Stakeholder-Centered Design Presentation at MD&M West 2019

Considering product development for all of the people who interact with it over its life, not just the end-user, is how M3 works with our clients to create great products and experiences. We call it Stakeholder-Centered Design.

M3 uses a process we call Product Journey Mapping to uncover key interactions that can make or break a great design. For example, a product that is easy to use, but difficult to buy is likely going to have problems succeeding in the market no matter how cool or innovative it might be. Stakeholder-Centered Design ensures that all the links in the chain from how potential customers become aware of your product through taking it out of service are considered in a way that results in the entire experience being successful.

So how the heck does M3 do this? Lucky for you, we have a video overview of the process. Our COO, John Bernero, presented it at a the MD&M West show and we have recorded his talk and are making it available to our readers in video form. Without further ado, please click on the image below to see and hear John’s insights:

Header slide from MD&M Stakeholder-Centered Design Presentation

Video Transcript

So the topic of my presentation today is user center design is dead. And really what I’m going be talking about today is what we call stakeholder center design. We feel user center design is pretty limited in how you may think about it. And so, therefore, we want to talk about how that’s a thing of the past, and we want to think more holistically / bigger picture. I’ll walk you through those steps.

As far as the presentation goes today, I talk about a little bit of the differences between user centered and stakeholder centered design. Why it’s important, why you want to think bigger picture. And then I’ll actually walk you through the five steps that we take to through this process. I’m going to show you an example of how we did something to essentially come up with a journey map at the end, a map with workflows, stakeholders, and identifying pain points.

Before I get started, just a little bit about M3Design. So we’re a Product Development firm based outside of Austin, Texas. We work with many companies, both in the healthcare space, as well as outside. And we work with our clients to identify how to meet their business objectives through great product design and user experiences. Here’s some of the products we’ve worked on in the past. As you see, it’s a variety of things. There’s dental products, server rack mounted equipment, consumer goods, and even machine design.

So let’s go ahead and get started. So let’s talk about the difference between user versus stakeholder center design. All of you probably have one of these in your pocket today or on the table. Hopefully, you’re not looking at it right now. But there are certain products that user center design is a great methodology. A phone like this, the person who purchased it is usually the person who also takes it out of the box, sets it up, loads up all the apps that they want, and uses it on a day-to-day basis until the next one comes out, and then you either turn it in or give it your kids as an mp3 player.

But when you look at other products and you start thinking about the healthcare market, here’s an example, an MRI machine. So who is the user? Is it the patient? Is it the rad tech here that’s actually responsible for collecting good data? Is it the radiologist who is not even in the room and who’s responsible of looking at the output of this image and determining the diagnosis? Or is it the patient – or, sorry, the physician who ordered it? How about healthcare insurance companies who are the ones that are going to be paying for it or otherwise?

So when we talk about stakeholder centered design, you want to think big picture and not just focus on just who is the primary user during the end use environment. The one thing we see a lot with so many companies that are developing the product is they’re really focused on the end use, the person who is primarily using a product and it’s by far – it’s very important. But in the example of the MRI machine, there’s lots of other stakeholders involved. And so understanding who those are is pretty key.

And then if you take it a little bit, a step deeper, in that type of workflow, not just in the use, but how does someone decide to purchase this product and how is involved in that process? So often times in medical devices, the person purchasing it never actually uses the product. So what are they looking for that allows your product to be sold in the first place before it can be able to be used? There are different people who are responsible for setting it up or making sure that it’s in operation and ready to go before the procedure or what happens during the actual use of the therapy or applying the therapy.

And then something goes wrong, and it will, who is responsible for making sure the product is back up and running and able to do what it’s intended to do. And then, also, you gotta think about what happens at the very end, which is how do you dispose of the product because there may be some regulations there to think about. So let’s talk about why this is important. Like I mentioned before, we’ve used this journey map to identify the different steps. But a lot of times when we talk to clients and work through a new product, they’re really focusing on what happens during the procedure, and they may have some understanding prior to it.

But what we like to do is look at the big picture. What happens at the very beginning? Who’s setting it up? Who’s responsible for making sure that this thing is working? And then what happens afterwards? We actually follow the product within the hospital system or even if it’s in the home [for those types of] care products, all the way along the way. The reason this is important once a product is used, let’s say a spinal instrumentation, here and is an example I’ll show you here in a little bit, but in spinal instrumentation, once it’s done, it goes downstairs into a hospital area in an area called sterile processing, and this individual here on the right is responsible for cleaning it.

If you talk to these users, you often find out that the person cleaning it may have high school degree. Maybe not. And the turnover rate or how often these employees are staying in this job is very low. So you’ve got untrained individuals. You have people who really don’t have love for their job responsible to making sure that the product gets cleaned properly between uses. Oh, and by the way, how many different flavors of this product or types of products are they seeing each day?

And they’re expected then, at that point, to understand exactly how to best clean that. And so the reason why we like to think about big picture and understand all these different steps is we don’t want something like this happening, right. We don’t want your product to fail because maybe it wasn’t designed properly because you hadn’t considered maybe some limitations or relying on individuals to do the job right such as cleaning the system, even though you might put together cleaning instructions and post them on the wall, the chances of them understanding that and always reading that may not happen.

And then the reason we do this, too, as you talk to stakeholders and understand as you’re adding new features, you start identifying – you may have some – introducing some new unintended users or stakeholders. And so with this, it’s a good risk mitigation process. Product development is all about risk mitigation, you know, how you go about it, how you’re gonna design controls and everything else. But if you look at it from a business risk perspective, understanding the overall workflow allows you identify potential risk areas.
So let’s go through the five steps of stakeholder center design. These are the five, and I will go into one – each one, one-by-one. So the first thing you do is you map out the journey as I kind of showed before. Identify all the steps that happen from the very beginning to the very end. Identify the lists of stakeholders that are involved. and then map those two together. Find out who is responsible for doing what job at what point. What this allows you to do is identify the unknowns. You might find that you don’t know a lot of information in a certain area.

And the next one is you want to fill those gaps of knowledge. Let’s take a deep dive in one of these examples. So since I showed the instrumentation of a spinal system, I want to use this example of a spinal deformity system and say, essentially, it’s a product that is used to treat thing like scoliosis and requires a lot of hardware in order to correct the deformity of the patient. The image in the middle, this is showing the surgical team at work. They’re engaging with lots of tools. They’re engaging with lots of equipment. And so understanding the end use is very chaotic and everything else. But in order for this procedure to go well, everything needs to be in place ready to go before it even starts.

So the first thing we want to do is map out the product journey. Just ask yourselves what are the steps during the product journey map and put them all up. So in this case, what’s also kind of unique with the system is that sometimes the instrumentation set is not actually at the hospital all the time. Sales reps or sales distributors actually are the owners of the product. They don’t actually sell it to a hospital. The implants that get put in are what gets sold. And so what they do is they manage that inventory.

The other thing, too, is that the implants are actually packaged with – in the sterilization cases with the instrumentation. So all those need to be ready to go and they’re not actually boxed off on the side. And so the sales rep actually has to deliver this set to the hospital prior to the procedure, and either go through the hospital protocols for cleaning and sterilization, and then the surgical team will then make sure it’s ready to go before the patient comes in and then they’ll do the procedure.

Then afterwards, that case goes all the way downstairs, gets cleaned, and the sales rep grabs it and maybe takes it got another location. So there’s a lot of things happening that aren’t in the procedure so we’ll talk a little bit about that. Part of this is we look at workflows or what’s happening at each step for the end use there is certain surgical technique or workflow that’s happening so we’ll map that out and we’ll map out for each of the other journey steps such as deliver the setup and everything else.

And when we do this with our clients, what we notice is we do this on the wall with Post-It notes, and the nice things is it’s visual representation of how much knowledge we have. Often times, we find out that we have a lot information that happens in the procedure, but all these ancillary steps and the further on afterwards, there’s really not a whole lot of information that’s known and identifies maybe some gaps of information.

The next thing we do is identify a list of stakeholders. In this case, you’ve got – the surgeon or the physician, but there’s two personas of that. There is a neurosurgeon and an orthopedic surgeon and they have very different needs of what they’re looking for. We have a scrub tech, who is the assistant, who is the one that’s responsible for setting up the room and handing the instruments from the back table to the surgeon and keeping up with their pace. You have a OR coordinator who is responsible for scheduling and works with the sales rep, who is a circulating nurse, who is responsible for making sure that team has what they need, and the sales rep, who is there to make money.

And then you have the sterile processing employees, and you have others as well. We map this out, and then what we do is we put these all together. We kind of figure out which stakeholders are involved in which step. And, in this case, we have the result of maybe the sales rep and so on and so forth. They see during the procedures, a lot of people are involved, and there are some key stakeholders earlier on and later on that have nothing to do with the procedure, itself.

So step four is identifying the unknowns. And the reason we do this is to identify what research techniques or what research we should go do, how we fill those gaps of knowledge. So what we’ll do is we’ll ask things like what are some of these journey steps that we don’t know about. Many times, our client has really understanding in one area, but has never followed products from the whole landscape. Maybe they’ve – the people that we’re talking to aren’t experts in that area, and we need to gather some other people from – other people within the organization.

We also identify what stakeholders might be underserved or ignored. A lot of times, it’s like, oh, don’t worry about them. They don’t have any impact on the product. But the reality is that anyone that touches your product has some ability to impact how successful a product is once it comes out to market. And, of course, what and who are we ignoring? And it’s okay that they ignore this. I’m not saying that you have to go through this process, but what you’re doing is you’re adding risk to your overall product design.

You can go through your design controls and have your user needs all identified and everything else, and still get a product to market. What I’m talking about is how do you take this product to the next level? How do you develop new innovative products? How do you identify unmet needs? How do you identify future business opportunities that maybe aren’t happening today. So once we have all the gaps identified, what we’ll do is we’ll develop a research plan, and then we’ll execute on that research plan.

This is usually a combination with us, the client, if they have a research partner, too, possibly. But what we do is we identify who’s going get what information, and then we’ll use the appropriate research techniques, and then we’ll use the appropriate research techniques in order to gather that and bring it back to the table. And once we do that, we often times find things that we were wrong about or things that we didn’t think about, or new stakeholders, new steps that we had never considered.

But we also identified potential pain points. What are the things that people just struggle with or are unable to do– or just get in their way of their ability to provide effective care. And then also identify unmet needs that people really wish in a product, but they currently aren’t able to do. The other thing we find out is things like workarounds. There’s many times you go in a surgery, I remember in one case, the surgeon was using a navigation system and had a touch screen, but the surgical team couldn’t touch the screen. He had to communicate to the circulating nurse and say hit this button. Do this.

So what he ended up doing was getting a Kocher or a towel clip and stuck it on top of the monitor. And what that allowed him to do is the tip of the Kocher was dirty but the handle was clean. So he could grab that Kocher and touch the screen, just jam it back into the actual monitor. It’s a funny what to find out once you go up and actually see for yourself. So this is what a journey map looks like. I’m gonna try to walk through this. I now the presentations will be shared later. If you want to get this earlier, let me know. I can send it to you later today if you’d like.

But what we do is we map out all the different steps here kind of on the X-axis and then over there is like the locations or areas that we’re talking about. So what this goes from is – actually let’s go – I’ll walk you through it. The first thing we do is the – this is the sales rep gets a call from the OR coordinator and finds out that surgeon Y has this procedure coming up in a day. So the first thing that sales rep says, yep. He calls into his main office and makes sure he’s got the instrumentation ready to go and he can take it for the whole day.

People then go through a process of making sure that everything in the kits needs to be there. So if all the implants in there, all the screws, the rods, the blockers, so all the instrumentation, do we have all that in that case? Because once it gets sterilized, you can’t see inside of it until you open it up and it’s too late at that point because you’re already to – the surgeon is ready to go. The next step is then they deliver this to sterile processing, and work with the OR coordinator or the sterile processing department.

And the first thing they do is take all the instruments out and then they clean it. Go through a pass-through cleaners, sterilize it, blue wrap it or if it’s one of these other cases, it’s just sterilized, and then they place it into storage by the OR. And then there’s pre-operative planning so things that happen before the procedure starts. You’ve got circulating nurse and the scrub tech getting the room ready. They’re setting it up. They’re bringing all the case and trays in. They’re opening it. They’re using – they’re getting gowned up.

They transfer all the sterile implants and instrumentation onto a back table. They often bring the patient in and then they do a timeout before the procedure starts. The surgeon even just comes in at the very end and is ready to go as soon the – you know, let them figure it out. I’m too busy, and I’ll just come in and start right away. So we map that out. And then we also map out what happens during the procedure. You see there’s a lot of steps in the things I showed before.

There’s actually a parallel step here because what’s happening at the surgical table is above, and what’s happening at the back table with the circulating nurse is down below. And the circulating nurse is kind of trying to quickly go back and forth with the instrumentation. The challenge, too, is some of the circulating –that’s scrub tech. The challenge is a scrub tech may not be very familiar with the set of instrumentation. They may have done mainly cardio cases in the past, and someone called in sick and they had to assist in this room. And so they’re all of a sudden expected to understand what the workflow is, what the instrument – what is it, and there’s tons of instruments.

So what happens is we have a sales rep in the room with a laser pointer kind of helping and guiding the circulating nurse. So now you have the sales rep in the room, too, kind of babysitting the procedure and telling a joke or otherwise. So the procedure goes on. They do lots of screws so that’s why this squiggly note because they have to do tons and tons of screws and rods. So they go through the process. And then once the surgery is done, they’ve gone through the process. They gather the instruments, and then get a break, send them downstairs to get cleaned. And the sales rep grabs it and then rushes off to the next procedure at another hospital. Very inefficient and whatnot.

Now, each product is a little bit different, right. So what we do is we look at the overall product journey and the stakeholders, and what we find out is there is always something that we learn. So what we do is we map out our pain points. So what’s shown in red, it’s just some areas that are some opportunities. There’s a lot more that we came up with but I just wanted to highlight just a couple – a few ones. But, number one, this whole inventory, expecting the sales rep to make sure all the implants and instrumentation is there. It’s time-consuming. It’s inefficient. It not allows them to be a salesperson.

Now, they’re a material management person, right, and transporter and driving through back and forth. You’ve got inefficiencies where sterile processing is cleaning – taking these kits out and recleaning instruments when maybe there’s opportunities there that could be identified. The back table, there’s lots of instruments. They’re expected to know it. And then what’s seen here in red is – is to do this procedure you bring this big C arm in the way and take fluoro shots, usually an AP or lateral shot.

And when you do that, the flow of the surgery stops. Essentially, you gotta get up, and you gotta wait – the surgeon has to talk to a stakeholder we didn’t identify until we went through the process, which is this rad tech, who is the person responsible for moving the C arm in and out of the operating room transporting from the different shots. And it’s just inefficient. And the surgeon also has very weird posture because they’re trying to do their product, their implantation, and they’re getting around this big, bulky instrument.

Now, you might say, well, that’s just how it’s done. Well, why? I mean, let’s just ask ourselves. We’re trying to improve healthcare and come up with new ideas. Why are we letting certain technology in the way? Maybe there’s an opportunity there to identify some new ways or better ways of doing this procedure that’s more effective and efficient. So the other thing this does, it provides a good framework for concept development.

So once you’ve done this research, you’ve mapped it out, we print out big plots of this, and we have it with us in the client teams. It’s a great reference to kind of talk through things on why are we designing what we’re doing. So you get lost when you go – user, you know, design requirements and there’s a hundred plus things on that this. Well, this gives a really good visual to the team is what’s important and what are some things outside of this making this product safe and effective. How can we make a better user experience to your stakeholders.

So to sum it all up. Surgeons are impatient, and they want a lot. But the reality is there’s a lot that happens before or after or during a procedure, and this goes with any product that you might be working on. And so going through this process, I think, what we’re trying to come out with is a better understanding of the big picture. And the reason we do that is if we want to take inventory of all stakeholders working – who are interacting with your product, we’re gonna identify those knowledge gaps and decide do we need to come up – or find more information in that area or are we okay moving forward with this project potentially at risk?

We then execute on appropriate research techniques. Not every technique out there is appropriate so we kind of need to figure out based upon what you’re trying to gather, what the best method is to gather information. We update the journey map as we get more and more information and establish the concept development framework. But at a high level, it has the potential to identify new product opportunities and even system opportunities. Maybe you’re not willing to or able to tackle right away but allows for things on the roadmap.

Here are the five steps again. You map the product journey, identify stakeholders through the stakeholder mapping or journey mapping, the final support, and fill the gaps of information. We publish on this, if you like. Here’s a couple links to a whitepaper related to stakeholder center design, also an e-book, and then we have some other publications that we put on our website as well. We post on these about once a month. Here’s my contact information. I love to catch up and talk if you have a technique or have a question about this. I’ll be around until about 3:00 today. But I look forward to continuing the discussion. Thank you. I’ll open it up for questions at this point.

Audience: So sometimes when you’re considering the needs of all your stakeholders, there’s conflict. There’s competing needs to give one stakeholder what they need means taking it from someplace else. How do you – is there a process for distributing the pain or concentrating the pain, or, you know, is there a –?

Speaker: Yeah, you have to prioritize. You know, once you have all this information, at the end of the day, you still need to prioritize things. So you may need to prioritize things due to safety or people might want something but you can’t deliver that to them because it may be too unsafe. We might prioritize that based upon, you know, marketing needs or what their influence is in purchasing a new product or using a product. So not every stakeholder or step in the journey it at equal priority level. You kind of have to go through a process of prioritizing it.

We do a thing called success drivers. That’s like a 10,000-foot view of what success means in this product. What that allows us to do when we build out concepts and that, we can score those against the success driver and make sure that we’re still on track to make a private should that will be successful in the market.

Audience: I have a question about how you identify your stakeholders. So, you know, you identify the stakeholders as people who interact with the product [inaudible]. And for [inaudible] but also people who work in transport storage processing. How do you get around the fact – or do you get around the fact that that means you design for these people who are users that validates the design for each of these types?

Speaker: So that’s – the journey map is separate than your design requirements, and so I think that’s where the prioritization is. In terms of – as you identify the differnet stakeholder and what their needs, it comes down to what the FDA is looking for, what’s safe and effective. They don’t care if you need money. They don’t care if you deliver a good user experience. What they care is that you don’t hurt anyone or harm anyone. And so keep that in mind when you’re developing and identifying. Some things, you might be looking at more from a business perspective or you’re trying to deliver a better customer experience than your competition

Audience: Do you have tools to identify the unknown because we have projects where you kind of don’t know until you know and you’re behind the eight ball.

Speaker: Yeah. So we start every project with this process regardless of when the client comes into us, and they’ve had like some user research and everything else. And what we do is we map out what the information is already there. We use this journey map. Really, it’s about identifying where are areas of information you don’t know, or challenging assumptions. They come to you and say I need to do X, Y, Z. You say why, you know, and try to really dig in deeper into their –. As you go out in the field, as you do research, as you learn things, you find new stakeholders, new steps that you hadn’t considered.

And then you decided if you wanted to go off and start doing some more research there. Now, you don’t go to this research for research sake, you still have this timeline you gotta meet. You have budgets. So what we do there is just identify – make sure you prioritize things and make sure you identify the risks. Like it’s okay to go through a product design not having – knowing every single stakeholder and every product journey. What you’re doing there at that point is you’re adding risk and you may be even missing potential product opportunities that you can release in the product either with that one or future product lines.

Audience: Have you done this with like a very innovative sort of like new products? Because a lot of the surgical stuff, the orthopedic stuff all seems like kind of similar and just like an incremental change to a current existing product. Is there anything that you’ve done where it’s like a brand-new ballgame?

Speaker: So we worked on a project for a client that we developed with them, and we went through this process and mapped it out. What we identified at that point was an unmet need. We looked at – I can’t tell you what it is because it’s not public yet, but we identified this unmet need. Marketing was excited about it. We should do this, and we did some feasibility testing and realized this is a lot harder to do than we thought.

And the reason they had us work with them on the product is that a competitor had a product and it was all about speed to market and filling the portfolio gap, right. So by adding this new feature, although it’ll be great, it wasn’t addressing their immediate business objective. So we actually recommended we table that new idea and just focus on the original one. So we tabled that. They came out with the product. It’s been successful, and they reached out to us and we went through this process of identifying a new way of doing something that hadn’t been done in the past.

And with that is it’s hard to – people have a hard time envisioning how to do something that they don’t have a preference for. So we had to use different techniques, mock-ups, different concepts to help paint the picture as we’re talking about the idea to get new user feedback and an understanding that iterated along that way.

Audience: In the mock-ups, did you have like real physicians and scrub techs and stuff, you know, walk through in a pretend scenario?

Speaker: Yep. Yes. So we had mock-ups. We created a discussion guide, and we kind of simulate this. We had cadaver labs. We’ve done, you know, lots of things that we facilitated and supported in order to kind of get to the good information. You know, you gotta go into those things with an open mind because they may say, hey, this is not a good idea, right. Or we may find out that you’re really in love with this idea, but at the end of the day, they’re not willing to pay for it.

And, at that point, it might – for a designer or whoever, they might think it’s a great idea, but that’s where you might find that early on. Any other questions? All right. Well, thank you very much. Again, if you need me, just let me know and we’ll all be around. So thank you. [Applause].

[Closing]

[End of audio]

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About M3 Design
Founded in 1996, M3 Design is a product development company located in Austin, Texas. M3 is a team of world-class designers and engineers that challenge convention to help their clients maximize business opportunities by creating exceptional products and experiences with them.

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