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Most of us spend most of our working lives in teams. Management teams, product development teams, and cross-functional task forces are all types of teams. So how does a team, often thrown together by circumstance, come to perform at the top of their game?
This is part 2 in a series. Read the other part here: When managers learn together
[Listen to audio version, read by David Hodes]
We know what it’s like to watch a sports team perform at the highest level. Rugby is my preferred game and, despite my support for the Wallabies, I’m always in awe of what the All Blacks consistently achieve every time they take to the field. If they are not the best team of any sport of all time, they have to be serious contenders with a win rate of 77.41% over 580 tests between 1903 and 1919. So what gives them their advantage? No doubt, they have a deep pool of extraordinarily talented players. But that can’t be it. Many national teams have exceptional talent. Could it be that they have mastered the art of learning as a team? That they have found a way to hand down to every generation how to build a championship team forged by the will to be a team of champions?
The idea of team learning is one of the five disciplines Peter Senge writes about in his book The Fifth Discipline. But what does team learning mean? Can a team learn? A team is an abstract noun, and therefore doesn’t have a brain of its own to do any learning. No, team learning is how the team members learn how to function more and more coherently in pursuit of a common goal.
“If they all pull in different directions,
there’ll be an awful lot of wasted effort”
In that pursuit, you can do everything right to encourage individuals to be their best. They can get trained in their functional discipline, learn the general rules of leadership, and you can even create an environment where you empower them with all the authority they require to execute their accountabilities. But if they all pull in different directions, there’ll be an awful lot of wasted effort. What’s needed to make it all work together is alignment. Part of that alignment is generated by creating a shared vision, but that is not enough. We have to do our learning together to be an effective team.
According to Senge, learning together has three critical dimensions: the need to think insightfully about complex issues; the need for innovative, coordinated action; and the need to work effectively with other teams, as, for the most part, senior teams achieve their goals through the efforts of other teams. Common to all three of these critical dimensions is the need to communicate effectively. But, in some sense, saying we need to communicate effectively begs the question. It’s too skeletal a form of words to grasp the profundity of its importance. So, let’s take a deeper dive.
The word communicate has the same root as communion, which comes from the Latin verb communicare ‘to share, communicate, impart, inform’. Well, how do we go about our work of communicating, whether in writing or conversation, but especially, for our purposes of team learning, in conversation? The word conversation means ‘to turn together’. So we can think of it as turning together to face what we see as our current reality and how we intend to get from where we are to where we want to be. None of us is so talented that we have an omniscient vision and no blind spots. When we turn to each other, the informing sentiment should therefore be a degree of humility.
Whether we talk about ego or pride, both words point to an inability to see the other as anything more than an ‘it’—an inanimate object in the field of awareness, separate from the self and seen for the most part in terms of ‘its’ utility to the person making the demand for time and effort. These conversations contain none of Senge’s three criteria for team learning. It’s as if the one doing the talking is simply projecting their thoughts onto a screen—analogous to the curtains closed across a window to the exterior. There is no curiosity about the ‘its’ point of view unless it affirms the opinion of the narcissistic protagonist. Like the man in Plato’s cave, they wrestle with the shadow of the bear cast onto the wall rather than addressing the bear standing at the entrance.
When we turn from the wall and face the entrance, we have disconfirming data. The world is not as we had previously surmised, and we have to take stock. Only then can we move from the ignorance of our self-made projections of how we have shaped the world and make observations about the reality in front of us. This kind of thinking and conversing is fuelled by reason and puts a premium on empirical evidence for a given point of view.
Discussions, on the other hand, often mean we argue our case and seek to win that argument. We have all felt the impulse to be right rather than to understand. Perhaps we want the reward for being clever enough to win the fight, but in so doing lose sight of the fact that the person or people with whom we are conversing are often not wrong but simply hold a different point of view. In the febrile times in which we live, this striving for the ‘correct’ response or approach to the question of the day tends to leave us with a view that the other is not only wrong for the opinions they hold but are wicked for doing so.
“We have all felt the impulse to
be right rather than to understand”
It’s only when we break through the invisible shield of learned cynicism and expose ourselves to being vulnerable that we can engage in the kind of conversation that fosters team learning. Living only through the apparatus of our rational mind might win some arguments, but does little to encourage deeper conversations that produce genuine fresh insight into what would otherwise be intractable problems. This level of conversation goes by the name of dialogue, based on the Greek dia, ‘through’, and logos, ‘meaning’.
The starting point for dialogic conversations is a posture of empathy. We must situate ourselves in the shoes of the other to first come to know their world of facts and sentiment before attempting to navigate a way through. The only way we can tap the potential for many minds to be more intelligent than one is if we create a space in which each team member has the opportunity to give full expression to what’s on their mind. While doing so, they must suspend the natural impulse to trigger defensive routines. Older areas of the brain, such as the amygdala, must be consciously held in check if the fight, flight or freeze impulse is not to sabotage the conversation. As Viktor Frankl put it, ‘Live as if you were living for the second time and had acted as wrongly the first time as you are about to act now.’
This transition from discussion—with the same ‘I’-to-‘it’ connotations as percussion and concussion—to dialogue, is predicated on everyone in the team’s ability to actively suspend assumptions. Those assumptions could be based on the data and information being offered to the conversation, or it could be about the motives or behaviour of the person making the offering. Applying the degree of mindfulness required to suspend these assumptions is no easy task and requires ongoing practice. A foundation of that practice is to revere the principle of free speech. If I can’t say what I’m thinking, how will I know if it’s true or needs correction or modification?
Given that you will seek to develop a culture in which free speech is encouraged, every time you feel or notice a defensive routine popping up, you have to remind yourself that the essence of the team rests in its collegiality. We are in this together. It’s impossible to conceive of a universe in which we would all think the same. Having different opinions means that, from time to time, you will offend, and at other times you will be offended.
Practising reflective dialogue, as the name implies, means reflecting on how the conversation impacts you at both the level of reason as well as emotionally. Furthermore, as your desire strengthens to transcend the strictures of your current situation, you feel compelled to invest the time and effort necessary to understand the impact of the conversation on your colleagues. As the practice deepens, the conversations move into a different mode again—generative dialogue. Generative in the sense that they generate new possibilities, as they allow for the demise of flawed mental models and the generation of innovative new ones.
Ultimately, ‘team learning’ uses collective intelligence to build alignment around a common goal. Therefore, we need the capability to develop collective intelligence within our team and across other teams with whom we need to interact in pursuit of our common goals.
“Team learning uses collective intelligence
to build alignment around a common goal”
In rugby, we have the forward pack, the half-backs and the backline, sometimes called the three quarters. On match day, there are also those on the substitutes’ bench, the coaching staff, the team manager, and of course, all the fans. On those rare occasions when my beloved Wallabies bring their best game to defy the odds and beat the mighty All Blacks, I know this is no fluke. There is present a collective intelligence, honed through the physical and mental practice of suspending whatever defensive routines have been the story informing prior defeats. In so doing, they have found through a dialogue of colleagues, not only each other but also that which aligns all of the parts to a victory for the whole. It’s the essence of team learning in action.
Read Part One: When managers learn together
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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.”
A medical device patient journey commonly depends on several healthcare professionals:
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.
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:
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?”
“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:
These personas clarify who performs each job and what support each person requires.
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:
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.
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.
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:
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.”
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:
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.
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.”
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.
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:
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.
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.
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.”
A typical medical device journey may include:
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.
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:
The answers reveal the true performance of the patient system.
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?”
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:
These differences affect whether patients enter the pathway, remain engaged and successfully adopt the solution.
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.
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:
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.
Stories create understanding, but investment decisions require structured evidence.
Patient observations and comments should be converted into outcome statements that identify:
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.”
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 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:
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.
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.
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