How to find unmet needs in healthcare: 6 lessons I learned from my field study in China
Earlier this year, I went back to China for a new medtech product development project. Over a two month period, my colleague and I traveled thousands of miles between 4 different cities, and immersed ourselves in 3 major hospitals to identify the unmet needs of physicians. We used Stanford biodesign methods as our tool for our study. (For those who are not familiar with Stanford biodesign, it is a systematic and human-centered approach to develop new medical technologies.)
While I was trained as a medical doctor, this experience changed my role from a provider to an observer, or an amateur detective. As intense and eye-opening as it was, I learned 6 important lessons on how to spot innovation opportunities in healthcare.
Ready to dive in? Read on:
Lesson 1: Observe with the beginner’s mind
Buddhism has the wisdom, “In the beginner’s mind there are many possibilities, in the expert’s mind there are few.” Since I started medical school 10 years ago and have been in the healthcare industry ever since, my brain is more or less wired like a physician. This helped me a lot when I tried to step into another person’s shoes and understand what they think, feel and need. But it sometimes blinded me from the common scenes because I tended to take them for granted.
So during our study, I played a little zoom-in and-out game: When we were in the field, I would let myself soak into the scenes and observe everything with an empty mind; when we had breaks or conversations, or we started decoding notes at night, I would step back and zoom out a little to question everything, including my own assumptions. Although this effort wasn’t easy at the beginning, it certainly paid off and helped me discover many hidden insights.
Lesson 2: Get up early and live with your users
Why get up early? I cannot find a better explanation than what Jan Chipchase, the Zen master of ethnographic study, put in his book, “Hidden in plain sight”:
“The best time to observe a city is around the crack of dawn and the hours that follow…the start of the day tends to be more consistent and more regimented than the day’s end. For those of us trying to soak up local nuances, it’s easier to observe more people in a shorter space of time as the city finds its rhythm to the tune of the morning commute.”
While Jan is talking about observing a city, I find it also very true when it comes to observing a hospital, especially in China where many patients travel overnight from rural areas to see top experts in major cities. They come to wait in lines before 6am and by 7am, hospitals are already crowded.
When we were in the field, we followed doctors and patients from morning to evening and sketched out the doctor and patient journeys at every touch point. It is important to identify all the stakeholders and get a holistic view from different providers (e.g. specialists, nurses, social workers) in different departments. Then your product team can design the products that work well with or even enhance the existing clinical workflow.
Lesson 3: Understand people who like you and people who don’t
You may have heard of the famous Customer Development model coined by Steve Blank. The customer development process should start from day one, in parallel with product development process. At the first step of this process, called “customer discovery”, you need to go to the “earlyvangelists” (i.e. your potential first customers) and discover whether the problem and the product concept you identify are actually correct. The goal of our study, however, was to focus on the problem without getting into the solution hypothesis. So we deliberately selected those hospitals that embraced us as well as those who did not, in order to get a full spectrum of understanding of the problem.
Although each person’s opinions mattered, we turned on our critical ears and took them selectively, as Reid Hoffman explained in his interview with Mark Zuckerberg on “Masters of Scale”:
“… entrepreneurs need to both listen to what users say, and selectively ignore them. People can’t always accurately predict their own tastes or even their own interests… People systemically are very poor at predicting their own reactions to new things.”
Lesson 4: Pay close attention to nonverbal cues
Part of the work required us to act a little like detectives. We would watch very closely for nonverbal cues, such as body language, facial expressions, voice nuances, what people wear, and what they carry. These subtle signals could often reveal more unconscious and meaningful insights than verbal messages. For example, one physician sighed a little when she examined a patient. We noticed that “sigh” and started digging deeper: Why was she frustrated? Was it about the patient, the device, or something else?
Physicians don’t always do what they say, and there can be all kinds of reasons: the complexity of the case, peer pressure, patient-physician relationship, physician reimbursements or other financial incentives, and on and on. Chinese and American physicians can have very different views because of the differences in culture and healthcare environments. Noticing their verbal and nonverbal inconsistencies can often tell you some interesting insights.
Lesson 5: Ask the right questions in the right way
There are many interview techniques such as asking open ended questions, asking 5 why’s, and not suggesting answers to questions, to name a few. But in a chaotic environment like Chinese hospitals, physicians can hardly find the time for an “interview”. I often found it more productive to just grab any space in their busy workflow to insert my questions, then they could answer them right away. There are 3 questioning techniques worth mentioning:
- Ask for a specific instance such as “tell me about the last time you…” instead of “what you usually do”, because examples or stories can often reveal much richer details than generally speaking.
- Ask what product they dream of rather than what features they can improve, because this will open up their imaginations and help them focus on the future.
- Ask 5 why’s in a zigzag way to get to the core of the person’s beliefs and motivations. You can ask 5 why’s in a row, but it can be difficult in the hospitals without being interrupted. Instead, I tried to zigzag a little and throw a couple of how’s in between.
Lesson 6: Get to the fundamentals with different perspectives
Although this field study was only carried out by two people, we were a complementary and multidisciplinary team. My colleague is a PhD in engineering and a Stanford Biodesign fellow; I am an MD with experience in marketing and product development. This team structure worked well when we were in the field because we each saw things differently. But more importantly, after collecting and analyzing the data, we could critique each other’s findings from different perspectives and really get to the core. We also constantly brought in other business stakeholders to get their inputs, and checked with the physicians to make sure our findings were real and fundamental.
One thing that helped us along the way was to build respectful, win-win relationships with Chinese doctors and hospitals before the project got started. If you ever go abroad to do a healthcare-related project, understanding the foreign healthcare systems can be very handy.
What do you think? What other lessons do you have on finding unmet needs in healthcare? I’d love to hear your thoughts in the comments!
This article was originally published on Linkedin. If you are interested in using my illustrations, they are under a Creative Commons License. Just make sure you link back to my post where the original illustration is featured. Thank you!
