A few months ago, this blog commented on a short piece about the use of ethnography as a strategic tool (Try Ethnography for Health Care Strategy). The source article had been a short, theoretical, and perhaps even whimsical exploration of the use of anthropologists in developing business strategy. Well, along comes Business Week on June 24 with “How to Kick off an Innovation Project” by Jessie Scanlon which gets practical really fast in describing how Office Max used ethnography to do an image turnaround – complete with a “how to” guide. It struck me then, and now, that there are valuable pearls for healthcare leaders here.
Doing our Homework
The pretty clear business point made by Ms. Scanlon in this article is that “doing the homework” on a new product, service, or image may be up for re-examination. In the case of a corporate initiative the holy grail is obtaining a preference, trend, and purchasing pattern information through market research based on a combination of surveys and purchase pattern data. HD needed to get an edge on Staples, it’s key competitor, so:
“…the first step was to understand the problem and the opportunities. A standard customer survey commissioned by the company in 2006 provided a starting point, revealing a split in how men and women thought about office supplies…
But while that observation opened the door to a new strategy, it wasn’t enough to tell Office Max what to do:
“In order to get beyond the survey data, Office Max asked GravityTank, a Chicago innovation consultancy, to study women who buy office supplies. ‘If you wanted to understand the behaviors of a long lost tribe in the Amazon, you wouldn’t send them a census survey. You’d observe them,’ says Ryan Vero, OfficeMax executive vice-president, and chief merchandising officer, who initiated the research. Ditto, he says, with consumers. ‘Ethnographies are a critical component of our innovation process.'”
Try Looking at the Patient
In this day of extensive remote data availability, clinical and business managers can easily solve the problem, invent the product, or evaluate the process “on paper” or “on screen.” Thanks to robust modern informational technologies, through laboratory and radiographic testing (for clinical problems) and detailed performance metrics (for business processes) are available online. So it’s tempting (and sometimes necessary) for clinicians to conduct “armchair rounds” as the basis for treatment recommendations and for business leaders to conduct “remote troubleshooting” as a means to leverage management and make critical decisions. But as anyone who has been a clinician for a while knows, doing so is at your (or the patient’s) hazard.
So for Office Max, the homework only began with the data – the real innovations came as a result of direct customer observation. Which led to a significant refocus of its competitive product and marketing strategy towards the purchasing habits and preferences of female office products purchasers. And it learned how to do it through careful observation on the ground:
“Over the course of two weeks, the Gravity Tank field teams, including a researcher and videographer/photographer, spent one or two days with each subject, arriving at the woman’s home in the morning and shadowing her as she traveled to work and back. ‘We try to watch for workarounds. Things people don’t necessarily perceive as a problem, because they’ve developed a way around it…'”
But not every situation requires expert ethnographers and videographers. Sometimes it;s just careful and direct managerial observation and attentiveness. An approach that may be underutilized by healthcare leaders in solving, for instance, persistent operational problems (in a way that works for staff and patients), designing facilities and clinical programs (to real use requirements), clinical information systems (to actually decrease physician work), and managed care operations (to conform with the reality of network physicians with multiple payor relationships).
Scanlon offers some pretty simple steps that can be used by any healthcare leader. These stay far short of hiring a busload of consultants – which might be warranted for major strategic changes such as Office Max’s. But the approaches apply well to new products, programs, or initiatives as well as today to day operational challenges. What they have in common is “looking beyond the numbers,” stepping out, and observing users and the user environment:
Focus on Unspoken Needs
By watching the patient or user behavior, find out what they can’t (or won’t) easily tell you in response to surveys and questionnaires. What slows them down, frustrates them, causes them to work around the system, or – worst case – not return!
Study customers in their environment
The Office Max approach began before the store encounter and extended beyond it to provide a full environmental picture of the consumer experience. There’s value in observing patient or user behavior at the clinic, in the hospital, or in the user setting (in the case of a product). But only by understanding the continuum of experience that included the “before and after” can insights be gained into barriers to getting there and complying with advice and recommendations. Which is the data you need to achieve high user penetration to services or high compliance (and results) clinically?
Watch for Contradictions
Ever hear a patient, physician, or product user promise to do something that never ended up happening? Or describe a requirement that really didn’t result in pleasing them in the end? Observation gets you out of the “what I say v. what I do” dilemma.
Identify Your Target Customer
According to Scalon, it doesn’t take high numbers of observations, just the right ones: “In-depth ethnographic studies usually involve no more than a dozen subjects, so make sure they are the right ones.” This increases the upfront challenge but results in a high value, limited resource, study.
Use Multiple Tools to Record Material
Just like any test or metric, measure from different angles using different tools. Listen to the heart AND get an ECG if you want to be sure of what’s going on. In the case of ethnographic observation, take notes, use video and audio recordings, and perhaps use multiple observers over time. The goal is to get it right, not quick.