Introduction
Since you’ve been following my blog content closely, by now you already know that I’m an advocate of the VOC (Voice of the customer), as it’s a source of innovation for medical device companies. More so, I have already treated the interviews extensively as a method to collect input from customers.
Today, I will provide you an analysis of customers’ observations known also as ethnography, as a complementary tool to collect customer needs and wants.
What Is Ethnography?
The term “ethnography” is an academic and more polished way to refer to observations. Ethnography is a research methodology used by anthropologists, and it implies the observation of people in their natural environment with the goal of understanding how people live their lives.
Furthermore, Ethnographic research involves collecting data in real life settings, rather than under artificial experimental conditions to ensure that it reflects the ‘lived’ experiences of the people studied.
Anthropologists typically immerse themselves into the life of the community under study, and they collect information from a variety of sources such as observations, participation in group activities, informal conversations and interviews.
Ethnography & Marketing
In marketing, ethnography is often used as an alternative or complementary method to traditional face-to-face interviews and focus groups.
Likewise, it is used to gather insights for product and service development.
Ethnography as practiced by marketers follows the same principles and includes the core components as traditional ethnography.
A good example of these are, close contact with users through fieldwork, observation, participation, and interviewing them to gain information about their perceptions, feelings, and problems.
However, there are two important differences to consider:
Goal: Anthropologists use ethnography to understand human behavior, whereas marketers seek to understand the perspectives and activities needed to develop products that satisfy customer needs.
Time: The different focus between anthropologists and marketers has implications in the ethnographic process. Academic researchers normally dedicate long periods to data collection, whereas marketers adopt a rapid approach with emphasis on application of the data.
Why Is Ethnography Important In Medical Devices Development?
Ethnography promotes innovation
The first element of the creative thinking process is problem finding; customer observation is without any doubts a valuable tool in this context. It allows the observers to understand users, see first-hand how they act, what they want, and what their attitudes, perceptions, and behaviors are.
Which means that the observers can discover unmet needs, unique problems and understand the impact of a product within a specific context.
Ethnography can be helpful in finding application or optimization of new technologies. Customer observation in the field helps to identify potential uses for new products and technologies. Observation can be helpful for engineers, technologists, designers, etc… to understand how the user acts and works in their natural environment.
Ethnography is a fundamental tool to generate user-driven innovation through understanding the customers, uncovering their needs and involving the end user in the innovation process.
Ethnography complements other VOC methods
Observation in a natural setting can offer access to insights that might not be available through interviews, surveys, focus groups and other tools. Ethnography is an effective way to identify latent customer needs. That is because users are not necessarily able to precisely communicate what they need; and latent needs are often difficult to articulate in interviews.
In some cases, the customer may not even have realized the need or may consider a problem embedded in a technology as inevitable.
The need for observation is also related to the fact that what people say, what people do, and what they say they do are not always the same thing.
There are several reasons why customers might not be able to accurately describe their own activities or would describe their actions differently from their reality- sometimes it is not socially acceptable or they simply tend to forget.
For example, nobody will tell you that they are not following the instructions for use of a medical device, but we all know that this behavior is very common.
Hence, Ethnography is very powerful in finding incoherence between what is said and what is done.
Ethnography avoids imposing experiences and worldviews
If you’re not very familiar with the different contexts of use, then take the example of country specific clinical approaches; here, the development team risks relying on their own limited experiences and perceptions to fill in gaps in their knowledge.
However, the possibility to integrate different perspectives can help the development team avoid creating products that meet their own needs rather than those of their users.
How Ethnography Is Done
Step 1- Setting Objectives:
Before even starting at all, the objectives of the ethnography must be set, defined, and agreed on.
Possible appropriate objectives are:
- Reveal unmet needs and wants
- Gain insight into a particular niche or other potential market segments
- Learn how customers use a product or service in their everyday life
- Discover product decision points
- Find and document the real benefits for customer experience
- Probe problems and opportunities associated with complete cycle of care
- Understand and document the pain points
- Learn selection behavior in a specific clinical setting
- Test new products in context
Note:
This list is not complete and there are many more objectives that ethnography can help to fulfil; however do not ask the ethnography to produce data as a quantitative technique.
Step 2- Recruitment:
Gaining access to “appropriate” clinical settings to perform ethnography could be challenging. First, the “appropriate” clinical settings should be clearly defined according to the objectives to avoid misalignment.
Second, salesforce contacts and the customer network should be leveraged to conduct observations in “appropriate” settings in different facilities, countries, etc. It is also important that the group of customers observed may be diverse, but representative of the target customer.
Step 3- Field work:
Depending on the objectives of the ethnography, the observation could be limited to the procedure or span the entire cycle of care (preparation, procedure, post-operative care, discharge, etc).
The observers, always according to the objectives, can collect the perspective of different stakeholders. Such as the patient, the surgeon, the nurse, the administrator, the payer, etc.
It’s important to develop a plan for the observation and related discussion. Also, all the observers must have a pre-defined role(s), which includes taking notes, photos, videos, asking questions and leading discussions.
That is because the more the visit is pre-structured, the higher are your chances of collecting useful information.
In my opinion the correct number of observers is two. Going alone is not impossible but it requires solid skills and could be very difficult to collect all the insights.
Three observers will facilitate the collection of data but will make it more difficult being seen by the customers as team members. The observers’ goal is to get in someone else’s shoes; therefore, they should try to establish a relationship.
Being considered part of the team is not easy, but it must be the first goal because the customers will not share feedback and opinions that might reveal problems or needs, with strangers.
To be accepted, the observers must be engaged in the activities and live the observation time as the customers, for example joining them in the cafeteria etc.
More so, the observers must have a clear understanding and some knowledge of the medical situation that will be observed. This will help to portray them as professionals with a genuine interest and will facilitate the collection of useful information during the observation.
Step 4- Data collection:
There are different ways to gather data during ethnography in a medical environment, but the most common of them all is taking notes.
However, new technologies allow something that a few years ago was impossible, which is gathering data through video, audio and pictures.
It is important to complete the documentation during or immediately after the observation to be accurate and avoid forgetting facts. The level of details of the notes could be variable although never minimal; observers should always follow the same routine, capturing key elements and paying particular attention to some “red flag” which might signal opportunities.
Some examples include:
- Risks for patients or healthcare providers
- Total time for the complete cycle of care
- Stress generated
- Malfunctioning of equipment or devices and implications
- Uncertainty and difficulty to take decision
- Dogma and established beliefs (we have always done it in this way)
- Inefficiency and costs (people involved)
- Lack or difficult transfer of information
Step 5- Data analysis:
Ethnography produces a high volume of raw data such as notes, lists of behavioral observations, pictures, videos and audio; therefore, data analysis and interpretation can be challenging. If possible, the data analysis should begin while the data is being collected, so that the observers can easily decide whether to probe some leads for further investigation or not.
Synthesizing the data is labor intensive and should involve multiple members of the team.
Organizing data involves the following:
- The data must first be grouped into basic categories, for example, setting, types of activities, events, special signals, process, phrases etc.
- Search for pattern and outliers:
- Once organized the data the team should try to identify patterns. Situations, events that do not fit with the rest of the findings must be identified. These cases should be isolated and further investigated or dismissed.
Ethics in Ethnography
Ethics in ‘Ethnography Performing’ in a medical setting is not the same as performing ethnography in a store or in an office. There are different rules in different countries, but in general, observers should be very respectful of the environment, remembering that they are providing medical care to real patients.
Likewise, the privacy of the patients must always be protected and any request from the facility in order to observe, should be satisfied.
Limitations of Ethnography
Although ethnography is a useful tool, there are few limitations that you must be aware of to get the best results. And I’ll be discussing some of them below:
Observer Effect
The first is the “observer effect” also known as Hawthorne effect. It refers to a type of reactivity in which individuals modify an aspect of their behavior in response to their awareness of being observed.
For instance, surgeons, nurses, other providers or patients may change the way they perform tasks or respond to problems when they are being watched.
However, this effect can be minimized if the observers become part of the team. Thus, in this way the stakeholders become more comfortable with the presence of the observers and less controlled about their actions.
Validity Of The Data
At the end of the ethnography the observer must be confident that the data collected represent the reality of the target market or segment.
As an observer, you need to be pragmatic and perform observations in several different settings to collect sufficient insights. However, ethnography is not suited to scope a wide market.
Findings can suggest strategic and tactical direction for product development, but the findings may or may not be representative of the entire global market. The results should be validated with other tools, such as a quantitative test.
Resources
Ethnography can be very labor intensive and time consuming, and observers can spend several days in the field.
It is difficult to estimate a priori how much time and resources should be dedicated to observations, and almost impossible to get the right sample size due to the cost.
Hence, judgement should be used during the ethnography to evaluate the benefit of continuing the observations.
When the flow of insights and new ideas is reducing, and some elements repeatedly emerge, then it is probably time to stop.
Observer Bias
As the observers become familiar with the setting and develop empathy and a kind of relationship with the customer under study, they get access to deeper information. However, they will lose the beginner mindset and become more biased.
Observers must be aware that going into observations with the wrong mindset will prevent them from picking-up little details that could lead to innovation.
Inefficiency And Unpredictability
Ethnography, as many field activities, inherently lacks the level of structure and control found in other settings, eg, laboratories that may help with objectivity, efficiency and predictability.
It may take few observations to identify significant opportunities or in some cases several might not be enough. Due to the volume of data collected, analysis and interpretation might become difficult and long; moreover, the results may need to be re-validated with other methods frequently.
Conclusions
Ethnography is an extremely valuable methodology that can be used to collect the VOC because, as already discussed, what people say and what they actually do are not necessarily the same.
Observing stakeholders using products and behaviors in a real-world clinical setting can help identify needs that hardly can be collected otherwise.
Furthermore, relying on interviews or observations alone is not a good idea since the two techniques work best in combination. Hence, following these suggestions can help you add a powerful tool to your Voice of the Customer.
What are your best strategies to collect the VOC? Share your thoughts in the comment section below and if you like the content of this blog don’t forget to subscribe.