Balancing Wants and Needs in HC

Posted on June 10, 2014


There’s an old saw in business to the effect that you can’t trust the customer to know what they want.

In other words, a customer cannot envision a solution that does not yet exist. Therefore, it is a professional’s job to invent that solution, rather than wait for the client to describe it, and then try to build the widget or service.

For clients with an easily bruised ego, this is a controversial thought.  ‘It’s my money and I determine what I buy, not you, the company.’  For them, it is a power argument.

However, this is misplaced anger.  Some of the greatest inventions, especially in technology in the last fifteen years, were objects we the consumers never knew we needed.  A business created something first; then we bought it.  No focus group requested TiVo or an iPod or Twitter or any of the thousands of productivity apps we use daily on our phones.   Yet, once they existed, customers realized they had value.

In 1998, I had the pleasure of hearing Thom Mayne, co-founder of Morphosis and future Pritzker Prize winner, lecture on his work to our AIA Baltimore members.  Mayne was an avant-garde architect at the time, and not yet widely successful in getting his projects built.  Nevertheless, his work had been influential for nearly twenty years.  Mayne dropped many inspirational and aspirational quotes on us that evening, though one particular quote elicited a gasp from the crowd:

“I never ask clients what they want.  Never, never!  How could they know what they want?  They don’t understand architecture.”

Although he was forcefully echoing the common business axiom above, it was easy to dismiss his comment as a pretentious decree from an elitist architect who, at that time, had few concrete examples of his ideas to prop up such a viewpoint.

However, two other comments later provided context for his position.  First, he mentioned a need for client trust, and second, being hired as a professional to use his judgment.  He noted how his son, I believe, needed medical treatment.  In meeting with the doctors, Mayne was not about to discuss or argue procedures with the doctor, and saw no similar reason a client would argue with him about aesthetics or space.

Then, about six weeks ago I listened to a Lean Planning and Design seminar.  While describing processes for executing a Lean assignment with a typical healthcare client, the presenter offered very matter-of-factly:

“Design what they need, not what they ask for.”

Eerily similar to Mr. Mayne’s this comment was, delivered less like a sledgehammer but equally poignant.  Once client trust is established, the essence of successful work is to focus on the need, not the want.  And now connecting the dots, it is clear industry leaders are relied upon to use their experience, knowledge of the market, data, and proprietary tools to help make that determination.  The client is not equipped to provide that insight.

As an architect and needs assessor, I often hear the explanation that ‘‘yeah, but we’re different”.  The reality is everyone likes to think their situation is unique, but there is actually quite a lot of commonality in operational, strategic and facilities struggles.

Despite a legitimate underlying issue that needs real attention, an administrator’s experience may only span her hospital, or perhaps a few hospitals she has worked for.  Collectively, our team has hundreds of past projects, case studies, data points and tools to draw upon for improvements.  We have seen this before, and our job is not for the client to hand over a program so they can say: “just design and build what we tell you”.  Our job is to determine if you really need a project.  And if so, what is the greatest impact you can make with your budget?

A couple of weeks ago, I wrote about the ‘too much what, not enough how‘ phenomenon.  That discussion breached the touchy subject of healthcare culture again, which addressed in the past, can be a hindrance to better outcomes and an improved patient experience.  As the healthcare market continues to shift, we must right another wrong for the betterment of project, and treatment, outcomes.  As a project and client team, we must ignore the want, address the need.