STAY CONNECTED AND SIGNUP TO RECEIVE INSIGHT updates
If you have the courage not to start a task until you are confident you have all you need to finish it, you and your organisation will be more productive. To validate that assertion, we have to unpack the concept.
[ Listen to audio version, read by David Hodes]
This is part 2 of the series. For more on this, see Part 1 | Part 3 | Part 4 | Part 5
We can start with what we mean by a task. The late great maven of work management, Elliott Jaques, defined a task as: ‘An assignment to produce specified output (including quantity and quality) within a targeted completion time, with allocated resources and within specified limits (policies, procedures, etc)’.
Let’s look first at the full kit challenge from the perspective of an operator. For a reasonably routine activity such as maintaining a piece of mechanical equipment, it’s not so difficult to understand what fully kitted could mean. We start with a schedule of the work scope. That scope would define the resource types required to acquit the task; say, perhaps, a fitter and a rigger.
We need the named qualified people to do the work at the time and place demanded by the schedule. They would need the instructions around how to get it done, including safety requirements. There would be requisitions for the parts necessary to complete the task, as well as any tooling and equipment. And, we’d need Operations to agree to isolate and turn over the equipment for maintenance at the given time and place.
We’ve done a good job of full kitting if we hand over a comprehensive list enabling the task to be completed, uninterrupted from beginning to end. Even better would be to identify the risks of what might go wrong—anticipating, say, a part that’s not due for service, but which often shows signs of wear and tear on inspection, thus demanding a replacement. Carrying that part along can save expensive downtime for the crew as they wait for the expediting of an ad hoc requisition.
Moving up the chain, we come to the work of the supervisor, who could be servicing several crews. What might full kitting look like for them? For a start, they will be looking into a deeper horizon than the operators. Let’s suppose they are planning for the week ahead while the operators execute this week’s plan. The supervisor’s full kitting might involve a review of all the work orders that fit into the planning horizon.
“How do we repeatedly do what we’ve been tasked with to
an agreeable standard, in a safe manner, productively?”
Has all the work been captured? Is he confident that all of the bills of material and task lists have been updated according to the feedback received from the last time they did those jobs? He will examine the rosters and look at who’s on leave, whose qualifications are expiring and where there are likely to be overs and unders on staffing. He’ll have to liaise with operations, and sometimes do that across two or more departments to ensure their commitment to coordinating operations and maintenance activities for the upcoming tasks. He’ll be liaising with Supply to ensure all the necessary paperwork is in place for the provision of parts and equipment. If he predicts clashes for scarce items, or long lead times for parts, he’ll have to factor this into his calculations.
The manager will have a whole area to full kit, before executing. Her time horizon will be deeper again than those of her subordinates. She will consult the budget and look where she can either increase throughput or save costs. She will review the ontime performance of the tasks across different periods in the past to understand what she can reasonably expect to set as team goals. She would be closely examining the reasons for previous delays such as materials shortages, missing work instructions, people failing to turn up to work, safety incidents and the like.
She’ll review the data on how much wrench time was used to perform the tasks against the time standards recorded in the maintenance system. She will take time to think about how her team might change the way they work to be more reliably productive, and thus reduce disruption to operations to a minimum. She will want to understand how communication and collaboration can be better managed across the business silos and will participate in an integrated planning review.
What might full kitting look like for the executive, say the VP of Operations? As he plans the work for the medium horizon of the business, he would want to know how best to deliver on his mandate of safety, volume and costs. He’ll be reflecting on his operating philosophy and thinking deeply about setting the goal and, in turn, what constraints prevent him from achieving it. What operating philosophy, he muses, could best inform his sense- and decision-making? He’ll be thinking about his grand vision and how best to communicate it in an inspiring but pragmatic way. Which initiatives are going to get funded, and what business case supports those decisions?
What changes to the organisational design will help deliver clarity on accountability and allow the chain of subordinates the resources they require to manage their work effectively? What learning initiatives need support so he can equip all levels of the workforce to be innovative and build an engine that perpetually converts knowledge into additional value? All the while, he’ll be mindful of the impact of his interventions on organisational culture. He’ll be designing initiatives which enhance internal cohesion between all the parts of the business while simultaneously increasing the capacity for adaptation to external changes in the marketplace.
As you read through the list of items, perhaps you thought of additional activities each of the four personas could undertake. No doubt you could, but that was not the point of listing them. What I’d like you to reflect on is when you look at your work, do you have a means by which you break that work down into its component parts? For the truth is that the prerequisite to being fully kitted is to have a plan.
So, we might extend the fabled mantra of ‘plan the work, work the plan’ to: ‘plan the work—fullkit the plan—work the plan’. And if we take a step back to see the work behind the work of planning the work, we ought to be thinking about what full kitting for the act of planning might involve. For example, carving out flow time; assembling all the documents, reports, and analysis required to be ready to go into a state of deep work; thinking ahead to what kind of desk research may be necessary; and creating a list of hyperlinks to the relevant online resources you’re likely to need.
Regardless of the level of our job, we all have heuristics, or rules of thumb, which have proven good enough to tame the mystery of how work gets done. The deeper we go into the knowledge economy, though, the more we find ourselves overwhelmed by the need to keep abreast of the know-how required to be effective in our jobs. Not only is the work we are asked to undertake increasingly complex, but there is the additional complicating factor of the ever-growing interdependencies through all the internal and external links of the value chain.
“Think how much more productively you could deal with a Murphy event, if everything else is under control”
So, how do we repeatedly do what we’ve been tasked with to an agreeable standard, in a safe manner, productively? As far as is reasonable—and in most cases, that’s pretty far—we must make a conscious effort to turn the heuristics into algorithms. The easiest way to make what we tacitly understand when we prepare to commence a task into an explicit set of instructions is to develop checklists.
In other words, being fully kitted means ensuring your checklist is complete before you commence the task. There will always be the case where the unknown-unknowns will run interference with your best-laid plans. But, is that a valid reason to avoid the effort required to work fully kitted? Think how much more productively you could deal with a Murphy event, if everything else is under control.
If you have the courage not to start a task until you are confident you have all you need to finish it, you and your organisation will be more productive. I rest my case.
____________________________
This article is part of our series: Five commandments for high-performance execution
Part 1: Maintain True Data
Part 2: Work Fully Kitted
Part 3: Control Work Release
Part 4: Resolve Issues Rapidly
Part 5: Act by Priority
____________________________
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:

[Background image: Parts of Canon Camera, Vadim Sherbakov on Unsplash]
____________________________
Healthcare professionals are central to the patient’s progress from awareness of a therapy to successful long-term use. They identify risk, interpret evidence, diagnose conditions, discuss options, perform procedures, provide training and monitor outcomes.
Yet many medical device development programs treat healthcare professionals primarily as users to be trained or customers to be persuaded.
HCP-Centered Design takes a wider view. It examines the work healthcare professionals must perform, the system in which they perform it and the constraints that limit their ability to move suitable patients through the care pathway.
“If patient flow depends on a healthcare professional, that professional’s available capacity may determine how many patients ultimately receive the therapy.”
A medical device patient journey commonly depends on several healthcare professionals:
Each professional governs a transition in the flow of patients.
If one transition lacks sufficient capacity, information or clarity, the whole pathway slows. More marketing, sales activity or production capacity will not compensate for a shortage of specialist time or a burdensome diagnostic process.
This is why HCP-Centered Design is not simply about making an interface easier to use. It is about enabling the system of care to perform.
A healthcare professional’s work depends on information and actions supplied by others. They may rely on referrals, patient histories, pathology, imaging, electronic records, clinical guidelines and the availability of equipment or trained colleagues.
After reaching a decision, they may need to explain it, document it, arrange authorization, coordinate treatment and prepare the next person in the pathway.
A technically strong solution can still create difficulty if it:
The relevant design question is not merely, “Can the HCP use this product?”
It is, “Does this solution improve the HCP’s ability to complete important clinical work within the conditions in which care is actually delivered?”
“HCP” is not one persona.
A general practitioner, specialist, interventional physician, nurse, technician and clinical administrator encounter different stages of the pathway. Each has different responsibilities, authority, expertise and exposure to risk.
Even within a profession, context matters. An experienced specialist in a major hospital may approach the same task differently from a professional who encounters the condition infrequently or works without immediate specialist support.
Useful HCP personas distinguish factors that influence work:
These personas clarify who performs each job and what support each person requires.
The HCP journey often begins before the visible clinical procedure.
It may include receiving a referral, gathering information, forming an initial view, ordering investigations, interpreting results, deciding whether the patient is eligible, discussing treatment, obtaining authorization, preparing for the procedure, delivering care and arranging follow-up.
At each stage, ask:
The resulting journey map should distinguish processing time from waiting time. A decision may require only minutes of specialist attention while patients wait weeks to access that attention.
This reveals the practical relationship between HCP capacity and patient flow.
The Theory of Constraints directs attention to the factor limiting the performance of the entire system.
In some pathways, the constraint may be the number of qualified interventional specialists. In others, it may be diagnostic capacity, physician confidence, authorization effort, operating room access or the time required to train patients.
The constraint may also be hidden inside the HCP’s working day.
A specialist supporting a therapy must still manage other clinical duties, administration, meetings, documentation and urgent cases. The question is not simply how many specialists exist. It is how much of their usable capacity is available for the activities upon which patient flow depends.
“The scarcest resource may not be the healthcare professional. It may be the few hours of focused capacity available for the critical work.”
Improvement away from this constraint can make performance worse. Sending more referrals to an already overloaded specialist increases the queue. Adding information may increase cognitive burden. Creating another approval may consume the capacity required to treat patients.
HCP-Centered Design seeks to protect and expand the capacity that governs flow.
Policies and procedures describe how clinical work should happen. Observation reveals how it actually happens.
Healthcare professionals routinely compensate for missing information, awkward interfaces and unreliable handovers. These workarounds may become so familiar that nobody reports them as problems.
Gemba research should examine:
The purpose is not to judge the healthcare professional. It is to understand the system surrounding the work.
“A workaround is often evidence that the system has failed to support the person doing the work.”
Healthcare professionals do not simply use devices. They use them to make progress in clinical work.
An HCP may need to identify risk, reach a confident diagnosis, select an intervention, perform a procedure safely, explain options, monitor progress or recognize deterioration.
A structured job map divides this work into eight stages:
This wider view prevents the product team from concentrating exclusively on the procedure.
The greatest value may come from reducing preparation, improving decision confidence, clarifying an exception, simplifying documentation or improving the handover to follow-up care.
Comments such as “the interface is difficult” or “we need better information” indicate dissatisfaction, but do not provide sufficient direction for design.
They should be translated into measurable outcome statements, such as:
“Minimize the time required to identify which clinical information is missing before making a treatment decision.”
Or:
“Reduce the likelihood that a clinically significant change goes unrecognized between scheduled reviews.”
A broader population of healthcare professionals can then assess the importance of each outcome and their satisfaction with their current ability to achieve it.
Highly important and poorly satisfied outcomes provide a rational basis for prioritizing innovation.
“Adoption follows when a solution makes important clinical work safer, clearer or easier to complete.”
The five-step FOCUS process creates a practical improvement cycle.
Find the constraint. Determine which HCP activity or resource currently limits patient flow.
Optimise for it. Protect the constraint from avoidable work, missing information, interruptions and rework.
Collaborate around it. Align upstream and downstream teams so patients, information and resources arrive when required.
Uplift it. Add capacity, redesign responsibilities, improve technology or remove restrictive policies.
Start Again. Identify the new constraint once flow improves.
This approach allows the organization to distinguish activity from value. It also turns HCP engagement into an ongoing management discipline.
HCP-Centered Design must connect clinical reality with patient needs, technology, regulation and business strategy.
A Value Management Office can help coordinate these perspectives across the product lifecycle. Its role is to ensure that projects, resources and stage-gate decisions remain connected to patient flow and business value.
The organization should be able to show:
The goal is not simply a device that healthcare professionals can operate. It is a solution they can confidently incorporate into care and a delivery system capable of getting that solution to more patients.
Use the HCP-Centered Design assessment to determine how well your organization understands clinical work, HCP capacity and the constraints governing patient flow.
The resulting evidence should guide product design, process improvement and investment toward better products, delivered faster, with more lives changed for good.
Medical device companies devote enormous skill and investment to developing safe, effective products. Yet a technically successful device changes no lives while suitable patients remain unable to reach it.
Between a patient becoming aware of a therapy and receiving its intended benefit lies a pathway of referrals, consultations, diagnostics, approvals, procedures, training and follow-up. Every step consumes time. Between the steps, patients wait. At some points, they become confused, discouraged, ineligible or lost to the process.
Patient Centered Design must therefore address more than the design of the device. It must improve the performance of the entire system through which patients reach, receive and live successfully with the solution.
“A life-changing therapy changes no lives while patients remain trapped in the pathway leading to it.”
A typical medical device journey may include:
Companies often manage these stages as separate functions. Marketing works on awareness. Medical affairs supports clinicians. Market access addresses reimbursement. Sales works with specialists. Clinical teams gather evidence. Training teams support adoption.
The patient, however, experiences one journey.
From the patient’s perspective, a delay between two organizational functions remains a delay. A repeated test remains repeated work. An unclear handover creates uncertainty regardless of which department owns it.
Patient Centered Design begins when the organization sees and manages this journey as a connected system.
Every step contains some necessary processing time. A consultation takes time. A diagnostic test takes time. An authorization must be assessed. A procedure must be performed.
The patient’s total lead time, however, also includes the waiting between these activities.
A consultation may take 30 minutes, but the patient could wait six weeks for it. A diagnostic test may take an hour, followed by another delay before a specialist reviews the result. Prior authorization may require little actual work while adding weeks to the pathway.
This distinction matters because organizations often improve processing time while leaving the larger queues untouched. Saving five minutes during an appointment produces little benefit if the patient waits months to reach it.
Patient Centered Design therefore asks:
The answers reveal the true performance of the patient system.
Theory of Constraints teaches that the performance of any system is limited by a constraint. Improving a part of the system that is not constraining flow may create more activity without increasing results.
If diagnostic capacity is the constraint, generating more awareness may simply produce a longer queue for diagnosis. If specialist capacity is the constraint, accelerating authorization may move patients more quickly into another wait. If training after first use is inadequate, increasing procedures may produce poor experiences and avoidable follow-up demand.
“More activity at a non-constraint creates work in process. More capability at the constraint improves the system.”
The constraint is not always a physical resource. It may be a policy, an eligibility rule, missing evidence, a fragmented handover, an information delay or the cognitive burden placed on the patient.
The most important question is therefore not, “How do we improve every step?”
It is, “What currently limits the flow of suitable patients to successful use of the therapy?”
Numbers show where patients are lost. Patient research helps explain why.
Two patients with the same diagnosis may respond very differently. One may actively seek new treatment options. Another may delay action until symptoms become severe. A third may want help but lack confidence in navigating the healthcare system.
Meaningful patient segmentation considers characteristics that influence behavior:
These differences affect whether patients enter the pathway, remain engaged and successfully adopt the solution.
The Gemba is the place where work actually happens. For patients, this includes the home, clinic, hospital and all the places where they manage their condition between formal encounters.
Interviews alone may miss important evidence. People normalize inconvenience, forget workarounds and simplify their past decisions. Observation allows the development team to see what patients actually do.
Good research combines three activities.
Observe. Watch how patients obtain information, prepare, use the solution and respond when something goes wrong.
Immerse. Understand the physical, emotional and practical conditions surrounding the experience.
Engage. Ask open questions that allow patients to describe their goals, fears and frustrations in their own language.
The purpose is to discover the patient’s reality before asking them to evaluate the organization’s preferred answer.
Patients rarely want a medical device for its own sake. They want the progress it may enable.
They may want to recognize deterioration earlier, preserve independence, reduce pain, avoid repeated visits, return to work or prevent a disease from controlling daily life.
A useful job map examines eight recurring stages:
This reveals opportunities beyond the immediate use of the device. The most valuable improvement may involve helping patients prepare, confirm readiness, recognize an exception or understand what happens next.
Stories create understanding, but investment decisions require structured evidence.
Patient observations and comments should be converted into outcome statements that identify:
For example:
“Minimize the time required to recognize that my condition has changed sufficiently to require clinical help.”
Patients can then assess the importance of each outcome and their satisfaction with their current ability to achieve it.
Highly important and poorly satisfied outcomes represent genuine opportunities. This prevents teams from prioritizing attractive features that do not materially improve the patient’s life or progress through the pathway.
“Innovation becomes valuable when it improves an outcome that matters and remains poorly served.”
The Patient Centered Design pathway can be improved through a repeating discipline:
Find the constraint. Identify what currently limits patient flow or successful use.
Optimise for it. Make the best possible use of existing constraint capacity.
Collaborate around it. Align functions and partners so their actions support the constraint.
Uplift it. Add capability, remove restrictive policies or redesign the pathway.
Start Again. Once the constraint moves, identify and address the next limiting factor.
This prevents improvement from becoming a collection of disconnected initiatives. It directs scarce resources toward the factor that most strongly governs the result.
Patient insight should influence more than early product design. It should shape clinical evidence, regulatory strategy, reimbursement, manufacturing, education, market development and post-market support.
The organization should be able to show:
The goal is not simply to place the patient at the center of a diagram. It is to organize the enterprise around delivering better products faster, so that more lives can be changed for good.
Use the Patient Centered Design assessment to determine how well your organization understands its patient journeys, priority outcomes and constraints to patient flow.
The result should be more than another collection of patient opinions. It should provide evidence that directs strategy, investment and execution toward the changes that matter most.
Discover better ways to do better work.
We alternate our own actionable articles with three relevant links from other authorities.
We’ll only use your email address for this newsletter. No sales callsDiscover better ways to do better work.
We alternate our own actionable articles with three relevant links from other authorities.
We’ll only use your email address for this newsletter. No sales calls