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Few performance standards deliver the competitive advantage you gain by keeping your promise to deliver on time, doing so faster than your competitors, and suffering no defects while you’re about it.
[ Listen to the audio version, read by David Hodes]
When we exclude the big three financial numbers of Throughput, Operating Expense and Investment, three operational measures stand head and shoulders above all others:
Due Date Performance (DDP) – how good we are at keeping our promise
Lead Time (LT) – how long it takes to get specified work done
Quality (Q) – how much rework must be done to eliminate defects
Let’s deal with each of these in turn and explore why they are so important.
Due Date Performance: No matter your line of business, the ability to deliver on your promise is a sign of integrity. It doesn’t matter whether the promise is internal to a downstream function, external to an expectant customer, or even just turning up on time for your colleagues. Doing what you say you will do, when you said you would, builds trust and is a basis for delivering value—even when you’re the Prime Minister of Australia.
I once was on a project where every effort was made to improve DDP for the delivery of iron ore. Why, I asked, was it so important to be so committed to being on time for what is, after all, a mere commodity? The marketing manager explained that if they were very reliable in delivering on time, the mills they supplied would feel more comfortable reducing the amount of ‘just in case’ inventory they would have to carry in the event a shipment missed its promised date.
Carrying less inventory had a real financial impact in terms of how much cash was tied up and how much space was needed for storage. So much so, that the marketing manager significantly incentivised his team for the price they got above the daily traded price, encouraging them to make the case to the buyer of their commodity.
In another case, at a refinery, a prime measure for maintenance work is ‘schedule adherence on the day’. Much of the maintenance work done in the refinery is done after carefully coordinating the activities of operations, contractors, supervisors, shared services, materials and equipment. If anyone is delayed, then everyone is delayed, and costs and volumes suffer.
For airlines, the industry standard is On Time Performance (OTP). For me, I would rather that my flight left and arrived on time more than any other aspect of how I would value the experience. So important is on-time performance that the Australian Department of Transport makes these figures available publicly.
In supply chains, we sometimes call due date performance by the acronyms OTIF or DIFOT—that is, On Time In Full, or Delivered In Full On Time. It is as important to measure the inbound due date performance as it is to know how you are performing in your delivery to promise to your customers. Let’s say you need five different suppliers to deliver your product or service to your customers. Each supplier promises 95% on-time delivery. As a consequence of covariance, though, the probability of having all suppliers line up so you can hit your own due date drops from 95% to a lowly 77%. The consequences of such poor performance could be additional costs of having to hold just-in-case inventory, expediting costs, reputational loss and even loss of customers whose own supply chains and reputations have been damaged by your poor performance.
For project management, due date performance is at least equal in importance to any other type of business activity, and often even more so. Many projects have significant operating costs associated with each day they run late. But, probably more importantly, being late means you could miss a critical integration milestone, a practical completion for handover, or a window for the launch of a new product. I was once working with a consumer appliance company’s new product development department. Any product shipped late for Christmas would have to wait five months until Mother’s Day before the opportunity for launch came around again. The costs in lost revenue, advertising penalties from the big retailers, and inventory holdings were enormous for every product that didn’t make it on time, in full.
Lead Time: How long does it take to deliver your service, product or project? The longer your lead times, the less responsive you are to changing market demands, and the higher your inventories and work in process. Furthermore, the longer your lead times, the bigger the penalty you place on your internal or external customers for having to work with you. By contrast, who wouldn’t want to change their mind in response to market conditions and work with suppliers capable of turning on that dime? If you can be that agile when your competitors cannot, that’s a source of competitive strength and enduring loyalty.
To properly understand lead time, we need to break it up into its components and see the end-to-end cycle from intention to delivery.
In supply chains, we measure the order lead time as the part of overall lead time accounting for the delay in turning a sale signal into a committed order. Imagine if you buy a bar of chocolate in a supermarket, and for that very bar, a purchase order is immediately raised on the supplier. It doesn’t have to wait for the fortnightly sales and operations planning meeting before collating a big batch of orders to place on the supplier. You’ve just saved yourself two weeks of order lead time, and thus reduced your overall lead time by those two weeks.
Next up, you might wait at the factory until you have a big enough collection of orders to run a big enough production batch to maintain low unit costs. This production lead time is another component of the overall lead time. Consider the trade-off between minimising unit production costs and delivering extraordinary agility from small batches and quick turnarounds. The implication for your customers is for them to meet their needs without having to invest in excess inventory. This feature of your offering could easily be converted into a higher price.
And of course, there’s always the temptation to wait until the truck or ship is full before you transport your goods. This transport lead time can also be reduced, giving the same potential benefits as all the other components of lead time. Ship smaller batches more frequently and think carefully about the trade-offs for throughput, cost and inventory—for both you and your customers.
“What prevents me from delivering my work in zero lead time?”
The same principles of lead time reduction apply in the world of projects. The faster we deliver, the less is invested in work in process, the less money we burn on project resources and the sooner benefits are realised. The quicker we can get to the toll gates, the quicker we can get to the end of the project. A delay in any phase could put the whole project in significant jeopardy. I recently witnessed a major project delayed by one month because it wasn’t ready for the investment review committee. The consequence was an entirely avoidable delay of an entire rainy season lasting six months.
Lead time can also be a lever for differentiated pricing. A simple example is an airline seat booking. Although the costs of carrying you are the same whenever you make your reservation, most airlines have differentiated pricing, depending on the lead time to departure. There are often commercial situations where the market has an expectation of lead time, and the price competition for delivering to that market-based expectation is quite ferocious. However, imagine if you had the means to offer your product or service at 60% of the industry norm for lead time—say, six weeks instead of ten? In many cases, you would be able to charge more for that expedited service based on your customer’s need to include it in their offer. After all, why not profit from their poor planning?
The whole idea of the Theory of Constraints is that we should always ask the seemingly absurd question: ‘What prevents me from delivering my work in zero lead time?’ Once we know the answer to that question, we are ready to understand the trade-offs between time and money. And, as we know, time is money and money time.
Quality: Dr W Edwards Deming made quality famous in the west with his System of Profound Knowledge. He is quoted as saying that ‘quality is pride of workmanship’. It’s the kind of pride that made Steve Jobs have the Macintosh team sign their names into the inside cover of the computer, knowing there was no way even a technician would get in there to see it. In a sense, their spirit of quality was etched into the product without anyone being able to see it.
“You cannot ‘quality check’ your way out of a bad system of quality management.”
For me, the simplest way of thinking about quality is to measure how much rework needs to be done. A badly made product must either be replaced with a new one or sent back to get fixed. Think of the cost in terms of customer frustration, let alone the tangible material and labour costs.
Deming taught us that the ultimate guarantee of quality is a function of the design of the system used to produce the product or service. He noted that you cannot ‘quality check’ your way out of a bad system of quality management.
That’s not to say that every product or service has to be of the very highest quality, in the sense that we might say it’s ‘the Rolls Royce’ of its type. In the same way we have a concept of just in time, we can also profitably have a concept of ‘just on quality’. This idea could be misconstrued to mean that a product or service is just good enough to get away with its otherwise inherent flaws. But this is not the case. Just on quality means that it is fit for purpose in its intended use, and one should avoid ‘gold plating’ when the additional effort delivers nothing beyond what the customer is willing to pay for.
Due Date Performance, Lead Time and Quality—three critical measures that can make a world of difference to your ability to deliver more throughput at a lower operating expense and off lower investment.
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What’s next?
The change to using Theory of Constraints (TOC) as an underlying operating system is both profound and exhilarating. We’ve developed the Systems Thinker Course to bring the ideas into your organisation.
[Background image: Three Telephones by Pavan Trikutam on Unsplash]
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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.

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