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Applying Lean Design Principles


Over the last decade, Sequence has evolved the way we manage design and development processes for complex programs. Today’s project kick-off balances variables like users’ needs and wants, clients’ business requirements, development realities, and third party technology platform dependencies.

In this context of complexity, we frequently apply lean principles to the design and development process to increase the odds of marketplace success while reducing program risks.

In the start-up world, companies that use a lean approach are focused on creating products that address real user needs and wants using an iterative process. For both our start-up and large company clients, we frequently use a lean, hypothesis-driven approach. In lean programs, we break an effort into sprints, with a hypothesis or hypotheses that we test with real users at the end of each sprint. User feedback guides what happens in subsequent sprints. The whole process means that a clients’ odds of success are much higher than an old school, “build it and they will come” approach.

We also use lean methodologies when we work on our own projects.

A recent example of Sequence’s use of lean process, in which we tested hypotheses over several iterations, was driven by our desire to improve how a patient experiences the doctor’s appointment process.

As a result of both our work with companies in the world of health care and our own personal experiences, we had established a strong, collective opinion at Sequence that the actual process of making an appointment with the doctor as well as the appointment itself was full of opportunities to improve the patient experience.

Instead of relying on our gut feel, we conducted a survey of 2,000 adults in the U.S. in early 2016. The survey unearthed powerful data points, like the fact that 88% of people still use the phone to make a doctor’s appointment. Many of our hypotheses about the inefficiencies of the doctor’s appointment process were supported by the data we collected. You can download the
white paper No Room for Waiting

So the next stage of this program involved looking at the appointment experience as well as the data and then building out a patient and health care provider journey map. The journey map allowed us to articulated the specific needs, wants and points of frustration from the time someone decides to contact the doctor until they receive care and even post-visit follow-up from the doctor.

This multi-faceted journey map led us to sketch out a range of service experiences and digital tools that could make the doctor’s office visit a better process for a patient. The journey map thus led to creating high level (“epic”) user stories.

At this point, we contemplated building functional app prototypes to gather additional feedback from users, but chose to do something a bit different than the typical lean process that leads to a prototype software build for testing. We added a significant step before starting to build software.

Because the health care process involves numerous stakeholders, regulatory constraints and legacy technology infrastructure, instead of building a limited, single tool to gather user feedback, we thought that fostering a conversation with prospective consumers, health care providers, insurance companies, and others in the health care ecosystem would be a valuable, intermediary step. Our means for conveying ideas, testing hypotheses, and gathering feedback became a video articulating how a seamless, consumer-centric system—that we named On Call–could work.


It’s a conceptual service offering that drives an improved patient experience. You can see the video here or here.

Since we introduced the findings from the study and the work at the beginning of April, the video has been driving both conversation and pointed feedback—precisely the point when you are prototyping in a lean process. The difference here is that the responses are to a video—not the detailed elements of functioning prototype software. Building testable prototypes could be the next step.

Very interestingly, we’ve fielded a consistent question from consumers, physicians, hospitals, researchers, and insurance companies, each asking “Is this service available in my area?” The many questions of this nature validated that the pain point—and potential conceptual solution—are of interest to a range of stakeholders.

Stay tuned for the next step in our lean journey to bring a better patient experience to life.

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