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Team Learning

David Hodes

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.

Are we communicating?

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?

A collegiate culture

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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Understanding the jobs healthcare professionals need to accomplish

David Hodes

Healthcare professional jobs to be done

A clinician checking a monitor is performing an action. The job may be detecting a meaningful change in the patient’s condition soon enough to respond appropriately. A specialist reviewing a report may be trying to decide whether an intervention is suitable, rather than simply consuming more information.

This distinction matters to medical device development. A product can make an action easier while leaving the clinical job difficult or creating additional work elsewhere.

Question 1.1.4 asks how well your organization understands the jobs healthcare professionals are trying to get done. A strong answer describes those jobs from their perspective and uses evidence to identify the outcomes they need to achieve.

“The job explains why the information matters and what must happen after the professional receives it.”

Define the clinical purpose behind the interaction

Begin with what the healthcare professional needs to accomplish. Depending on the role, this may involve recognizing risk, determining eligibility, delivering treatment, explaining options or evaluating outcomes.

Keep the job statement independent of a preferred product. “Review our dashboard” describes an interaction. “Determine whether the patient requires a change in care” describes clinical progress.

Define the context and boundaries. The work may differ across acute care, routine follow-up and home monitoring. A job that includes several independent clinical purposes may need to be separated into smaller, researchable scopes.

The team should be able to explain why the professional performs the work, what constitutes completion and who depends on the result.

Identify who performs each job

“HCP” covers professionals with different responsibilities, authority and expertise. A physician deciding on treatment, a nurse preparing a patient and a technician acquiring measurements may interact with the same device for different reasons.

Identify the job executor and the people who influence or support the work. Clarify who can make the relevant decision, who supplies necessary information and who acts on the result.

Do not assume that the purchaser, prescriber and daily user have the same needs. A product selected for one group’s convenience can introduce burdens for another.

Research each important perspective while retaining a clear account of the job under investigation. Differences across professional roles should inform the design rather than disappear into an average customer profile.

Study the work in its actual setting

Clinical research combines observation with empathy interviews. Applied to healthcare professionals, it examines clinical work where it happens.

Watch how professionals prepare, locate information, make decisions and respond to interruptions. Ask them to explain recent cases and the reasoning behind their actions.

Observe the tasks before and after device use. A procedure that looks efficient may depend on extensive preparation by another team. A report that looks clear may require a clinician to reconstruct its meaning from several systems.

Discuss observations with the people involved. Familiar workarounds may compensate for a missing capability. Understanding them helps distinguish a product preference from a need that governs successful completion of the job.

Separate current behavior from the desired outcome

Professionals often describe needs through the solution they know: another field, a different screen or a new report. These requests provide useful clues, but they still require interpretation.

An illustrative request for “all the data on one page” may reflect a need to establish whether enough information is available for a decision. The best response depends on the missing information, its relevance and the decision being supported.

Ask why the requested change matters. What uncertainty would it remove? What work would it reduce? What would the professional be able to accomplish more effectively?

Map the complete clinical job

Use the eight-step job framework to investigate the work surrounding the visible activity.

  1. Define. Establish the intended clinical result and the decision or action required.
  2. Locate. Obtain the evidence, equipment and resources needed.
  3. Prepare. Arrange the patient, environment and supporting work.
  4. Confirm. Verify readiness and determine whether proceeding is appropriate.
  5. Execute. Perform the assessment, procedure or other clinical activity.
  6. Monitor. Evaluate progress and recognize deviations from the intended result.
  7. Modify. Change the approach within the professional’s authority when necessary.
  8. Conclude. Document, communicate and prepare for the next episode of care.

Treat these steps as prompts for discovery. In practice, professionals may revisit information, pause a procedure or return to preparation. The map should preserve the dependencies that make the job possible.

“Preparation and follow-up are part of the clinical job even when they happen outside the product team’s field of view.”

Convert clinical experience into measurable needs

A desired outcome statement describes how the professional judges success. It identifies the direction of improvement, a measure, what is being controlled and the context in which it matters.

For example: “Minimize the time required to determine whether the information needed for an eligibility decision is complete.” Another might be: “Reduce the likelihood that a clinically significant change is missed during review of monitoring results.”

These are illustrative research statements, not claims of demonstrated product performance. They require validation with the professionals whose work they describe.

Avoid combining several outcomes into one statement. Speed, completeness and accuracy may all matter, but respondents need to evaluate each clearly. An outcome should also leave room for alternative ways of satisfying the need.

Preserve judgment and accountability

Clinical jobs involve interpretation and responsibility as well as information processing. Understanding the outcome does not establish that the product should take over the professional’s decision.

Clarify where the device supplies evidence, supports a task or performs a defined action. Examine what the professional needs to recognize limitations, handle exceptions and decide when additional expertise is required.

A design that reduces routine effort can introduce new review work or uncertainty. Research should capture these consequences alongside the intended benefit.

When professionals ask for greater confidence, determine what supports that confidence: appropriate evidence, clear limitations, interpretable results or a reliable escalation process. Design decisions should preserve the professional’s ability to act responsibly within the care setting.

Establish priorities through importance and satisfaction

Once qualitative research has produced clear outcomes, use quantitative research to determine their importance and how well current approaches satisfy them.

Ask professionals to rate the outcome itself, with a defined reference situation. Satisfaction should concern their current ability to complete the job, rather than whether they like a brand or presentation.

Include relevant variations in setting, experience and workload. The priorities of a high-volume specialist service may differ from those of a clinician who encounters the condition occasionally.

Opportunity assessment considers importance together with the gap between importance and satisfaction. It helps direct attention toward underserved outcomes. Apply consistent scales and interpret scores alongside the underlying evidence. Necessary safety requirements remain obligations even when survey respondents rank them differently.

Look for hidden differences between groups

Average scores can conceal important difficulties. A need may be well served for experienced users but poorly served for professionals without immediate specialist support.

Examine whether respondents cluster around different patterns of unmet outcomes. Investigate the circumstances that explain those patterns.

A group may struggle primarily to prepare the patient. Another may struggle to interpret results or coordinate follow-up. These differences can call for different product capabilities, training or service arrangements.

Bring clinical needs into the target product profile

A target product profile connects prioritized outcomes with the Voice of Technology and the Voice of Business in one shared definition. For healthcare professional jobs, this creates a shared view of what the solution must enable.

Technical assessment examines feasibility and readiness. Business assessment clarifies objectives, resources and implementation conditions. Clinical evidence and relevant requirements shape what can responsibly be promised.

Record the important outcomes, intended users and operating context. Identify the measures and evidence that will establish whether a concept improves the job.

Use the profile to guide tradeoffs. A feature that helps one professional may transfer work to another. The team needs to assess its effect on the complete clinical activity and the patient pathway.

Test concepts against the work they should improve

Concept evaluation should examine realistic tasks and scenarios with representative professionals. Ask what the proposed approach changes about their ability to achieve the priority outcomes.

Observe preparation, interpretation, exceptions and handover. Measure relevant effort or performance where the study supports it. Investigate whether support requirements make adoption practical in the intended setting.

A preference survey can identify an attractive concept, but it does not establish successful clinical use. Keep unresolved questions visible and plan the evidence needed to answer them.

Connect the results with the wider care system. The Theory of Constraints helps determine whether improving this job releases capacity or removes an obstacle governing patient progress.

“A useful concept improves an important clinical outcome of the job and remains practical within the system delivering care.”


What comes next

Examine one clinical job your solution supports. Can the team state its purpose, identify its executor and show which outcomes remain poorly served?

Observe the work, validate the outcome statements and measure priorities. Then test concepts against those outcomes and their effects on patient flow. That is how Patient Centered Design connects professional insight with better products and more dependable care.

READ MORE

  • MedTech

Understanding the Jobs Patients Need Doing

David Hodes

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.

  1. Define. Establish what the patient needs to achieve and the circumstances that matter.
  2. Locate. Establish how the patient will find the information, materials or support required, including your solution.
  3. Prepare. Uncover how the patient will arrange the environment and resources for the job to be done.
  4. 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.
  5. 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.
  6. Monitor. How will the patient assess and know for sure your solution is progressing successfully.
  7. 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.
  8. 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.

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