Culture | Operations | People | Process | Strategy
STAY CONNECTED AND SIGNUP TO RECEIVE INSIGHT updates
It pays to stand on the shoulders of giants, those who have come before and exposed eternal truths. You get to see further, you have a reference point to test your own understanding and insight and it gives you the confidence to continue, even when you are not sure of the ground you’re standing on. Their work is the compass you pull from your pocket when you’re not sure which direction to take.
Dr W Edwards Deming was a giant amongst the giants. He studied electrical engineering at undergraduate level, and mathematics and physics as a postgraduate. He worked as a statistician in the US Department of Agriculture and was a leader in the post-war reindustrialisation of Japan. Lean, Six Sigma and TOC all owe Dr Deming an enormous debt.
[Listen to audio version, read by David Hodes]
He managed to distil his life’s work into his System of Profound Knowledge, which incorporated in it his famous 14 points:
- Create constancy of purpose toward improvement of product and service, with the aim to become competitive and to stay in business, and to provide jobs.
- Adopt the new philosophy. We are in a new economic age. Western management must awaken to the challenge, must learn their responsibilities, and take on leadership for change.
- Cease dependence on inspection to achieve quality. Eliminate the need for inspection on a mass basis by building quality into the product in the first place.
- End the practice of awarding business on price alone; instead, minimize total cost by working with a single supplier for any one item, on a long-term relationship of loyalty and trust.
- Improve constantly and forever every process for planning, production and service.
- Institute training on the job.
- Institute leadership. The aim of supervision should be to help people and machines and gadgets do a better job.
- Drive out fear, so that everyone may work effectively for the company.
- Break down barriers between departments. People in research, design, sales, and production must work as a team, to foresee problems of production and in use that may be encountered with the product or service.
- Eliminate slogans, exhortations and targets for the workforce asking for zero defects and new levels of productivity.
- Eliminate numerical quotas for the workforce and numerical goals for management. Substitute leadership.
- Remove barriers that rob people of their right to pride of workmanship and eliminate the annual rating or merit system.
- Institute a vigorous program of education and self-improvement for everyone.
- Put everybody in the company to work to accomplish the transformation.
When I look at these fourteen points, I can’t think of a single organisation I have worked with which has successfully implemented all fourteen. I wonder what kind of workplaces we would create if we understood better what Deming was driving at. So long ago Deming articulated a path that encouraged me to pursue my ideal of Just Work. A way to frame the transformation that the 14 points calls for is Deming’s system of profound knowledge:
- Appreciation for a system
- Knowledge of variation
- Theory of knowledge (epistemology)
- The psychology of people, society and change
Let’s take each in their turn and recognise how such a seemingly simple construct can provide a pathway to transformation.
Appreciation for a system
Systems, by their nature, are complex. They are made up of parts but have a quality that makes them function in a way that none of the parts can on their own. Take a car, for example. You could lay out all the parts of a car on a workshop floor and not one of the pieces can get you from where you are to your destination—only the car can do that. A fundamental characteristic of a system is that the sum of the parts is never equal to the whole. And yet, when we examine systems, we will often get overwhelmed by the complexity and resort to trying to understand the whole by breaking it up and then looking at the parts. This is the reductionist approach to making sense of and trying to influence the world we live in.
We make an additional fundamental error when we consider our systems—be they of education, business, government, health or any number of others. We have emerged from the mechanical age and tend to ignore the distinction between living and non-living systems. How often do executives and managers talk about driving change? As if the system they are looking to influence were a machine. When non-living systems, such as software programs, bicycles and steam turbines are broken, we fix them. Bugs are reprogrammed, chains are fixed and bearings are replaced. Living systems, though, are complex and adaptive. In our free society, if your boss is tyrannical, you can leave; if I lose my sight, my other senses will attenuate to mitigate the effect; if a meteor hits the earth and the dinosaurs disappear, the conditions arise for the human experiment.
‘Systems are perfectly designed to give the results we get’
With our anthropocentric view of life, we often forget that we are a part of that ecosystem of nature which made it possible for us to be here in the first place. We’ll tend to think that we have an existence which dwells in independent, disembodied thought and forget that we are bound by the same time and space in which all of this good earth dwells. We should constantly practice lifting our awareness of the axiom that systems are perfectly designed to give the results we get. Such awareness should encourage us to take a humbler stance towards the challenges we face, acknowledge the progress we have accomplished so far and understand that if ever we are going to solve our most pressing problems it cannot be other than through a profound appreciation for and primacy of the whole.
Knowledge of variation
Our very existence depends on variation. No random mutation of genes, no evolution and no human beings. But, we needn’t go so far. Deming was referring to the context of business and the economy. How can we hope to get better and better quality if we don’t know how to understand variation? In Deming’s world, he talked of two different types of variation: common cause and special cause.
Common cause variation occurs as an intrinsic part of the system being examined. If I have a jig which saws steel at a tolerance of 1mm, then I can expect that all the measurements of my cut pieces of steel will be within 1mm. He and his thinking partner from Bell Telephone Labs, Walter Shewhart, developed and popularised the idea of statistical process control and taught the world how to use control charts to routinely improve quality. He was quite adamant that poor quality could not be ‘inspected out’ but could only truly be remedied through improving the system responsible for the outputs.
Special cause variation is that which cannot be accounted for by the system’s daily operations. If my production target is 1,000 steel bars, each to a tolerance of 1mm, but the bearings on my saw seize because someone forgot to lubricate them, I cannot say that the production loss for the day was a part of common cause variation.
Goldratt, with his Theory of Constraints, built on the work of Deming and Shewhart, among others, when creating his production system Drum Buffer Rope and his project management system, Critical Chain. Common to both methods is a profound understanding of statistical phenomena such as covariance (the effect of fluctuations on dependent events) and the central limit theorem (the law of large numbers and the power of aggregation).
Theory of knowledge (epistemology)
How do we know what we know? The simple beauty of a sunset is in fact the earth rotating. If you mix the two deadly elements of sodium and chlorine, you get the indispensable condiment of salt. And if the foetus you carry has x and y chromosomes, congratulations! You’re having a boy. Galileo, often referred to as the first scientist, presaged the enlightenment and its adoption of reason as the basis of expanding our knowledge. The scientific method tells us to ask a question, do background research, construct a hypothesis, test our hypothesis by doing an experiment, analyse the data and draw a conclusion and then share our results.
Deming and Shewhart distilled this scientific method down further with their Plan-Do-Study- Act (often misrepresented as Plan-Do-Check-Act). You plan what you are going to do, you do it, you study the results against what your hypothesis said would be the outcome, and then you act according to that new knowledge. This is the heart of the empirical method of advancing knowledge and stimulating progress. As evidence of progress, how vastly superior are even our least expensive cars today in terms of comfort, safety and economy than those Deming was helping perfect in the fabled Toyota production lines?
‘Having a theory of knowledge allows us
to make predictions of the world around us’
What are other ways of knowing what we know? We can apply our powers of reason: think deductively and you take a known fact and, through the application of logic, arrive at another known fact. This is what we do when, for example, we apply our minds to the puzzles of algebra. Alternatively, we can think inductively: we see a pattern of observable phenomena and create a model for how we think the pattern might evolve. Complex modelling of the effects on climate of putting ever increasing amounts of carbon into the air is one such example. Deming argued that having a theory of knowledge allows us to make predictions of the world around us and actively shape our future rather than merely reacting to events.
But reason and logic alone are not the only ways we come to know what we know. The psychologist Jonathan Haidt uses the metaphor of an elephant and its rider to understand how we make decisions. The rider is our conscious mind, with which we make sense of the world around us and use our reasoning faculties to do everything from knowing when to cross the road to developing a business strategy. The elephant however is the unconscious mind. ‘Like the rider on the back of the elephant,’ writes Haidt, ‘the conscious, reasoning part of the mind has only limited control of what the elephant does.’
The unconscious mind is the home of emotion, justice, courage and love. How do we know those virtues? How do the poet and the artist come to share their knowing with the rest of us? What theory of knowledge will prise open those secrets? Can musicology ever trump music?
Of course, you could argue we’ve already crossed over from epistemology to psychology. Which is entirely appropriate as Deming insisted these four parts were indivisible.
The psychology of people, society and change
According to the Cambridge English dictionary, psyche means the mind, or the deepest thoughts, feelings or beliefs of a person or group. You cannot hope to transform a system such as a business without a deep appreciation of how the human mind works. Since the pioneering days of Freud, Jung and Alfred Adler, we have come an incredibly long way in understanding intellect, temperament, behaviour and motivation. Deming implores us to drive out fear and remove barriers that rob people of pride of workmanship and eliminate the annual rating or merit system. I find it difficult not to be moved by Deming’s unswerving belief in the worker’s desire, given the opportunity, to do what is noble and dignified. Driving out fear is the precondition of learning, experimenting and ultimately of innovation.
And if we talk about society, what kind of society offers the best chance of increasing prosperity? We ignore the hard-won freedoms of our civilisation at our peril. Freedoms that include free speech, free enterprise, and freedom of association, all under a rule of law that prevents the arbitrary exercise of state power. If you think the business of free speech isn’t an issue for business, have a look at the world’s most successful hedge fund run by Ray Dalio and the way how, as he describes in his book Principles, he has inculcated into everything he does at Bridgewater the propelling question ‘How do I know I’m right?’ Or read in the book One Mission about the radical transparency that General Stanley McChrystal brought to his victorious fight against Al Qaeda in Iraq.
Then there is the perplexing issue of change. Most of us are at our best when we find ourselves surfing the boundary between what is old, known and ordered and what is new, unknown and chaotic (or at least unstructured). Too much order and we become sclerotic. Lots of rules and regulations, but no clean, fresh air to breathe. At best, it’s soporific; at worst, tyrannical. Without discipline, however, life becomes chaotic—at best merely a dream, and at worst a nihilistic nightmare. To live our most fully expressed life, we must search within for the seat of the dynamo – that place which perfectly couples the power of intention with the discipline of the will.
Deming allows us to stand on his shoulders. His insights remind me of eternal truths which talk across all ages in the same way that philosophers since Socrates have done for these thousands of years. It pays to pause from time to time and enjoy the view. Then let’s get back to work inspired by what’s possible.
____________________________
What’s next?
The change from standard thinking to Theory of Constraints (TOC) is both profound and exhilarating. To make it both fun and memorable, we use a business simulation we call The Right Stuff Workshop.
We’d love to run it with you. To learn more:
- download the brochure (no email required)
- schedule a call
____________________________
[Background photo by Elena Taranenko on Unsplash]“Learning is not compulsory…
neither is survival.”—Dr W Edwards Deming____________________________
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.
The healthcare professional: a hidden constraint in patient flow
A healthcare professional can recognize the value of a medical device and still struggle to incorporate it into care. The referral may be incomplete. Diagnostic evidence may arrive late. Preparation may require extra staff. Follow-up may introduce work that nobody has agreed to own. Managing the patients before and after may require additional staff which adds risk to the business side of the practice.
Those difficulties affect the clinician’s ability to help patients reach and benefit from your solution. They deserve attention during development and throughout deployment.
The purpose is to understand how professionals encounter, assess, recommend and use a solution, and what constraints they encounter in using your solution.
A useful map connects the professional’s experience with patient flow. It helps the organization identify where support, coordination or design changes can improve the delivery of care.
“Clinical enthusiasm cannot create the time, information or supporting capacity needed to deliver a therapy.”
Identify the professionals who shape the pathway
Healthcare professionals perform different jobs at different stages. A referring practitioner, diagnostic specialist, interventional physician, nurse and educator may all influence whether the same patient receives successful care.
Define which groups participate in your pathway and what each contributes. Who recognizes the need? Who establishes eligibility? Who performs the procedure? Who trains the patient? Who monitors outcomes and manages exceptions? Who manages insurance?
Include people whose work makes these actions possible. Coordinators, technicians and administrative staff may arrange appointments, prepare equipment or assemble records. Their contribution can govern whether clinical time is used effectively.
The map should make dependencies visible across roles. It should also clarify which actions fall within your organization’s influence and which require collaboration with care providers or other affected parties.
Distinguish roles from personas
A professional title tells you part of the story. Experience, setting, case volume, access to support, business acumen and familiarity with the therapy can change the work considerably.
An experienced specialist in a well-supported center may encounter different difficulties from a clinician who sees the condition infrequently or works in a rural area. A nurse coordinating a dedicated service may have options unavailable to someone balancing that responsibility with other duties.
Develop personas around these differences. Examine confidence in interpreting evidence, decision authority, available time, training needs and exposure to clinical or organizational risk.
Use research to test the distinctions. Personas should explain variations in behavior and requirements. They should help the team understand why an approach that works in one setting may fail to support another.
Map the journey from first awareness to continuing care
The professional’s journey may begin with awareness of an unmet clinical need or information about a potential solution. It continues through evaluating evidence, discussing alternatives and deciding whether the therapy belongs in their practice.
Adoption can involve local approvals, purchasing, training, changes to referral patterns and coordination with other teams. Clinical use then includes preparation, treatment, documentation, handover and follow-up.
Map these activities without assuming a single linear sequence. Professionals may return to evidence review after a difficult case or revise their approach when colleagues raise concerns.
Distinguish the journey of adopting the therapy from the recurring journey of delivering it to each patient. Both matter, but the barriers and improvement measures can differ.
Capture decisions and dependencies
At each stage, ask what the professional is trying to accomplish and what must be available before the work can proceed.
A decision may depend on diagnostic results, a complete patient history, clear eligibility criteria or advice from another specialty. A procedure may depend on staff, equipment and an appropriate location. Follow-up may depend on information that must be captured earlier.
Show the handovers between roles, including who supplies information and who receives it. Record where uncertainty is resolved and where work is repeated.
This reveals how a product can add burden beyond its immediate interaction. A useful output may still consume scarce clinical time if the professional must retrieve, interpret, reformat and document it through separate systems.
Measure the work and the waiting
The time required for a clinical activity can differ greatly from the time a patient waits to receive it. Both belong on the map.
Measure preparation, clinical work, documentation and recovery from problems where relevant. Record queues, appointment delays and time lost waiting for missing information.
Distinguish professional effort from elapsed time. Some delays consume little active attention but prevent patients progressing. Others require repeated chasing, rescheduling or explanation, drawing capacity away from care.
Define a common unit of work so comparisons remain meaningful. Cases with different complexity may require different analysis. Averages alone can hide the patients or professionals who face the greatest difficulty.
The purpose is to understand usable capacity and patient progress in the actual working environment.
Find the capacity that governs patient flow
A pathway may depend on a small amount of specialist attention surrounded by many competing demands. Headcount alone will not show how much of that attention is available.
Examine what professionals spend their time on, including avoidable administration, repeated assessments and interruptions. Determine whether the relevant constraint is clinical expertise, supporting staff, diagnostic access, equipment or a policy governing work.
The Theory of Constraints helps focus improvement on the factor limiting the whole pathway. Increasing referrals to a service already unable to process them can lengthen waiting without increasing treatment.
Investigate the apparent bottleneck before choosing a response. Better preparation or coordination may release capacity. In other cases, additional resources or changes to the operating model will be necessary.
“The measure of a design improvement is its effect on clinical work and patient progress, including the work it creates elsewhere.”
Observe clinical work at the Gemba
The Gemba is where the work actually happens. Direct observation helps teams understand how professionals use information, equipment and judgment under real conditions.
Observe preparation, interruptions, handovers and the work following the visible procedure. Ask what the professional expected to receive and what they had to obtain independently. Capture workarounds and job “cheat sheets” that are homemade to make working with your solution easier.
Workarounds deserve particular attention. A clinician may keep a private checklist because the formal process omits an important step. A coordinator may repeatedly contact another service because information arrives inconsistently.
These practices reveal requirements that interviews alone may miss. Discuss observations with the people involved so the team does not mistake an isolated event for a routine pattern. Include different settings and experience levels in the research.
Build the baseline from several sources
Gather organizational knowledge and assess technology and business perspectives before moving toward a solution. Apply that discipline to the professional journey.
Use existing clinical insight, training questions, support records and prior implementation experience to draft the map. Identify assumptions and gaps.
Assess the technologies already supporting the work. Consider compatibility with the environment, availability, maintenance, reliability and the practical resources needed for use.
Clarify the business conditions surrounding adoption. Purchasing arrangements, competing initiatives, staffing decisions and local policies may determine whether a clinically attractive solution can be implemented.
This baseline makes research more focused. It also prevents the development team from proposing changes that depend on unavailable capability or unacknowledged commitments from others.
Involve the people who can enable change
Voice of Business research asks leaders about desired outcomes, frustrations, risks and obstacles. It also identifies decision makers and influencers who should participate early.
For a healthcare professional pathway, this means understanding who can authorize changes to responsibilities, processes, resources and technology.
Ask which other initiatives could affect implementation. Identify the independent reviewers who can challenge the team’s assumptions. Agree what success will look like from the perspective of clinical work and patient outcomes.
Make the findings visible to the team members and relevant leaders. A professional may welcome a new approach while lacking the authority to secure the resources it requires. The project needs a realistic route from individual support to organizational adoption.
Use FOCUS to improve the journey
Apply the five-step FOCUS process to the evidence gathered through mapping.
Find the constraint. Identify the activity or resource currently governing the flow of suitable patients through care.
Optimize for it. Protect scarce capacity from incomplete information, unnecessary preparation, avoidable interruptions and repeat work.
Collaborate around it. Coordinate upstream and downstream roles so patients, information and resources arrive when needed.
Uplift it. Add capability or change responsibilities, processes and technology when existing capacity cannot meet the need.
Start Again. Review the pathway after improvement and identify its new limiting factor.
Automation can help when the task is understood and the proposed change supports clinical work. Evaluate its consequences, including review effort, exception handling and any burden transferred to another professional.
Turn the map into a shared improvement plan
The map should lead to a manageable set of changes with clear owners and measures. Test those changes in relevant settings and examine their effect on both professional effort and patient progress.
A Value Management Office can connect the initiatives with priorities, resources and project decisions. Clinical teams and other participants must remain involved in judging whether the changes improve work in practice.
“An effective professional journey supports a clinician through the complete job, from readiness to follow-up.”
What comes next
Use the healthcare professional journey to examine one priority pathway. Can your team explain who performs the work, where capacity is lost and what currently limits patient progress?
Build the map with the professionals involved. Establish the baseline, test an improvement at the constraint and review the result. Patient Centered Design advances when the solution and the surrounding system make beneficial care easier to deliver reliably.
“`
