As we all face the unprecedented challenges of a world constrained by the COVID-19 virus, how can we mitigate the effects of the pandemic? I offer a view shaped by the Theory of Constraints (TOC).
[Listen to audio version, read by David Hodes]
The first step in a constraint analysis is to define the boundary of the system. In this case, I will focus on Australia and all the people within its borders. The second step is to determine the goal of that system. Fundamentally, in our case it is the electorate who have the right to set the goal. In practical terms, we achieve this through the election of a majority of members to our federal and state parliaments, based on their policy platform and competence—especially their ability to deal with what British Prime Minister Macmillan described as ‘events, dear boy, events’.
In TOC terms, the goal, too, should have specific attributes. You should always be able to get more of it, and you should not state the goal as a target. Thus, ‘We will achieve a budget surplus of x by 30th June 20xx’ should be restated as ‘We will achieve a budget surplus no less than x by no later than 30th June 20xx’.
Define a simple, higher-order goal
Furthermore, the goal should be simple and easy to articulate and serve the purpose of having everyone in the system recognise it, from the Prime Minister and Premiers to the most humble and vulnerable in our society. Crucially, we must understand the goal in the context that shows how it serves the higher-order mission, vision and purpose of the system we’re examining—the Commonwealth of Australia. Importantly, a well-crafted goal allows the actions taken when executing the strategy to be measured. Thus, it’s possible to assess whether or not those actions are effective and able to deliver more units of goal achievement.
This goal definition for the fight against the coronavirus thus raises some interesting questions. How could it be framed? We’ve all become familiar with the idea of flattening the curve—that is, to slow down the rate of infection through enforcement of social distancing. This policy allows the health services to use the limited capacity they have to service all of those for whom COVID-19 effects have become acute. As I write, preparations are underway for 20 per cent of the eight million people in New South Wales (NSW) to catch the virus. The forecast is that 5 per cent of people affected—up to 80,000 people—would require intensive care.
Australia as a whole, however, has only just more than 2,000 intensive care beds. That’s quite some constraint. If the virus was allowed to run wild, without any mitigating actions, and vast swathes of the population contracted the disease at more or less the same time, that would be 40 people for every bed, if NSW took all available Australian ICU beds. What chance is there that the rest of the states would accede to this proposition? If the goal is to save as many lives as possible, what are the decision-making criteria going to be for the triage? Who’ll be the lucky one and how many of the remaining 39 will make it on their own? It appears that the younger you are, the less severe the symptoms, but for our large, old and aging population, we are going to have to make some pretty tough, unpopular and socially divisive decisions.
What about the economic goal?
One in 13 jobs in our economy comes from tourism and hospitality. International arrivals have ceased; domestic travel is being heavily cut. Qantas and Virgin are under pressure, and possibly will be for some time. Qantas has cut international capacity by 90 per cent and domestic capacity by 60 per cent until the end of May. How many of the 30,000 people who work for Qantas will still have a job in a couple of weeks? What happens to every small-business owner who has a restaurant, a pub or a café? What happens to all the commerce that stops as a consequence of millions of people having no more than the dole to see them through the crisis?
In a recent essay, Victor Davis Hanson made the point about the USA, which faces similar issues to those we’ll experience in Australia: ‘We sometimes forget, in legitimate fears of the coronavirus, that every action prompts a reaction and the massive curtailments of the U.S. economy can have as many health consequences as the virus itself—if millions lose income and jobs, become depressed in self-isolation, increase smoking, and drug and alcohol use, and postpone, out of fear, necessary buying and visits to doctors and hospitals for chronic and serious medical conditions unrelated to the virus.’
The truth is that no one knows how the pandemic will play out. In an excellent simulator contained in an article in the Washington Post, you can get some idea of what the four basic strategies are to minimise the effects of the pandemic: free for all, attempted quarantine, moderate social distancing, and extensive social distancing. These kinds of scenarios are what’s exercising the minds of our finest epidemiologists, virologists and public health policy officials.
So, with all of that as context, my stab at articulating a utilitarian goal: minimise the adverse health, wellbeing and economic consequences of the COVID-19 pandemic for the population of Australia and the benefit of the world.
“…resolve the diabolical dilemma of minimising the health outcomes of the virus while ensuring the least harm comes to our economy.”
Given the above, we can conclude that our political leaders have to achieve a feat of creating national unity of purpose that is unprecedented outside of wartime. We’re asking them to resolve the diabolical dilemma of minimising the health outcomes of the virus while ensuring the least harm comes to our economy.
Allow me to step down from those lofty heights and provide some thoughts which go back to the roots of TOC. Below is a diagram of the 5-Step FOCUS.
Let’s use it to see what TOC thinking can contribute to achieving the stated goal.
Find the constraint: Currently, there are several candidates for the constraint, depending on the level of resolution you’re taking, but the one that worries most people is the supply of ICU beds and even more so, the availability of ventilators.
Optimise the constraint: There are only two ways to optimise the constraint—either build more capacity or slow down the demand.
Ways to build more capacity could include:
- massively mobilising projects and resources to create more ICU beds
- ramping up the design and production of ventilators
- insisting that the doctors, nurses and other frontline healthworkers do only that which only they can do
Ways to slow down demand could include:
- massively increasing the supply of test kits
- optimising the process of conducting the tests; for instance, with drive-through testing
- ramping up the throughput of pathology labs to deliver the results of the tests in record time
- applying big data concepts, including AI to help with an increase in knowledge about the COVID-19 epidemiology and virology
- Using IoT and mobile phone geolocation to identify who is infected and with whom they have come into contact
- Mobilising manufacturing capacity to create vital goods, such as sanitiser from alcohol facilities, or face masks and protective clothing from those with expertise in the provision of these goods to hazardous industrial and mining environments
Collaborate around the constraint: One of the most encouraging and heartwarming examples of collaboration I read about is the development of a Facebook Group who volunteer to do domestic duties for the families of doctors, nurses and other frontline health workers. Others include:
- Maintaining social distancing following best practice
- Not hoarding supplies
- Accelerating the capacity building of broadband so that it doesn’t become the communications bottleneck
- Learning how to work productively and socialise from home
- Reading, learning and growing
- Taking the time to reflect deeply on your life and how you can contribute, in whatever way, to positively moving the dial. This crisis is a singular opportunity to reconnect with all that is true, good and beautiful—dare to be that most generous, mindful and compassionate person you could be
Uplift the constraint: This too shall pass. We know that, on the horizon, there will be a vaccine. To get to that place, we must encourage behaviours that include:
- Removing all waste from the conduct of clinical trials, including senseless bureaucracy
- Developing a portfolio of approaches to the creation of a vaccine to increase the possibility of finding one that works, sooner
- Supporting collaborative efforts in promising places such as Australia, the USA, Israel and Canada where there are encouraging signs of cures
Start again: I am firmly of the view that the world we left so rudely just a couple of weeks ago will be a very different place once we are over the crisis. I was struck deeply by the fact that it was the nation-states that responded to the crisis, not the supranational constructs of, for example, the European Union or the United Nations. In short order, every country closed its borders and the WHO played along with China’s cover-up. One has to tap the deeper root of national memory, legends and myths to find the source of resilience, unity and sacrifice. Anzacs and the diggers come to mind for me in Australia.
I also think there has been an awakening of the limitations of globalisation and the consequent need to diversify supply chains. For example, Australia has only 27 days of liquid fuel as a reserve with 90% of refined fuel imported. What does this mean for us as we come to understand better what a totalitarian regime in China is capable of doing? Anyone want to put our whole economy at risk with the regime that lied and covered up about the coronavirus and who makes imperial claims on our vital shipping lanes in the South China Sea?
I’ll leave it for now on another quote from Victor Davis Hanson, whose wisdom applied to his analysis of the United States is equally prescient for Australia: ‘In addition, it is not wrong to remind the public that current but once caricatured policies of secure borders, targeted travel bans, demands for transparency and symmetry from major U.S. trading partners, recalibration with China, and a return of manufacturing and assembly of key U.S. industries, from high-technology to pharmaceuticals, was long overdue—and must continue to ensure U.S. security and the long term health of its people.’
There will be enormous opportunity to prosper in that world of the future, so let’s be sure, each of us in our way, to make our contribution and do our duty.
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My own sense of duty is to contribute where I can to the national effort by offering innovations in productivity. To the project and production work, such as increasing supplies or optimising testing processes, organisations can apply the TOC solutions of Critical Chain Project Management (CCPM) and Drum-Buffer-Rope (DBR). These methods are pragmatic, grounded in reason and are backed up by decades pf empirical evidence to prove their efficacy.
If your organisation could use this kind of thinking to transcend your corona constraint, please don’t hesitate to schedule a call. And if you know someone who’s battling with their own corona constraint, please forward this article to them.
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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:
- download the brochure (no email required)
- schedule a call
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[Background image: Whiteboard process, Chromatograph on Unsplash]“Know the whole, focus on the constraint.”
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Understanding the jobs healthcare professionals need to accomplish
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.
- Define. Establish the intended clinical result and the decision or action required.
- Locate. Obtain the evidence, equipment and resources needed.
- Prepare. Arrange the patient, environment and supporting work.
- Confirm. Verify readiness and determine whether proceeding is appropriate.
- Execute. Perform the assessment, procedure or other clinical activity.
- Monitor. Evaluate progress and recognize deviations from the intended result.
- Modify. Change the approach within the professional’s authority when necessary.
- 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.
Understanding the Jobs Patients Need Doing
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.
- Define. Establish what the patient needs to achieve and the circumstances that matter.
- Locate. Establish how the patient will find the information, materials or support required, including your solution.
- Prepare. Uncover how the patient will arrange the environment and resources for the job to be done.
- 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.
- 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.
- Monitor. How will the patient assess and know for sure your solution is progressing successfully.
- 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.
- 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.
