Or how I learned to combine the frameworks: 5 Whys, First Principles, Jobs To Be Done, Design Thinking & Lean Startup.
(Originally published in German on the blog produktbezogen.de in January 2017. Back then, there were not so many public hints that Elon Musk would become what he is today.)
Every time I sit in a doctor’s waiting room for what feels like an eternity, I suffer endlessly. It’s not because I’m already feeling ill, but because time seems to crawl at ten times the normal speed in such places. If you want to understand Einstein’s theory of relativity, try visiting a doctor without an appointment. Not only could you be doing a hundred more enjoyable things, but there’s also that ever-present anxiety of catching something from the other patients. In my opinion, this “waiting room phenomenon” is a major problem that needs solving! But what’s the best solution? And how do we get there? It’s time to talk to some other product people…
A week later, I meet Dale Carnegie, Clayton Christensen, Steve Jobs, Elon Musk and Eric Ries in a workshop.
— EVERYONE IN THEIR MINDSET —
Me, over-enthusiastic: “Good morning! I’m glad you’re all here.”
Steve, impatient but polite: “Alright, what do you have for us?”
I explain the waiting room problem.
Elon, lost in thought: “That’s a big problem…” And he immediately drifts off into his own world, as if no one else exists.
Clayton, thinking aloud: “Yeah, that’s an interesting job…”
Dale, confused: “Doctor?”
Clayton, muttering: “No, the waiting room…”
Eric adds: “Is that even an assumption?”
Steve, determined: “I can build the best waiting room in the world!”
Eric suggests: “To avoid wasting too much time, we could implement one of Steve’s ideas in a waiting room and ask patients afterward if the experience was more bearable.”
Elon, dismissive: “I’m not sure the ‘best’ waiting room is even the right solution. I don’t think we’ve understood the actual problem yet.”
Steve stares at Elon, unblinking, clearly irritated.
— THE FRAMEWORK OF FRAMEWORKS —
Meanwhile, Dale is wondering why he was even invited to this workshop. He’s never developed a product. He stands up.
Dale, calmly: “Guys, I’m just a trainer in positive thinking who helps solve people’s personal problems. I don’t know how I can contribute here.”
Me: “Maybe we could apply your approach to solving personal problems to this one?”
Steve is already sketching his vision of a waiting room on a scrap of paper.
Dale, hesitantly: “Maybe.”
Eric, now intrigued: “I’d like to hear more about your method.”
Dale, after a brief pause: “Why not. I use a four-question approach with my clients:
- What’s the problem?
- What are the causes of the problem?
- What are the possible solutions?
- What is the best solution?”
Elon, rocking his chair, is back to staring at the ceiling, disconnected from the group.
Me, thinking aloud: “I believe your systematic approach could really help us solve the waiting room problem. It would let us apply our strengths in the right order.”
Clayton, supportive: “Yeah, it’s good to start with the problem before jumping to solutions.”
Steve, exasperated: “Clayton, would you take a walk with me?”
Clayton, surprised: “Now?”
Steve, with absolute certainty: “Now. Please.”
Clayton and Steve leave.
— 5 WHYS —
Eric leans in and starts an interview with me.
Eric: “Why do waiting rooms exist at all?”
Me: “So you don’t have to stand in the hallway while waiting for your doctor.”
Eric: “Why do you have to wait for the doctor?”
Me: “Because many illnesses are unpredictable, and people need to visit their doctors spontaneously. Even with an appointment, some consultations take longer than expected, so you end up waiting.”
Eric: “Okay, but why do you wait in the waiting room?”
Me: “Because you don’t know exactly when it’ll be your turn, so you have to stay close by until they call you in.”
Eric: “Why don’t you know when it’ll be your turn?”
Me: “Some treatments take longer or are really quick. Sometimes an urgent patient goes ahead of you.”
Eric: “Why aren’t these factors considered in estimates?”
Me: “Because they’re seen as random and unquantifiable.”
Eric, pleased: “The core of the problem is that doctors and their staff don’t realize they could gather data over time and potentially predict waiting times more accurately.”
Me, skeptical: “Assuming your idea works. Even the train system can’t predict delays well enough for people to avoid arriving too early at the station.”
— FIRST PRINCIPLES —
Elon has finally processed something and leans forward, gesticulating.
Elon, as if on a TED Talk: “Analogies won’t help us here. Imagine if people had said, ‘We don’t need cars because we have horses, and there’s grass everywhere for them to eat, but there aren’t any gas stations for cars, so we shouldn’t build them.’ If they’d thought like that, we’d never have cars today! But they didn’t, and cars were built.”
Me, confused: “I get your car analogy, but what does that mean for us?”
Elon, with condescending certainty: “The train system’s failures aren’t relevant here. They’re impacted by many factors—like weather—that don’t apply to doctor’s offices. We should avoid such simplistic analogies.”
The room goes silent. Everyone is deep in thought, except Elon, who looks quite pleased with himself.
Me, cautiously: “You’re right. The factors in a doctor’s office do seem more controllable. Maybe we can make accurate predictions.”
Elon: “Maybe. It depends on whether we can measure all the factors—scheduled and unscheduled appointments, critical patients, treatment durations, time of day, weekday patterns, seasons, holidays. With enough data and software, doctor’s offices could predict waiting times with increasing accuracy over time.”
At that moment, Steve and Clayton return, with Clayton looking both drained and annoyed. No one dares ask why.
Eric, excited: “You’re back just in time! We’ve analyzed the problem.”
Eric stands up and starts explaining what they missed.
Steve, impatient: “I want to show you my vision for the waiting room.”
Elon, dismissive: “Steve, now that we’re thinking we can better predict waiting times, shouldn’t we consider alternatives to the waiting room?”
Steve can barely contain his frustration but manages to hold it together.
Steve, with thinly veiled defiance: “Sure, go ahead.”
— JOBS TO BE DONE —
Clayton, constructive: “What’s the situation? Doctors have waiting rooms so patients can stay nearby and wait comfortably for their appointments.”
Me: “And patients want to spend as little time as possible waiting or, ideally, make use of that time elsewhere, outside the office.”
Clayton, thinking: “But patients have no alternative to the doctor. For the ‘treatment’ job, they can’t hire anyone else, just another doctor where the same problem exists. But for the ‘waiting time,’ they do have alternatives: magazines, social media, games.”
Steve interjects: “In my waiting room, no one will be bored.”
Clayton ignores Steve completely.
Clayton: “But if doctors realize offering an alternative to the waiting room could be a competitive advantage, they might even hire other products.”
Me: “What do you mean by ‘hire’?”
Clayton explains: “If it’s possible to predict waiting times accurately, a doctor could hire a solution like an SMS service to alert patients when it’s time for their appointment.”
Steve is back to sketching his elaborate vision.
— DESIGN THINKING —
Dale, excited: “I really like the SMS idea! Do you guys have any other solutions or ‘jobs’ we could hire?”
Everyone except Steve takes time to brainstorm, but no new ideas emerge.
— LEAN STARTUP —
Eric, determined: “We’ve got two solutions now: the traditional waiting room, possibly enhanced with Steve’s ideas, and the SMS solution. Our biggest assumption is that patients don’t enjoy waiting and would appreciate alternatives. So I’m going to the nearest doctor’s office and asking patients if they’d rather wait elsewhere, and if they say yes, I’ll ask for their phone number so we can notify them via SMS.”
Steve, incredulous: “And you’re not going to show them my vision?”
Eric, confidently: “No. It doesn’t add anything at this stage. The waiting room is known and accepted. No one will reject improvements. But we’ll learn something new if most patients prefer to wait elsewhere. If they’re even willing to leave their phone number, then we can build a prototype.”
Steve can’t take it anymore. His frustration boils over, and he storms out, tears of anger streaming down his face.
Steve, yelling: “I want to make the world a better place, and you’re coming up with cheap SMS ideas!”
Steve is gone. A pause.
Dale, satisfied: “I’m just happy I could be part of this.”
Me, thankful: “Without your input, we wouldn’t have made this much progress so quickly.”
Eric, reflective: “I didn’t expect combining other frameworks with Lean Startup could speed up learning even more.”
Clayton, with a grin: “For some reason, I’m craving a big milkshake.”
Elon, greedily: “I’m in.”
We leave the room, all of us lost in thought about milkshakes, when suddenly, we spot Steve again. He stops, looks at me for a long moment, then laughs, waves, and walks off.