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The U Journey: Crystallise Intent

David Hodes

Not long before I did my solo retreat in nature, I took part in a visioning exercise. The facilitator invited us to sit in our chairs, close our eyes and forget the rest of the group. He asked us to transport ourselves—alone in our chair—to a beautiful meadow, surrounded by mountains and forests, with a stream running through it.

As we heard the burbling stream and inhaled the crisp mountain air, he described a boundary on one side—a dry-stone wall with a country gate leading out of the meadow. When our scene was vivid enough, he asked us in our mind’s eye to rise from the chair and walk slowly but confidently through the gate. We were told we’d now crossed a threshold and were our future selves looking back on the person sitting in that chair. What did we see? What did we have to say to that person? What was our intent as we crossed the threshold?

[Listen to audio version, read by David Hodes]

This is Part 7 of our series on The U Journey: Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8

When you engage deeply with the U Journey process, you emerge from that time alone revitalised, strong and confident. You have a powerful vision which pulls you forward and you’ve let the old self die for the birth of the new. The alone time in nature is an exercise in scattering seeds across a fertile field, and though you don’t know what will germinate when, you feel confident in the deep knowing you have of the future you’re ready to will into being.

You’ve had the opportunity to think and feel deeply about your learning journeys and have synthesised their lessons into a more complete picture of how you will act to create meaningful change in the world. The natural anxiety you feel about having to lead yourself and others into a brave new future is tempered by the sense of mission you have about your life. In the words of Zig Ziglar, you have found your way to become a meaningful specific rather than a wondering generality.

“You’ve let the old self die for the birth of the new”

It’s a wonderful time to bring your whole being into the world, confident that you have explored yourself more deeply than you might ever have thought possible. From your learning journeys—including your visits to other organisations—you have come to really understand what it takes to be your best and to inspire your team to do likewise. There’s a particular potency that emanates from anyone who is being fair dinkum about what they are trying to bring into the world, and you become that kind of attractor to your boss, peers and subordinates. As you access the silent stillness you explored when alone, you can instantly bring that state of being into whatever it is you’re doing. You are forthright without being dogmatic, committed without being attached. You have stored in your way of being a key to a calmer, more deliberative and compassionate sense of self.

The journey so far
There are many lessons you have learned in the months prior to your journey to the bottom of the U. How important it is to have all the resources necessary to do the job: human, material, financial and informational. You understand the fundamental need for effective communications and an operational cadence suited to the nature of the work at hand. You feel more acutely the need to build effective, high-performing teams who develop trust through integrity, shared intent, the development of specific capabilities and the reinforcing virtue of stellar results.

You know that people work better when they have a sound structure, predicated on an aligned vision and a clear understanding not only of roles and responsibilities but, importantly, how work is to be effectively conducted across the functional silos. You know what it takes to build this requisite accountability hierarchy and the importance of matching what you are asking others to do with the authority you give them over the resources they require to deliver the desired outcome. You know of the importance of developing camaraderie and the capacity we all have to put aside our egos and work for each other to achieve something much bigger than any of us could achieve on our own.

You’ve heard the mantra ‘plan the work then work the plan’ many times, but you feel connected to the idea in a new way. It is the means by which you bring your vision into the world. It’s the way you get to answer the question: ‘What does the world call on me to do?’ You want to develop a stable team so your vision has the best chance of being developed, extended and strengthened through the participation of others. Yours is the spirit that transforms the cynics and the tyrants—or at least holds them at bay whilst you create an opening in which those committed to more visionary action have the chance to exercise their will.

“You no longer see yourself as a cog in the wheel of the mechanical construct…but understand in a profound way what it means to be part of a more deeply connected whole”

You know that measurement drives behaviour and you move confidently to articulate systems-based metrics which look to optimise the whole rather than strangling progress on the false promise of local efficiencies. Measurement is there to help you understand where you are and not to provide a reason to persecute those trying to deliver an outcome. You and your team have skin in the game, not because there is a financial reward for what you are doing but because you’re so deeply committed to being the change you want to see in the world. That you may get rewarded anyway is just an added and sweet bonus, not your primary motivator.

Ready to commit to change
More than anything, you understand how the organisation as a whole needs to understand and be engaged in what you are setting out to change. You no longer see yourself as a cog in the wheel of the mechanical construct of a project but understand in a profound way what it means to be part of a more deeply connected whole. In the words of the cognitive psychologist, Eleanor Rosch, as quoted in the book Presence:

In the ‘analytic picture offered by the cognitive sciences, the world consists of separate objects and states of affairs, the human mind is a determinate machine which, in order to know, isolates and identifies those objects and events, finds the simplest possible predictive contingencies between them, stores the results through time in memory, relates the items in memory to each other such that they form a coherent but indirect representation of the world and oneself, and retrieves those representations in order to fulfil the only originating value, which is to survive and reproduce in an evolutionary successful manner’.

By contrast, ‘primary knowing’ arises by means of ‘interconnected wholes, rather than isolated contingent parts and by means of timeless, direct, presentation’ rather than through stored ‘re-presentation’. Such knowing is open rather than determinate, and a sense of unconditional value, rather than conditional usefulness, is an inherent part of the act of knowing itself. Acting from such awareness is spontaneous, rather than the result of decision making, and it is compassionate…since it is based on wholes larger than the self.

The visioning exercise that began this article was one of the few occasions I found myself in a lucid dream that I remember to this day. When I saw myself sitting in that chair, I was wearing a cape. The cape was made of a kind of thick black linen and had stitched onto it pieces of earth-coloured ceramics in the shape of inch-long, two-dimensional diamonds. They were the most exquisite rustic colours, with a depth of texture I had never seen in reality. These were the living, earthy colours of the valley I sat in. But there was something missing. The pattern on the cape was incomplete—only something like a third of it was covered in the ceramic diamonds. I have no idea how I intuited what that dream was telling me, but I instantly knew the story.

It was talking about me and my incompleteness. I had until then always looked outside myself for those virtues best described as deeply humanist. As an engineer, I thought I could make powerful connections through the use of reason—those were the pieces already on the cape—and it would be up to others trained in the world of sentiment to complete the garment for me. However, I realised only I could make myself whole. I would have to let go of that safe engineer’s place and venture into the unknown. I, and no other, would have to risk looking stupid in my quest to find the missing pieces and make the cape complete.

My immersion in nature gave me the will to find those qualities within myself to be the whole person—just as I was on the day I was born. My intent was crystallised, and I knew that I could no longer dodge my destiny. The world, it now appeared, was made up of indissoluble wholes and I could step courageously into being the person wearing the completed cape. That sense of purpose inspires me to this day.

____________________________

This article is Part 7 of our series on The U Journey.

Part 1: How to change: Introducing Theory U
Part 2: Preparing for the Foundation Workshop
Part 3: Running the Foundation Workshop
Part 4: Stepping into Design
Part 5: Wisdom from outside your domain
Part 6: Retreat and Reflect
Part 7: Crystallise Intent
Part 8: Deliver

____________________________

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

    ____________________________

    “Whether you believe you can do a thing or not,
    you are right.”—Henry Ford

    ____________________________

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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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