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How to Specify Needs
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Из курса от партнера Duke University
Healthcare Innovation and Entrepreneurship
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Prioritizing Needs
What is the full cycle of care? How do you prioritize needs? How do you specify needs? How do you prepare a Need Statement?
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Marilyn M. Lombardi, Ph.D.Associate Clinical Professor
School of Nursing
Bob Barnes, PhDInstructor
Biomedical Engineering
Ladies and gentlemen, welcome back. On behalf of myself and Marilyn Lombardi,
today we're going to be talking about how to specify needs.
As we go through this, I hope you won't mind if from time to time I take a sip of
a hot tea. I've been dealing with some cough and,
and cold issues for the last few days. And that's probably apparent in my voice
as we speak today. as we move through this today, and we're
focusing on prioritizing needs. And today is specifically at least this
specific, time together I'll be talking about how to specify those needs.
Very difficult to prioritize them until we've actually specified them.
at this point you should have spent some time with Dr Lombardi.
I'm looking at my notes here. And I believe she covered the healthcare
dilemma. One of the first issues we've talked
about since then understanding the clinical context.
Doctor Lombardi has also talked to you about ethnography and she's talked about
the cycle of care. During this period of time I hope you
spent lots of time observing the healthcare environment, both inside and
outside the clinic. And I would assume, at least I hope, you
have been keeping copious notes. And if you had you will recognize that
there are many, many sources of potential needs that we could specify we could
identify they run interim. Those needs that we identify when we
watch the doctor or the clinician interact with a patient.
Those needs that we can think about in terms of just in general.
We think about the, the eight, categories the eight components.
And needs associated with quality. We can think about those needs and
consider those needs that come from what we may have read.
so we have observations, we have reading, we have interviews, we have a dramatic
source of needs. Now the problem with this, is that we
don't know what quite what to write, and some people want to write a problem
statement. And so you may have at this point
anywhere from 50 to perhaps several hundred pages of notes that you've been
observing in a clinical environment or observing healthcare for several weeks.
Maybe 40 to 80 hours worth of effort at this point.
Now, if you're a clinician obviously, you've been observing for years and
years. So you may have more than the proverbial
semester class of 40 hours to 80 hours of observations that you've been building
upon. Now, the problem with this is we've got
to be able to condense all these notes into something that's tractable.
So one of the things people start out with is a problem statement.
problem statements includes five components.
what I would call a semi-quantitative statement of pain or benefit.
Pain to be aleviated or benefit to be achieved.
As part of that problem statement, we include a definition or mapping of the
current state. We include a definition or a mapping of
what we would like the future state to be.
The idea being is we move from the current state to the desired state in
terms of our process, in terms of our procedures.
Then we will eliminate the pain and we will gain the benefit.
Now as part of that problem statement, we also identify the constraints associated
with problem, the constraints associated with the environment in which our
solution must operate. And the hardest thing of all in writing a
problem statement, is documenting those things that are actually assumed.
Remember that an assumption is anything that we accept as fact without
verification. And, unfortunately, that's where we get
into trouble many times in terms of when we're trying to develop new solutions or
innovative solutions for addressing problems.
A need statement is much simpler than a problem statement.
I didn't say it's easier to write. It's just simpler.
It's a non-quantitative statement of desired outcomes within a concise
context. For example, a problem statement could be
to reduce the number of hip replacement revisions among elderly patients.
Context: elderly patients. Context: hip replacements.
Now, we're talking about revisions, so we're not talking about initial
surgeries. We'll talk some more about what the
details of a problem statement. But a problem statement and a need
statement tell us different things. A need statement has not nearly so much
information as we have in the problem statement.
So what does this mean? If you have several hundred pages of
notes, and you've been observing for several weeks, then the problem is, to
write problem statements requires a tremendous amount of time, effort and
resources for which we'd like to get a return on investment.
If you've done all this effort, you'd like to get something out of it.
Need statements by definition require less time, less effort and less resources
to write. As a consequence we may get a higher
return on investment. We'll talk a little bit more about this.
Remember that what, where we are in this process, we're in the discovery phase.
I'm going to share with you an example. That example is based upon some of the
things that my students are doing this semester here at Duke University.
Currently about 35 of my students are following six, in six surgical
specialties. Now I've got 35 people.
those students had this time on average of about 50 pages of observation notes
and innovation notebooks. As a consequence of their following and
shadowing. Now at 35 people those 50 pages is about
1,750 pages of documentation. If I figure that there's that one idea of
every 5 pages that's 350 ideas. And that at some point I'm going to write
a detailed needs specification. We'll talk about the details of that in
just a few moments also. And I'd be looking at 3,500 pages of
documentation. Just think of the amount of effort, the
time, the energy, required to do that. So we have to have some way that we can
take this information and deal with it, in some way that we can identify those
things that we truly want to focus on. So, as we go through the next few phases
we're going to be talking about rough cut needs and how we can decide which ones we
want to quote unquote keep. And spend more time building preliminary
needs statement or preliminary needs specification.
And which ones of those after copious amounts of work, we would like to reduce
to a needs specification. Remember that a needs specification is a
clear input into our design process. Let's take a look at some rough cut needs
statement. There's a need for corrective colab,
pardon me, calibration or choosing the right implant size the first time.
There's a need for a more accurate imaging method for calibrating an x-ray.
Orthopedic surgeons need a calibration method for choosing the right implant
size the first time. Orthopedic surgeons need to be able to
choose the right implant size the first time.
If you look at these four, there's lots of similarity between them, but they're
not the same. Oh, there's a need for a device that
holds firmly but also allows easy adjustment of medical instruments during
minimally invasive surgery. Well, that's another need that one of our
students observed. There's a need to create space in the hip
capsule without using traction. And for those of you that have been in an
orthopedic environment, orthopedic operating room and seen the amount of
sheer energy it takes to, to avail the, for the surgeon to avail himself of the
ability and actually work in a hip capsule, then you'd understand why this
might be important. There's a need for more convenient and
safer ways to dispose off waste during surgery.
These are rough cut needs. Let's talk about these a bit further.
A good needs statement focus on, focuses on primary outcome.
There may be multiple outcomes we'd like to achieve, but it focuses on the primary
outcome. They're simple and short statements,
usually no more than 25 words. They do not include the solution.
Every time you say the word, lack of, you are in essence, in your need statement,
telling us what the solution is. So be careful with these.
Make sure that you don't have. Make sure that you don't have the
solution in your needs statement. We're trying to state the need.
[cough] Remember that every word in the needs statement counts, is important.
If it doesn't in, transfer information, then it shouldn't be there.
Words omitted are also important. Words that aren't there.
For example, in the statement that I made earlier about elderly patients.
As soon as I said elderly patient, she knew what's included.
The words that are not there have to do with pediatric patients.
Have to do with adolecent patients. Have to do with patients in their 30
through 50 year age in range. Those are not part of the context in
which a solution must operate. No need statement is perfect.
As you study more and more, as you work more and more with a need, you'll wind up
in many cases iterating and revising that need over and over again.
Let's take a look at those need statements we had earlier.
As our team looked at those need statements, there were two of those need
statements they decided they didn't even want to look at.
They weren't appropriate for them, they weren't appropriate for their background,
weren't appropriate for their interests. So it's perfectly okay in need statement
refinement to decide that there's some things you've reserved and you've written
needs for that your team or you are just simply not interested.
Perhaps you don't have the skillset for it.
Or perhaps you believe there's no market for it.
Or perhaps even the competitors are already producing solutions that are
adequate. From these, our team reduced these to,
there is a need to eliminate the use of traction in hip surgery.
Now, notice that we did not change the whole thing but we did do is we got rid
of two and kept one. There's a need to eliminate the use of
traction in hip surgery. We're not talking about knee surgery,
only hip surgery. We're not addressing reducing.
There's a need to eliminate the use of traction and only traction.
And we look at the other four. Those can be consolidated into, there's a
need to select the correct hip implant size the first time.
As long as you leave, leave the word orthopedic surgeon in, you're telling how
to achieve that need. And that's what you want in your needs
statement, to focus on an orthopedic surgeon, that's great.
But here we're focusing on the need. There is a need to select the correct
implant size the first time. Doesn't matter whether it's the
orthopedic or the nurse, pardon me, the nurse that's assisting but there's a need
to select a corrip, correct hip implant size the first time.
Now, for those needs, those rough cut needs that we decide or that we have
revised, pardon me, that we have revised, we want to convert those to preliminary
needs specifications. The reason for that is we need to know
more about them because we're going to further refine them.
And even then, we are probably going to eliminate a number of those.
A preliminary needs specification has four major components.
The background, it tells us specifically what is the problem, and it should be
done in a manner in which we can tell someone else a story.
Someone that's knowledgeable in this area, but it explains to someone
unfamiliar with the specific problem about the need itself.
Significance, why is this important? Why should anyone care?
Give us some idea about the number of instances, the degree of severity, the
difficulty in terms of re, retaining morbidity.
Perhaps something about mortality. But tell us why this is important.
The third attribute of a preliminary need specification is to address current
methods, technologies and solutions. It may be that we've come up with we
believe to be a very good need statement. But when we investigate a bit more we may
discover that there are already solutions that address this.
And those solutions may be adequate. For each one of these we will identify
the pros and the cons. The benefits and the problems associated
with those needs. The fourth attribute of this is
identifying who the key stakeholders are. Key stakeholders.
A stakeholder is anyone who can affect or is affected by the problem and or its
solution. The problem and or its solution.
It could be a wide number of people. Focus only on key stakeholders.
Key stakeholders are those people at high concern with this need and have high
power to accept or reject to support or deny work and emphasis on this need and
resolution in a need. For those key stakeholders we want to
also identify their requirements, in their words.
We're not writing engineering specifications at this point.
We're simply trying to capture what those key stakeholders would tell us are the
musts and the wants and the solution. Some things are must haves, in other
words our solution will not be accepted, our solution is not valid unless these
must haves are identified. There are also nice to haves or wants.
These requirements need to be prioritized from the most important to the least
important. Because as we begin to develop a
solution, we may discover that we're not able within the time and with the
resources we have to actually deliver a complete solution.
So here we are. At this point you know a bit more about
how to write a need statement. We've also talked about how to
consolidate those needs. We've identified ways in which we can
very simply filter off some of the needs that they may indeed be good, useful,
important needs. But for our team or for us as individuals
we're choosing not to pursue them. We've talked about how to write a
preliminary needs specification. Which when we talk about those in our
next section, we'll talk about how to prioritize those and how to eliminate
some of them. Again, thank you for your attention.
I look forward to talking with you in our next session.
Good day.
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