STAY CONNECTED AND SIGNUP TO RECEIVE INSIGHT updates
No matter how much you know, it will never be more than a pebble on the beach compared to the vast oceans of what you don’t know. But what if we can establish better ways of learning and sharing our knowledge together?
This is part 1 in a series. Read the other part here: Team Learning
[Listen to audio version, read by David Hodes]
With our system of education, through the colleges we attend, the courses we take, and the careers we then pursue, each of us has come to know the world in ever-increasing detail of ever-decreasing range. There is nothing wrong with having a depth of expertise in a given domain. For example, an accountant can work wonders with financial structuring and provide the means to make the right investment decisions. A lawyer can successfully put together contracts that mitigate risks and maximise opportunities. An engineer can design a new product that solves not only a single customer’s problems but delivers a whole new market domain. The marketing guru can facilitate an organisation finding its way through the jungle of competing products and help its success with sales.
But as we get deeper and deeper into our specialist domains, we become increasingly alienated from the knowledge of what constitutes the whole and, indeed, alienated from each other. We end up with different vocabularies, different acronyms and unknowingly carry with us the curse of knowledge gained from this deep dive into specialisation. Anyone not equipped with that knowledge has little clue what the hell we’re talking about. As a result, we don’t see what our colleagues see. We can’t properly hear what they say. We understand our world of work as if we were watching a silent movie with different sets of subtitles, describing alternate and competing narratives.
“Each of us has come to know the world in
ever-increasing detail of ever-decreasing range.”
On those occasions when we do learn together, it is usually about behaviour, leadership and culture. We investigate our values, reinvigorate the mission and set audacious goals. However, if we undertake learning about our management systems at all, it is often done either individually or in functionally specific groups. For example, the IT developer takes a course to understand how to harness the power of the digitising economy. The finance specialist subscribes to an online webinar about applying the new tax laws enacted for accelerated depreciation. And, the engineers mix it up with their colleagues and professional peers to learn how to use parametric modelling to automate the calculations for a load-bearing beam. What we don’t get is the opportunity to dive into the realms of our colleagues’ domains. Not that we need to be experts in what they do, but rather to understand in a deeper and more meaningful way why they do what they do and how they go about doing it.
A pillar of high performance is the strength and density of the relationships between the people in the team. Good relationships, as the name suggests, are a function of how we relate to each other; that is, the extent to which there is a mutual understanding of the whys and hows of the planning and doing of our work. What inspires, bores, or frightens us is the extent to which we have the capacity to effectively work together toward common goals. It follows, then, that if we want to accelerate the learning within our organisations, we should learn together, in mixed cohorts.
After all, learning on your own is an anxiety-inducing activity. Our internal voice of judgement continually provokes our sense that we are not quite good enough. Not quite up to the task of taking on something genuinely new and different. We can never be so wise as to have the ability to think through all the potential consequences of our planned thoughts and deeds, especially when we are embarking on a journey of learning on a range of topics for which all we have to offer is our ignorance.
We need others to cover for our blindspots as we undertake to cover for theirs. Doing so implies the need to develop trust in each other and to feel safe with the vulnerability that, despite appearances we might project to the contrary, there are many things we simply don’t know. Together, , we become capable of constructing the bigger picture, understanding how the parts serve the whole and hence accelerate our efforts to build a better future.
“If we want to accelerate the learning within our organisations, we should learn together, in mixed cohorts.”
So, if our goal is to better understand and relate to each other and our work, how should we form these cohorts? I want to focus on the manager level of work, or mode III, as articulated by Elliott Jaques in his stratified systems theory. At this level, the appropriate role horizon is one to two years. Managers at this level are generally accountable for discrete systems of management—IT, marketing, finance, operations, engineering and the like. They are charged with the work of efficiently and effectively operating those systems and to continuously be on the lookout for incremental improvements.
The bosses of these folk are either a General Manager or a Vice President, whose role horizon within the construct of the requisite organisation may vary from two to five years. These Mode IV and Mode V bosses are accountable for delivering step changes to the extant systems of management. When working at the requisite level, their job demands they introduce innovative technologies, develop new product and service offerings, and seek out ways to profitably grow their markets. Work at this level inevitably requires leading cross functional teams and integrating technology and processes across functional boundaries.
A critical question for these GMs and VPs is how they help their direct reports, the managers in question, avoid working incessantly in the heat of the daily firefight and apply themselves to focus cool-headed thinking to change up to next-practice ways of working. Whatever learning the managers do must be situated in the specific context of the business in question and cannot be limited to abstract concepts. Instead, they need to apply the new thinking to carefully crafted field experiments, designed to generate better outcomes through pragmatic, practical wisdom.
Typically, this kind of learning would take place over several months. In the case of Ensemble, we split the curriculum into six modules: Systems Thinking as applied to operations, organisational development and organisational design; Critical Thinking; Management Accounting; Project Management; Production Management and Replenishment Management. The idea is to provide a cross-functional cohort of managers with a carefully curated reading and viewing list before stepping into the physical or virtual classroom once a fortnight.
In addition to the prework of reading and viewing, we provide these managers with powerful questions to help them engage in 360-degree conversations with their peers, bosses, subordinates and cross-functional stakeholders. This metaphorically tills the fields of their minds such that when they engage in the workshops, they can seed their ideas within the cohort. Furthermore, suppose each of the cohort members brings their insights from their reading and reflections on the questions to the workshop. In that case, the thus enriched activity within the workshop is sure to bring about significant benefits from their cross-pollination.
While the morning session of the fortnightly workshop is given over to reviewing the topic covered in the field experiments of the prior two weeks, the afternoon session is set up to provide an injection
What are the principles that inform this idea of a cohort of managerial learning? First and foremost, it’s about creating a learning community. This community makes it safe to explore, ask questions without fear of looking stupid, and adventure beyond the constraints of what the participants, acting on their own, would otherwise consider the safe frontier. It allows for healthy scepticism but banishes the cynics. Relationships are strengthened and deepened as everyone comes to know better the world of their managerial peers. They develop a profound respect for the contribution each makes to the betterment of the whole.
A second principle is about accountability. By working as a managerial cohort, there is a strong sense of obligation to each other and the learning required to change up to the new ways of working. It’s not the type of accountability that is worn heavily and crammed down from the top. Rather, it’s more like the accountability of each of the players in a high-performing sports team, each wanting to give of their best, so the team wins not only the match but also the tournament.
Third, it’s about interaction. Not only between the members of the cohort but interaction with everyone with whom they come into daily contact. As they learn, the way they see what’s in front of them changes. They become better and deeper listeners and are encouraged to instil the habits of lifelong learning. They are ambassadors of the epistemic humility that is the ground of the philosophy of science, enlightenment and our age of reason. They come to learn that what they know is only ever a fraction of all there is to be known.
Finally, it’s about impact. The cohort may predetermine a capstone project as the muse during workshops and field exercises, or one could emerge as a consequence of the unfolding of the curriculum. Whatever the case, the team will develop a deep appreciation of what it means to work as one, together, to leverage the highest impact from their newfound capabilities. And, the managerial cohort, having learned innovative ways of working, can apply their newfound capabilities to make a measurable, meaningful and repeatable difference for themselves and those they choose to serve.
Read Part Two: Team Learning
____________________________
What’s next?
To get a flavour of the cohort experience, come to the Systems Thinker Foundations Workshop. It’s free, and you’ll leave with a framework you can immediately apply to your organisation. I hope you’ll join me.
Got a more urgent challenge? Schedule a free call with me.
We’d love to run it with you. To learn more:

[Background image: Pebbles on the beach, Jeremy Thomas on Unsplash]
____________________________
Healthcare professional jobs to be done
A clinician checking a monitor is performing an action. The job may be detecting a meaningful change in the patient’s condition soon enough to respond appropriately. A specialist reviewing a report may be trying to decide whether an intervention is suitable, rather than simply consuming more information.
This distinction matters to medical device development. A product can make an action easier while leaving the clinical job difficult or creating additional work elsewhere.
Question 1.1.4 asks how well your organization understands the jobs healthcare professionals are trying to get done. A strong answer describes those jobs from their perspective and uses evidence to identify the outcomes they need to achieve.
“The job explains why the information matters and what must happen after the professional receives it.”
Begin with what the healthcare professional needs to accomplish. Depending on the role, this may involve recognizing risk, determining eligibility, delivering treatment, explaining options or evaluating outcomes.
Keep the job statement independent of a preferred product. “Review our dashboard” describes an interaction. “Determine whether the patient requires a change in care” describes clinical progress.
Define the context and boundaries. The work may differ across acute care, routine follow-up and home monitoring. A job that includes several independent clinical purposes may need to be separated into smaller, researchable scopes.
The team should be able to explain why the professional performs the work, what constitutes completion and who depends on the result.
“HCP” covers professionals with different responsibilities, authority and expertise. A physician deciding on treatment, a nurse preparing a patient and a technician acquiring measurements may interact with the same device for different reasons.
Identify the job executor and the people who influence or support the work. Clarify who can make the relevant decision, who supplies necessary information and who acts on the result.
Do not assume that the purchaser, prescriber and daily user have the same needs. A product selected for one group’s convenience can introduce burdens for another.
Research each important perspective while retaining a clear account of the job under investigation. Differences across professional roles should inform the design rather than disappear into an average customer profile.
Clinical research combines observation with empathy interviews. Applied to healthcare professionals, it examines clinical work where it happens.
Watch how professionals prepare, locate information, make decisions and respond to interruptions. Ask them to explain recent cases and the reasoning behind their actions.
Observe the tasks before and after device use. A procedure that looks efficient may depend on extensive preparation by another team. A report that looks clear may require a clinician to reconstruct its meaning from several systems.
Discuss observations with the people involved. Familiar workarounds may compensate for a missing capability. Understanding them helps distinguish a product preference from a need that governs successful completion of the job.
Professionals often describe needs through the solution they know: another field, a different screen or a new report. These requests provide useful clues, but they still require interpretation.
An illustrative request for “all the data on one page” may reflect a need to establish whether enough information is available for a decision. The best response depends on the missing information, its relevance and the decision being supported.
Ask why the requested change matters. What uncertainty would it remove? What work would it reduce? What would the professional be able to accomplish more effectively?
Use the eight-step job framework to investigate the work surrounding the visible activity.
Treat these steps as prompts for discovery. In practice, professionals may revisit information, pause a procedure or return to preparation. The map should preserve the dependencies that make the job possible.
“Preparation and follow-up are part of the clinical job even when they happen outside the product team’s field of view.”
A desired outcome statement describes how the professional judges success. It identifies the direction of improvement, a measure, what is being controlled and the context in which it matters.
For example: “Minimize the time required to determine whether the information needed for an eligibility decision is complete.” Another might be: “Reduce the likelihood that a clinically significant change is missed during review of monitoring results.”
These are illustrative research statements, not claims of demonstrated product performance. They require validation with the professionals whose work they describe.
Avoid combining several outcomes into one statement. Speed, completeness and accuracy may all matter, but respondents need to evaluate each clearly. An outcome should also leave room for alternative ways of satisfying the need.
Clinical jobs involve interpretation and responsibility as well as information processing. Understanding the outcome does not establish that the product should take over the professional’s decision.
Clarify where the device supplies evidence, supports a task or performs a defined action. Examine what the professional needs to recognize limitations, handle exceptions and decide when additional expertise is required.
A design that reduces routine effort can introduce new review work or uncertainty. Research should capture these consequences alongside the intended benefit.
When professionals ask for greater confidence, determine what supports that confidence: appropriate evidence, clear limitations, interpretable results or a reliable escalation process. Design decisions should preserve the professional’s ability to act responsibly within the care setting.
Once qualitative research has produced clear outcomes, use quantitative research to determine their importance and how well current approaches satisfy them.
Ask professionals to rate the outcome itself, with a defined reference situation. Satisfaction should concern their current ability to complete the job, rather than whether they like a brand or presentation.
Include relevant variations in setting, experience and workload. The priorities of a high-volume specialist service may differ from those of a clinician who encounters the condition occasionally.
Opportunity assessment considers importance together with the gap between importance and satisfaction. It helps direct attention toward underserved outcomes. Apply consistent scales and interpret scores alongside the underlying evidence. Necessary safety requirements remain obligations even when survey respondents rank them differently.
Average scores can conceal important difficulties. A need may be well served for experienced users but poorly served for professionals without immediate specialist support.
Examine whether respondents cluster around different patterns of unmet outcomes. Investigate the circumstances that explain those patterns.
A group may struggle primarily to prepare the patient. Another may struggle to interpret results or coordinate follow-up. These differences can call for different product capabilities, training or service arrangements.
A target product profile connects prioritized outcomes with the Voice of Technology and the Voice of Business in one shared definition. For healthcare professional jobs, this creates a shared view of what the solution must enable.
Technical assessment examines feasibility and readiness. Business assessment clarifies objectives, resources and implementation conditions. Clinical evidence and relevant requirements shape what can responsibly be promised.
Record the important outcomes, intended users and operating context. Identify the measures and evidence that will establish whether a concept improves the job.
Use the profile to guide tradeoffs. A feature that helps one professional may transfer work to another. The team needs to assess its effect on the complete clinical activity and the patient pathway.
Concept evaluation should examine realistic tasks and scenarios with representative professionals. Ask what the proposed approach changes about their ability to achieve the priority outcomes.
Observe preparation, interpretation, exceptions and handover. Measure relevant effort or performance where the study supports it. Investigate whether support requirements make adoption practical in the intended setting.
A preference survey can identify an attractive concept, but it does not establish successful clinical use. Keep unresolved questions visible and plan the evidence needed to answer them.
Connect the results with the wider care system. The Theory of Constraints helps determine whether improving this job releases capacity or removes an obstacle governing patient progress.
“A useful concept improves an important clinical outcome of the job and remains practical within the system delivering care.”
Examine one clinical job your solution supports. Can the team state its purpose, identify its executor and show which outcomes remain poorly served?
Observe the work, validate the outcome statements and measure priorities. Then test concepts against those outcomes and their effects on patient flow. That is how Patient Centered Design connects professional insight with better products and more dependable care.
A patient may ask for a smaller device, a clearer display or an easier app. Those requests matter, but they leave a deeper question unanswered: what is the person trying to accomplish, and why does the current approach make it difficult?
Someone using a monitoring device may want to understand whether their condition is changing, decide when to seek help or manage daily activities with greater confidence. The device is one means of achieving that outcome.
A powerful question asks how well your organization understands the jobs patients are trying to get done. A strong answer connects patient research with clearly defined outcome statements that become the formal user needs your teams use to build the design history file. Outcome-based user needs are easier to validate, flow more easily into design requirements, and result in faster time to market.
“A feature request describes a possible answer. Understanding the patient’s job to be done sets your design team up to deliver a better solution faster.”
A useful job statement describes an activity the patient needs to accomplish in a relevant context. It should remain understandable without naming your product or preferred technology.
“Use our app every day” describes behavior your organization wants. “Provide a way to recognize when a change in my condition requires professional advice” describes the outcome a patient actually desires.
The distinction affects research. If the team starts with the app, it will ask how to improve screens and interactions. Starting with the job opens questions about information, confidence, timing and support. The best solution may involve changes beyond the app.
Define a scope the team can investigate. “Live a healthier life” expresses an aspiration but is too broad to guide detailed engineering decisions on its own. “Minimize the time it takes to find a solution to my health concern without needing to talk to a doctor or call someone” gives a team a direction, a measure, an object of control and contextual clarifier(s).
Journey mapping shows how people move through a particular care pathway. Job mapping examines what they must accomplish to achieve their purpose, including the work surrounding the interaction with your solution.
The two perspectives complement each other. A journey may show that a patient waits for follow-up. The job perspective asks what they are trying to understand or decide while waiting.
This matters because current processes can become embedded in the team’s assumptions. Patients may need a reliable way to recognize an important change; they do not necessarily need the exact sequence of activities currently provided.
Use the journey to understand context and dependencies. Use the job to examine whether a different approach could help the patient achieve the desired outcome more effectively.
Patient research begins with observation and empathy interviews at the Gemba, the place where the activity actually occurs.
For patients, that place includes the home and the settings in which they manage health alongside ordinary responsibilities. Ask people to demonstrate routines, explain decisions and describe recent experiences.
Observe what they do. Immerse yourself in the circumstances surrounding the activity. Engage through questions that let them explain their purpose in their own language.
A person may say that managing treatment is straightforward while observation reveals multiple reminders, improvised storage or reliance on a partner. Those arrangements can reveal effort and uncertainty that have become familiar enough to go unreported.
The aim is to understand the why your solution will win before making any decisions about what your solution will do. Customers will want your solution because of the outcomes it gives them, not because of what you made.
Patients with the same diagnosis may struggle with different parts of an activity. Differences in confidence, experience, resources and support can change how they define success.
Recruit participants whose circumstances reflect the population you intend to serve. Include relevant variations in health literacy, technology familiarity, physical ability and access to care. Are you targeting the tech savvy millennial, a busy parent trying to run a family with four kids or a retiree living in a managed healthcare facility?
Research should also examine emotional and social needs. A patient may want reassurance about managing a task alone or worry about drawing attention to a condition. Keep these needs visible alongside functional outcomes without assuming one design choice resolves them all.
The job mapping framework divides a job into eight recurring steps. These steps prompt investigation beyond the most visible interaction.
Apply these prompts to actual patient work. Some steps may recur or overlap. The map should help the team discover needs, rather than force experience into an artificial sequence.
“The most useful innovation may help a patient prepare, recognize an exception or recover confidence before it changes the device itself.”
Interviews generate verbatims: patients’ own descriptions of experiences, difficulties and expectations. Preserve that evidence, then interpret what each statement reveals about the job.
An illustrative verbatim might be, “I keep checking because I don’t know whether the reading matters.” The desired outcome may concern recognizing a meaningful change or understanding what action is appropriate.
A structured outcome statement identifies the direction of improvement, a measure, the object being controlled and relevant context. For example: “Minimize the time required to determine whether a change in a reading requires contacting my care team.”
Ask the team if there are uncovered outcomes that can set your solution apart related to how it is purchased, installed, received, set up, learned with training support, transported, maintained, upgraded, replaced or disposed.
This formulation gives research and design a clearer target. It does not establish a clinical threshold or promise that a device can safely make the decision independently, but often the features that will make your solution “easy to use” or set you apart will come from these outcome statements.
Several comments may describe the same need. One comment may contain multiple needs. Review the evidence carefully before combining it into a set of outcomes.
Remove duplication, separate distinct outcomes and retain links to the original accounts. Use plain language that patients can understand. Avoid embedding a particular feature in the statement.
Check the interpretation with participants or other appropriate reviewers. “I want fewer notifications” might mean reducing irrelevant interruptions while preserving important information. Treating it as a demand to suppress all alerts would misrepresent the need.
The output should be a coherent set of outcomes organized by job step. Completeness and clarity matter but typically it is ideal to have at least 100 and no more than 200 outcome statements for the team.
Qualitative research discovers needs and explains them. Quantitative research helps determine how widely they matter and how well existing approaches satisfy them.
Ask patients to rate the importance of each outcome and their satisfaction with their current ability to achieve it. Make the reference situation clear so respondents evaluate comparable experiences.
A high scoring importance outcome with low satisfaction deserves investigation. High satisfaction may indicate that the need is already well served so the team can use what already exists and put more time in creating innovative solutions to high importance low satisfaction outcomes. Low importance can reduce its priority, although clinical safety requirements cannot be dismissed through a popularity score.
Use a research design appropriate to the intended population. The outcome statements are easy to rate on a five point Likert scale. Choose population quantitative research in alignment with your target persona groups.
The Outcome Driven Innovation approach uses importance and satisfaction to identify underserved outcomes. Its opportunity calculation adds importance to the positive gap between importance and satisfaction.
Use compatible scales and a clearly defined calculation. Interpret the result alongside the underlying responses, research quality and the clinical context.
Examine differences between groups. An outcome that appears adequately served overall may remain difficult for patients with less support or a different level of experience.
These differences can reveal meaningful segments based on unmet needs. They help the organization avoid treating demographic similarity as evidence that patients need the same solution. Prioritization should retain enough detail to explain whose outcome the proposed improvement will change.
A target product profile brings the priority outcomes together with business goals, available technology and other relevant requirements. It helps the team agree what success should look like before committing to a concept.
Translate patient outcomes into design inputs and measurable requirements while preserving traceability to the evidence. Define which questions remain uncertain and what research or testing will resolve them.
Evaluate concepts against the outcomes they are intended to improve. Ask whether the proposed approach reduces effort, uncertainty or difficulty for the relevant patients and results in higher satisfaction scores than the baseline solution. A favorable reaction to an attractive prototype provides limited evidence unless the team can connect it with better execution of the job.
A priority patient need may involve work performed by a clinician, caregiver or service provider. Investigate those dependencies before deciding that a product change will solve the problem.
The Theory of Constraints helps identify where improvement can change the performance of the wider pathway. A better patient interaction can have limited effect if access to essential support remains constrained.
A Value Management Office can coordinate the initiatives needed to address these connected issues and keep investment aligned with patient outcomes.
“Patient insight becomes useful design evidence when the team can show which outcome matters, who struggles with it and how the solution improves it.”
Use patient jobs to be done to review one priority patient job. Can your team state it clearly, map its steps and demonstrate which outcomes are highly important and poorly satisfied?
Start with observation and patient conversations. Build and validate the outcome statements, measure priorities and test concepts against them. That discipline gives Patient Centered Design a practical foundation for better products and more lives changed for good.

Discover better ways to do better work.
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 callsDiscover better ways to do better work.
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