conditions for your team to thrive. If we seek to change people, we need to inspire them. That means establishing purpose. How? With a story that aligns desire with the will to overcome the challenges that will get in the way. Many companies now have a role called ‘chief storyteller’. It’s often a marketing or communications role, but it should really be the executive accountable. More than that, everyone should have a sense of shared narrative—and tell themselves a version of the story that gets them fired up. And if you’re keeping things to yourself and not sharing a story, know that your people will provide one of their own.

The ‘cancer’ I referred to earlier was a powerful analogy. It wasn’t the narrative; it was a cry of frustration. But it could lead to a more positive story, one where the cancer has been identified and treatment has begun. The road to recovery would be long, slow and painful. And in no way certain. But how different the mindset of the team if they believe the cancer can excised. The organisation could go through remission, get back on its feet and thrive. Or maybe you can drop that narrative entirely and create an even more positive story. In the next article, we’ll go deeper into these big overarching narratives and how to craft them.

Now read the other parts in our storytelling series:

Part 2: Telling big stories
Part 3: Sharing stories

____________________________

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 Klemen Vrankar on Unsplash]

    “There is nothing either good or bad,
    but thinking makes it so”
    —William Shakespeare, Hamlet

    ____________________________

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The healthcare professional: the hidden constraint in patient flow

Ensemble Administrator

Healthcare professionals are central to the patient’s progress from awareness of a therapy to successful long-term use. They identify risk, interpret evidence, diagnose conditions, discuss options, perform procedures, provide training and monitor outcomes.

Yet many medical device development programs treat healthcare professionals primarily as users to be trained or customers to be persuaded.

HCP-Centered Design takes a wider view. It examines the work healthcare professionals must perform, the system in which they perform it and the constraints that limit their ability to move suitable patients through the care pathway.

“If patient flow depends on a healthcare professional, that professional’s available capacity may determine how many patients ultimately receive the therapy.”

Healthcare professionals govern critical transitions

A medical device patient journey commonly depends on several healthcare professionals:

  • A primary care professional recognizes a problem or makes a referral.
  • A specialist assesses the patient and manages the disease pathway.
  • Diagnostic professionals generate and interpret evidence.
  • A managing physician supports authorization or reimbursement.
  • An interventional specialist confirms eligibility and performs a procedure.
  • Nurses, educators or allied health professionals help the patient adapt.
  • Follow-up teams monitor efficacy and coordinate adjustments.

Each professional governs a transition in the flow of patients.

If one transition lacks sufficient capacity, information or clarity, the whole pathway slows. More marketing, sales activity or production capacity will not compensate for a shortage of specialist time or a burdensome diagnostic process.

This is why HCP-Centered Design is not simply about making an interface easier to use. It is about enabling the system of care to perform.

The HCP works within a system

A healthcare professional’s work depends on information and actions supplied by others. They may rely on referrals, patient histories, pathology, imaging, electronic records, clinical guidelines and the availability of equipment or trained colleagues.

After reaching a decision, they may need to explain it, document it, arrange authorization, coordinate treatment and prepare the next person in the pathway.

A technically strong solution can still create difficulty if it:

  • Requires information that is hard to obtain
  • Interrupts established clinical workflows
  • Produces outputs that are difficult to interpret
  • Adds documentation without removing other work
  • Fails to connect with existing systems
  • Demands training that cannot be sustained
  • Transfers work or risk to another professional
  • Provides a result without clarifying the next action

The relevant design question is not merely, “Can the HCP use this product?”

It is, “Does this solution improve the HCP’s ability to complete important clinical work within the conditions in which care is actually delivered?”

Identify the real healthcare professional personas

“HCP” is not one persona.

A general practitioner, specialist, interventional physician, nurse, technician and clinical administrator encounter different stages of the pathway. Each has different responsibilities, authority, expertise and exposure to risk.

Even within a profession, context matters. An experienced specialist in a major hospital may approach the same task differently from a professional who encounters the condition infrequently or works without immediate specialist support.

Useful HCP personas distinguish factors that influence work:

  • Clinical responsibility and decision authority
  • Frequency of encountering the condition
  • Experience with the procedure or technology
  • Access to information and specialist support
  • Available time
  • Confidence in interpreting results
  • Responsibility for follow-up
  • Exposure to clinical, legal or financial risk

These personas clarify who performs each job and what support each person requires.

Map the HCP journey

The HCP journey often begins before the visible clinical procedure.

It may include receiving a referral, gathering information, forming an initial view, ordering investigations, interpreting results, deciding whether the patient is eligible, discussing treatment, obtaining authorization, preparing for the procedure, delivering care and arranging follow-up.

At each stage, ask:

  • What is the HCP trying to accomplish?
  • What information is required?
  • Where does the information come from?
  • What decision must be made?
  • What could cause delay or rework?
  • Who depends on this action?
  • What must happen before the patient can progress?

The resulting journey map should distinguish processing time from waiting time. A decision may require only minutes of specialist attention while patients wait weeks to access that attention.

This reveals the practical relationship between HCP capacity and patient flow.

Find the HCP constraint

The Theory of Constraints directs attention to the factor limiting the performance of the entire system.

In some pathways, the constraint may be the number of qualified interventional specialists. In others, it may be diagnostic capacity, physician confidence, authorization effort, operating room access or the time required to train patients.

The constraint may also be hidden inside the HCP’s working day.

A specialist supporting a therapy must still manage other clinical duties, administration, meetings, documentation and urgent cases. The question is not simply how many specialists exist. It is how much of their usable capacity is available for the activities upon which patient flow depends.

“The scarcest resource may not be the healthcare professional. It may be the few hours of focused capacity available for the critical work.”

Improvement away from this constraint can make performance worse. Sending more referrals to an already overloaded specialist increases the queue. Adding information may increase cognitive burden. Creating another approval may consume the capacity required to treat patients.

HCP-Centered Design seeks to protect and expand the capacity that governs flow.

Go to the clinical Gemba

Policies and procedures describe how clinical work should happen. Observation reveals how it actually happens.

Healthcare professionals routinely compensate for missing information, awkward interfaces and unreliable handovers. These workarounds may become so familiar that nobody reports them as problems.

Gemba research should examine:

  • How the HCP prepares
  • Which tools and information sources are used
  • What interrupts the work
  • Where the HCP waits or repeats activity
  • How uncertainty is communicated
  • What must be documented
  • How work passes to the next person
  • How the HCP recognizes that the job is complete

The purpose is not to judge the healthcare professional. It is to understand the system surrounding the work.

“A workaround is often evidence that the system has failed to support the person doing the work.”

Define the HCP’s job to be done

Healthcare professionals do not simply use devices. They use them to make progress in clinical work.

An HCP may need to identify risk, reach a confident diagnosis, select an intervention, perform a procedure safely, explain options, monitor progress or recognize deterioration.

A structured job map divides this work into eight stages:

  1. Define the intended clinical outcome.
  2. Locate the necessary information and resources.
  3. Prepare the patient, equipment and environment.
  4. Confirm readiness and choose between alternatives.
  5. Execute the clinical activity.
  6. Monitor its progress and results.
  7. Modify the approach when circumstances change.
  8. Conclude, document and prepare for subsequent care.

This wider view prevents the product team from concentrating exclusively on the procedure.

The greatest value may come from reducing preparation, improving decision confidence, clarifying an exception, simplifying documentation or improving the handover to follow-up care.

Convert experience into measurable outcomes

Comments such as “the interface is difficult” or “we need better information” indicate dissatisfaction, but do not provide sufficient direction for design.

They should be translated into measurable outcome statements, such as:

“Minimize the time required to identify which clinical information is missing before making a treatment decision.”

Or:

“Reduce the likelihood that a clinically significant change goes unrecognized between scheduled reviews.”

A broader population of healthcare professionals can then assess the importance of each outcome and their satisfaction with their current ability to achieve it.

Highly important and poorly satisfied outcomes provide a rational basis for prioritizing innovation.

“Adoption follows when a solution makes important clinical work safer, clearer or easier to complete.”

Apply FOCUS to HCP capacity

The five-step FOCUS process creates a practical improvement cycle.

Find the constraint. Determine which HCP activity or resource currently limits patient flow.

Optimise for it. Protect the constraint from avoidable work, missing information, interruptions and rework.

Collaborate around it. Align upstream and downstream teams so patients, information and resources arrive when required.

Uplift it. Add capacity, redesign responsibilities, improve technology or remove restrictive policies.

Start Again. Identify the new constraint once flow improves.

This approach allows the organization to distinguish activity from value. It also turns HCP engagement into an ongoing management discipline.

Connect HCP evidence with enterprise execution

HCP-Centered Design must connect clinical reality with patient needs, technology, regulation and business strategy.

A Value Management Office can help coordinate these perspectives across the product lifecycle. Its role is to ensure that projects, resources and stage-gate decisions remain connected to patient flow and business value.

The organization should be able to show:

  • Which HCP groups influence the pathway
  • What each group is trying to accomplish
  • How the work happens in practice
  • Which outcomes remain poorly served
  • Where HCP capacity constrains patient flow
  • How the proposed solution changes the wider care system
  • How improvement will be measured

The goal is not simply a device that healthcare professionals can operate. It is a solution they can confidently incorporate into care and a delivery system capable of getting that solution to more patients.


What’s next?

Use the HCP-Centered Design assessment to determine how well your organization understands clinical work, HCP capacity and the constraints governing patient flow.

The resulting evidence should guide product design, process improvement and investment toward better products, delivered faster, with more lives changed for good.

READ MORE

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Patient flow: the missing system in Patient Centered Design

Ensemble Administrator

Medical device companies devote enormous skill and investment to developing safe, effective products. Yet a technically successful device changes no lives while suitable patients remain unable to reach it.

Between a patient becoming aware of a therapy and receiving its intended benefit lies a pathway of referrals, consultations, diagnostics, approvals, procedures, training and follow-up. Every step consumes time. Between the steps, patients wait. At some points, they become confused, discouraged, ineligible or lost to the process.

Patient Centered Design must therefore address more than the design of the device. It must improve the performance of the entire system through which patients reach, receive and live successfully with the solution.

“A life-changing therapy changes no lives while patients remain trapped in the pathway leading to it.”

The patient journey is a flow system

A typical medical device journey may include:

  1. The patient becomes aware of a possible therapy.
  2. A primary care professional or specialist assesses the patient.
  3. Diagnostic work determines whether the therapy is appropriate.
  4. The patient secures authorization or reimbursement.
  5. An interventional specialist confirms and plans the procedure.
  6. The patient receives the device or therapy.
  7. The patient learns how to live with the solution.
  8. Follow-up identifies any necessary adjustments.
  9. Periodic reviews monitor longer-term efficacy.

Companies often manage these stages as separate functions. Marketing works on awareness. Medical affairs supports clinicians. Market access addresses reimbursement. Sales works with specialists. Clinical teams gather evidence. Training teams support adoption.

The patient, however, experiences one journey.

From the patient’s perspective, a delay between two organizational functions remains a delay. A repeated test remains repeated work. An unclear handover creates uncertainty regardless of which department owns it.

Patient Centered Design begins when the organization sees and manages this journey as a connected system.

Processing time tells only part of the story

Every step contains some necessary processing time. A consultation takes time. A diagnostic test takes time. An authorization must be assessed. A procedure must be performed.

The patient’s total lead time, however, also includes the waiting between these activities.

A consultation may take 30 minutes, but the patient could wait six weeks for it. A diagnostic test may take an hour, followed by another delay before a specialist reviews the result. Prior authorization may require little actual work while adding weeks to the pathway.

This distinction matters because organizations often improve processing time while leaving the larger queues untouched. Saving five minutes during an appointment produces little benefit if the patient waits months to reach it.

Patient Centered Design therefore asks:

  • How long does each activity take?
  • How long do patients wait between activities?
  • How many suitable patients enter each stage?
  • How many progress to the next stage?
  • Where and why do patients leave the pathway?
  • How much total time passes before the patient receives the solution?

The answers reveal the true performance of the patient system.

Find the constraint

Theory of Constraints teaches that the performance of any system is limited by a constraint. Improving a part of the system that is not constraining flow may create more activity without increasing results.

If diagnostic capacity is the constraint, generating more awareness may simply produce a longer queue for diagnosis. If specialist capacity is the constraint, accelerating authorization may move patients more quickly into another wait. If training after first use is inadequate, increasing procedures may produce poor experiences and avoidable follow-up demand.

“More activity at a non-constraint creates work in process. More capability at the constraint improves the system.”

The constraint is not always a physical resource. It may be a policy, an eligibility rule, missing evidence, a fragmented handover, an information delay or the cognitive burden placed on the patient.

The most important question is therefore not, “How do we improve every step?”

It is, “What currently limits the flow of suitable patients to successful use of the therapy?”

Understand why patients remain in or leave the flow

Numbers show where patients are lost. Patient research helps explain why.

Two patients with the same diagnosis may respond very differently. One may actively seek new treatment options. Another may delay action until symptoms become severe. A third may want help but lack confidence in navigating the healthcare system.

Meaningful patient segmentation considers characteristics that influence behavior:

  • The importance the person gives their health
  • Their confidence in dealing with healthcare professionals
  • Whether they act independently or need encouragement
  • Their comfort with technology
  • The pressures of work, family and daily life
  • Their ability to understand and act on clinical information
  • Their willingness and ability to pay
  • The outcomes they most want to achieve

These differences affect whether patients enter the pathway, remain engaged and successfully adopt the solution.

Go to the patient’s Gemba

The Gemba is the place where work actually happens. For patients, this includes the home, clinic, hospital and all the places where they manage their condition between formal encounters.

Interviews alone may miss important evidence. People normalize inconvenience, forget workarounds and simplify their past decisions. Observation allows the development team to see what patients actually do.

Good research combines three activities.

Observe. Watch how patients obtain information, prepare, use the solution and respond when something goes wrong.

Immerse. Understand the physical, emotional and practical conditions surrounding the experience.

Engage. Ask open questions that allow patients to describe their goals, fears and frustrations in their own language.

The purpose is to discover the patient’s reality before asking them to evaluate the organization’s preferred answer.

Understand the patient’s job to be done

Patients rarely want a medical device for its own sake. They want the progress it may enable.

They may want to recognize deterioration earlier, preserve independence, reduce pain, avoid repeated visits, return to work or prevent a disease from controlling daily life.

A useful job map examines eight recurring stages:

  1. Define what must be achieved.
  2. Locate the required information and resources.
  3. Prepare for the activity.
  4. Confirm readiness and choose between alternatives.
  5. Execute the activity.
  6. Monitor whether it is working.
  7. Modify the approach when circumstances change.
  8. Conclude or prepare for what follows.

This reveals opportunities beyond the immediate use of the device. The most valuable improvement may involve helping patients prepare, confirm readiness, recognize an exception or understand what happens next.

Turn patient experiences into evidence

Stories create understanding, but investment decisions require structured evidence.

Patient observations and comments should be converted into outcome statements that identify:

  • The desired direction of improvement
  • A measure of success
  • The object being controlled
  • The circumstances in which it matters

For example:

“Minimize the time required to recognize that my condition has changed sufficiently to require clinical help.”

Patients can then assess the importance of each outcome and their satisfaction with their current ability to achieve it.

Highly important and poorly satisfied outcomes represent genuine opportunities. This prevents teams from prioritizing attractive features that do not materially improve the patient’s life or progress through the pathway.

“Innovation becomes valuable when it improves an outcome that matters and remains poorly served.”

Apply the five-step FOCUS process

The Patient Centered Design pathway can be improved through a repeating discipline:

Find the constraint. Identify what currently limits patient flow or successful use.

Optimise for it. Make the best possible use of existing constraint capacity.

Collaborate around it. Align functions and partners so their actions support the constraint.

Uplift it. Add capability, remove restrictive policies or redesign the pathway.

Start Again. Once the constraint moves, identify and address the next limiting factor.

This prevents improvement from becoming a collection of disconnected initiatives. It directs scarce resources toward the factor that most strongly governs the result.

Patient Centered Design is an operating system

Patient insight should influence more than early product design. It should shape clinical evidence, regulatory strategy, reimbursement, manufacturing, education, market development and post-market support.

The organization should be able to show:

  • Which patients it intends to serve
  • What those patients are trying to accomplish
  • How the complete patient pathway operates
  • Where patients wait or leave the flow
  • Which outcomes remain poorly served
  • What currently constrains successful patient access
  • How the proposed solution improves the whole system

The goal is not simply to place the patient at the center of a diagram. It is to organize the enterprise around delivering better products faster, so that more lives can be changed for good.


What’s next?

Use the Patient Centered Design assessment to determine how well your organization understands its patient journeys, priority outcomes and constraints to patient flow.

The result should be more than another collection of patient opinions. It should provide evidence that directs strategy, investment and execution toward the changes that matter most.

READ MORE

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    We alternate our own actionable articles with three relevant links from other authorities.


    We’ll only use your email address for this newsletter. No sales calls

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