From Diagnosis to Discovery WHEN THE CONTRACT is clear, the work of understanding the prob- lem and the current reality begins. Our focus here, as throughout the book, is on the relationship aspect of consulting. Your particular area of consulting expertise will determine what kind of specific data you will collect. Systems people will look at information require- ments, engineers and scientists will look at the technical questions, financial experts look at money and economics, and so it goes. As each of us developed our expertise, we were trained in handling data and information. The intent here is to identify some particular skills in this phase that have not received much attention but are also important. This chapter does not begin to cover all the methods that can be applied to understanding what is happening. It does look at the way the consultant works with the client in what was tradition- ally called the diagnosis phase but is more accurately called discovery. There is in this phase a tension between what the client may want and expect and what is most likely to be helpful. The fundamental service we offer clients is to help them see how they can make changes in the future without having to stay dependent on our expertise. While clients may agree with this concept in theory, it is not what they want in practice. In practice clients want a turnkey solution. It is similar to when we are not feeling well. We want to go to a doctor, get a prescription, swallow a pill, and get on with ourcalled in, it is because the line manager's attempts at solving the problem have not been that successful. Or maybe the manager has no idea at all how to solve the problem. When a manager's attempts to solve the problem have not succeeded, it is probably because the manager's attempts to describe the cause of the pain have been inaccurate. The client's initial attempt to describe to us the cause of the diffi- culties is called the presenting problem. As a consultant, I never accept the presenting problem as the real problem without doing my own data collection and analysis. The presenting problem and the real (or underlying) problem are usually different. Because the line manager started from an incomplete definition of the problem, his attempts at solution have not entirely worked out. An impor- tant contribution for the consultant is to redefine that initial prob- lem statement for the client. Here's an example of how presenting problems get redefined. A large technical organization was having difficulty retaining new employees more than two to three years. The people would come to work, get training, work on the job for awhile, and then leave just when they were becoming valuable employees. The managers asked the first-line supervisors why the younger people were leave ing. The supervisors said there were two reasons. 1. Salaries weren't high enough to match the cost of living in the area. 2. Housing was very hard to find. Apartments were scarce and those houses for sale were so expen- sive that an employee had to save for ten years to have enough for the down payment. Top management accepted these two reasons as valid. They conducted a salary survey and made some adjust- ments in the compensation practices for short-service employees. They also created a housing section in the 180 Flawless Consulting, Second Editionwith human systems, and human systems are not amenable to tech- nical solutions. Human systems are complex and require more than mechanical, cause-and-effect solutions. Furnaces and software most often break down because people run them, people maintain them, and people ask them to do things they were not designed to do. The resolution of the problem most often requires a change in thinking and action on the part of the client, and this is the challenge. When we accept the term "diagnosis" as a description of this phase, we reinforce the belief that a prescriptive, engineering strategy can improve a living system. This rational stance undervalues the emotional and affective requirements of real improvements. The stance we want to take is that we can be a guide through a process of discovery, engagement, and dialogue, in which our clients will find an answer to their question and launch an implementa- tion that will be enduring and productive. It may seem like play- ing with words, but it makes a difference in what we do and what we leave behind. This chapter details the kind of discovery, engagement, and dia- logue that gives us our best shot at building client capacity and solving problems so they stay solved. The concern of the consultant is how to help the client to be open to the discovery process. This is much more important than for us to be right in our analysis. This means giving more attention to dealing with resistance. It also demands work on building the client's inter- nal commitment to the process at each step of the way. To wait until the feedback meeting to worry about client acceptance of recom- mendations is too late. The consultant is also concerned about how to handle the politics and personalities surrounding data collection. Even the most technical problem is managed by human beings, working in politically minded organizations. Navigating through our clients' management styles and organizational politics and help- ing them to look objectively at the data are vital tasks. The skill for the consultant is to address the organizational element of each prob- lem as rationally as we address the technical part of each problem. From Diagnosis to Discovery 175Scientists Technical/Business Problems How the Problem Is Being Managed Understand the basic nature of some . It is easy to hire a new chemist, but there material or reaction are tight budget controls on adding lab Identify products for commercialization technicians, equipment, or adequate space . Transfer their technology to the marketing Research, under pressure for results, over- or business groups promises, builds expectations, and then disappoints . Scientists are under such tight influence from business, no long-range viewpoint is possible . Such strong pride of authorship that it creates resistance in other groups in organization . Cultural gap between science and opera- tions people. Have different values, speak different language Corporate Technical/Business Problems How the Problem Is Being Managed Planners Do longer-range planning for the organization * Managers view five year plan as just an . Obtain figures and projections from line exercise managers . No personal commitment from top man- agement . Strained relationship and distrust between corporate and field organizations Personnel Technical/Business Problems How the Problem Is Being Managed . Improve policies and practices in areas of . Every manager is an expert on personnel compensation, benefits, recruiting, training . Personnel function is a low-status group . Improve general organization and manage and is treated accordingly ment development . Personnel specialists used as a pair of hands . Managers fear personnel will be involved in their performance evaluation, so they are reluctant to trust and include personnel 184 Flawless Consulting, Second EditionIf the client problem were purely technical, then client commit. ment would not be a concern. But there are no purely technical problem. As consultants, we always have a perspective on how the technology is being utilized or managed. Even if we hire a con tractor to install an electricity generator to power our house in event of a power outage. there are still questions of what size gen; erator, where it should be placed, which technology is best for our lifestyle and budget, and who will run and maintain it. A good contractor will as]: questions about client expectations, who in the household will be operating the generator, how much protection the household needs, how important having instant power is to the family, and most difficult of all. is there agreement in the fam' ily about the answers to these questions. These are questions about howr the "prol-zrlen'i"r is being managed, what it means to the \"client." what attitudes surround the seeming- ly simple step of purchasing some technology. A good contractor will treat these questions as being as important as the knowledge of how to purchase and install an alternative power source. If you tall: to architects and contractors. the hardest part of their job is dealing with client doubts and family dynamics. Designing and building a house they know how to do. Navigating their way through the pol- itics of the family is where the challenge lies. if this is true for a family. it is magnified when dealing with an organization. The politics of an organization is reality, always pre- sent and powerful, and this is the challenge of discovery and action. The pa rpsse, their. ofdiscoiery is to mobilize action on a problem. Action that will improve the organization's functioning. The purpose is out research. Research is aimed at simply understanding some- thing and heats the understanding itself as enough. in most cases. internal consultants are evaluated on how well their expertise is utilized by the line organization. External consultants, as well as seeing clients. evaluate them this way more and more. This emphasis on action and utilization has strong implications for how you approach discovery. 11'! awless Consutttng. Second Edition Research Approach Action Approach Interested in all factors that Interested in factors that are impact the problem at hand under the control of the client and affect the problem Being comprehensive and Completeness and comprehens complete in the discovery siveness are not necessary. phase is essential They can be overwhelming at the point of deciding what to do You can do research on The client's involvement in the your own. The organiza- study is important at each tion doesn't have to be stage involved as part of the research team You try to eliminate bias Consultants are getting paid and intuition of the for their own bias and intu- researcher. Heavy emphas ition-it is called judgment. sis on objectivity and hard You use all the feelings and data perceptions you have in addi- tion to hard data Essentially neutral toward Deeply concerned about the whether the organization attitude of the client toward approves of the outcomes the outcome of the study of the study These distinctions in approach may be overly polarized, but you must know that your objective is action, not understanding. When your objective is action, you need to concentrate on four things beyond the technical considerations. 1. Keep simplifying and narrowing and reducing your study so it focuses more and more on the next steps the client can take. 2. Use everyday language. The words you use should help the transfer of information, not hinder it. From Diagnosis to Discovery 177Figure 9. Continued Marketing Technical/Business Problems How the Problem Is Being Managed Research. . Policies on pricing, promotion, and packaging . Distrust and distance between marketing Product . Information on customer preferences and and the sales force Management market characteristics . Struggle for control . Market research operates as a black box. Rest of organization operates on their pri- vate opinions, doesn't believe the black box Management and Technical/Business Problems How the Problem Is Being Managed Organization . How to improve attitudes and productivity . Certain individuals and groups have a lot Development of an organization of power under the current system. Consultants . New organization structure Changing the structure will change the . New roles and responsibilities power balance among groups . A new structure signals who is on the way up and whose star is fading . A very authoritarian manager may not care about how people feel Purchasing Technical/Business Problems How the Problem Is Being Managed . Maintain good relationship with vendor, get . Material requirements are always chang best price and quality, assure at least two ing. Purchasing is the last to know vendors for each raw material . Management allows line organization to contact vendors directly without including purchasing Each discipline or function is faced with both technical and organ- izational problems. The presenting problem is almost always about the technical/business problem. Organizational problems include how the technical/business problem is being managed. The choice is whether you want to address how the problem is being managed directly or indirectly. To address the organizational side 185initial problem statement led to solutions in the form of compensation and housing aid. The consultants devel- oped a different explanation for the pain and essentially redefined the cause of the problem-new hires were not given enough support, attention, meaningful tasks, and feedback. Once management had this redefinition of the problem, they could start to solve it, which they did. They began a series of programs to have supervisors and new hires contract with each other for how much time they would spend together, the tasks they would be assigned, and when they would get feedback from the supervisor. Management also supported the supervisors in devoting more time to new employees. Over the next year, the turnover rate leveled off and in the second year began to go down. The contribution of the consultants was to redefine the presenting problem and to present to the client a clear picture of what was causing the difficulty. How the This is a critical area of inquiry in action-oriented data collection- Problem Is how the technical or business problem is being managed. Being Consultants are usually aware of the client's management style and Managed the politics of the situation, but we tend to shy away from dealing with them as part of our consultations. We feel that we have been asked to solve a business problem, not to comment on the organiza- tion. As a result, we tend to exclude organizational problems from our field of inquiry. We don't ignore the "human" problems entire- ly, though, for these are the things we talk about most with our col- leagues and friends. The way the problem is being managed usually gets discussed in the rest room, between meetings, after work when we are eating or drinking, or during breaks during the day. Sometimes the management issues are even more interesting than the technical issues. But there is a part of us (with support from the client) that does not want to get into the "personalities" or "poli- tics" or "relationships." It is a mistake to avoid these areas. The 182 Flawless Consulting, Second Editionwork. Better living through chemistry. When line managers decide their organization is not functioning well, they want someone to come in, take a good look with fresh eyes, and suggest a solution that will be quick, cheap, and painless. That is why the first ques- tions from the client are, "How long will it take?," "How much will it cost?," and "Give us a solution that will cause the least disrup tion." If we give the clients precisely what they ask for, we run the risk of not having served them well. If, however, we tell the client that the solution will take awhile, will cost more than they imagined, and more time and involvement will be required of them than they want to give, we run the risk of alienating them. Some of this will have been dealt with in the con- tracting phase, but this tension exists at every step of the way. What is hard to realize as a client is that the long-term solution to the problem will require some rethinking on their part and some rearranging of the way they work together. This relearning is what takes the time and effort. You can outsource or contract to an out- sider the research and technical problem solving, but implement- ing and sustaining a solution you always have to do yourself. We serve the client best by breaking out of the medical model we have come to expect. We are not an organization doctor who describes their symptoms, who looks them over, prescribes a solution, and sends them on their way. Better to define our task as a process of discovery and dialogue more than as an act of diagnosis and prescription. The term diagnosis implies that a third party, the consultant, can analyze the situation, come up with an accurate picture of what is wrong, and deliver a recommendation for corrective action. And that this will be useful. This frame of diagnosis and action is a comforting problem- solving model, but it is based on the belief that organizational improvement can be engineered. Most of the time this is not realistic. For strictly technical problems, such as a furnace that doesn't work or software that has crashed, this might seem reasonable. Especially if we were dealing with exclusively technical problems. It is rare, however, that problems originally defined as technical are amenable to strictly technical solutions. We cannot ignore that we are dealing 174 Flawless Consulting, Second Edition3. Give a great deal of attention to your relationship with the client. Include the client at every opportunity in deciding how to proceed. Deal with resistance as it arises, even if it doesn't have impact on your results. 4. Treat data on how the client organization is functioning as valid and relevant information. Also assess how the problem you are studying is being managed. These four competencies affect how your expertise gets utilized. They take your technical skill and problem-analyzing, problem- solving abilities as givens. This action orientation makes the assumption that client readiness to accept your input is as important to discovery as the technical analysis of the problem to be solved. Figure 8 shows the basic sequence for the discovery phase. Figure 8. The Discovery Model Presenting Problem Redefinition of Problem Clear and Simple Picture of What Is Happening How the Problem Technical/Business Is Being Managed Problem Recommendations 178 Flawless Consulting, Second EditionThe client gives you a . . . . . . . . . Presenting problem You begin to . . . . . . . . . . . .... .Redefine the problem or the cause of the problem Your goal is to develop . . . . . . . . .A clear and simple picture of what is causing and main- taining the problem Included in this clear and simple picture is a description of . . . . . . .The technical or business problem the client has asked for help on And also a description of . ... . . .How that problem is being managed-the attitudes of people, the manager's style, and the politics of the situation that affect the technical/business problem Both of these descriptions lead to . . . . . . .Recommendations on the tech- nical solution and on the man- agerial solution. uggling the Often the consultant's most important contribution to a client is a Presenting redefinition of the problem. The line manager begins by experi- Problem encing some pain. People are restless. Equipment isn't working. Output is down. Bills are being paid twice. Consulting projects get started because managers feel pain. It would be nice if projects got started because of a desire for further success or for preventive measures, but most often there is some pain in the picture. When the organization feels the pain, managers start to describe for themselves why the pain exists. When their explanation of what is causing the pain is accurate, their attempts to solve the problem are usually successful. When consultants are From Diagnosis to Discovery 179Withholding data on the interpersonal or process dimensions of a problem is to collude with the organization in not dealing with them. Part of the reason they can't manage their business as well as they would like to is because they can't articulate how to han- dle conflict and authority and communication. If you are also unwilling to put those dimensions into words, you're colluding with them in a way that's going to keep them from solving their underlying problems. To summarize, remember to do these things in discovery. Ask questions about the client's own personal role in causing or maintaining the presenting or target problem. Ask questions about what others in the organization are doing to cause or maintain the presenting or target problem. Plan the data collection jointly with the client. Involve your client in interpreting the data collected. Recognize the similarity between how the client managed you and how they manage their own organization. Condense the data into a limited number of issues. Use language that is understandable to people outside your area of expertise. Distinguish between the presenting problem and the underly- ing problem. Elicit and describe both the technical problem and how it is being managed.personnel department to help people find apartments and to work with realtors to identify moderately priced housing in the area. Both of these solutions responded well to the presenting problem of poor housing and unjust compensation. Unfortunately, a year and a half later, the turnover rate for the organization was not reduced, and in some sections it was higher. Top management brought in the training group in the company as internal consultants and asked them for help on the problem. The training people first inter- viewed first-line supervisors and short-service employ- ees. From these interviews came a different explanation of why people were leaving. The employees said: 1. When they arrived they were handed a stack of company manuals and were told to read them during the next few weeks. 2. They didn't get a real assignment until they had been there for almost a year. 3. They never got any accurate feedback from their supervisors about how they were doing. This made it hard for them to know what to work on for their own development. It also left them in limbo about their prospects with this company. 4. The first-line supervisors were under so much pressure to get the work done and to do it per- fectly, they just didn't have the time to spend with new hires. The interviews revealed a very different cause of the pain the company was experiencing in losing so many people. The original, presenting problem was that peo- ple were leaving, and they were supposed to be leaving because of low salaries and a tight housing market. This From Diagnosis to Discovery 181way the problem is managed has a powerful effect on the way our expertise will be used. We can't really avoid it entirely, even when the client agrees that we are only technical consultants. Technical/business problems almost always have accompanying management problems that affect how the technical/business problem gets resolved. Figure 9 shows examples of typical "management problems" that could occur along with technical/business problems in selected disciplines and functions. Figure 9. The Difference Between the Technical/Business Problem and How the Problem Is Being Managed Technical/Business Problems How the Problem Is Being Managed Finance Systems . Inadequate control procedures and practices . Defensive, cover-your-tracks environment . Too many reports . Withhold information and figures . Too few reports . Little verbal communication between groups Engineering Technical/Business Problems How the Problem Is Being Managed . Cost-reduction project . Operators have negative attitude toward . Develop new process or equipment company and supervisors. New procedures . Construction of new facility are resisted . Equipment failure . Supervisors too inexperienced. Passing through the job, don't deal with longer-run issues . Management pressure for product so great that operations will not give engineering any time on the floor to test new equip ment or process . Engineers so busy with crisis after crisis that new developments get low priority . Vice president is so involved in each detail decision of the new building that project is lagging behind schedule From Diagnosis to Discovery 183Overall Challenge: Breathe Biomedical (BBM) is a biotech diagnostics company manufacturing breath analysis products that enables \"early disease detection of cancer and other diseases through breath analysis - the new standard for routine screening and improving clinical trial outcomes.\"[1] They just received an award as a nurse-approved platform to get guidance and go-to-market feedback. They are a subsidiary of Picomole, a Canadian based biomedical rm. BBM would like to determine how to make their product part of routine screening as part of a BtoB or BtoBtoC market play. The challenge? How to help the company sell the product in the retail drug space and the service provider space in the United States. For your assigned target market, determine which indication (e.g. lung cancer, breast cancer, alzheimers, Parkinson's, NASH) would be the most useful as well as how to introduce the product, develop the business development and marketing strategies. All teams will focus on how to market the product to the nal customer using the channels below as an annual multi-disease early stage disease screening toot. 1. Introduce product into accessible pharmacies/heaith systems Le. CVS, Walgreens, Shields, Walmart. (*What is Amazon's play in the pharmacy space?) 2. Introduce product Into Pharmaceuticai(drug developers)/CRO's(contract research organizations for drug development). 3 Introduce product into genetic service providers i.e. 23andme. 4. Introduce product to General Practitioners. 5. Introduce product to Healthcare Systems. I.e. Veteran's Affairs, St. Elizabeth Healthcare Network, Cleveland Clinic. Exercises for students: 0 Determine which companies have most overlap across verticals as key targets to focus on. 0 Perform geographical assessment for go-to-market strategy, i.e. where should we focus rst for best rate of adoption based on patient populations, available infrastructure, payer/insurance preference. Deliverables 0 Identify key target verticals and the corresponding market penetration strategy for the product. 0 Identify the most direct route for a strategic exit. |.e. the least amount of time and cost with highest return for shareholders. 0 Ensure go-to-market strategy accounts for competitive analysis on existing screening technologies (LDCT, PET) and emerging solutions (Owlstone, e-nose, liquid biopsy etc). [1] https:ilbreathebiomedical.comiabouti is riskier for the internal consultant. You might hear clients say that they didn't invite you in to comment on their own personal style or the politics of the situation. To not address the organizational side is to see your technical recommendations distorted and only partially implemented because of the difficulty the organization has in communicating, trusting, and managing itself. A Reminder To consult flawlessly you need to begin to address the organiza- tional side of the problem as a regular part of your consultation. At a minimum, each assessment you do should have one section devoted to how the problem is being managed. This section needs only to present a clear and simple picture; it doesn't need to include specific recommendations. The fear of confronting the client on how the client is managing the problem is a feat that resides within the consultant. Line managers usually want feedback on how they are doing, and they have a hard time getting it. Their own subordinates are reluctant to give them feedback. You, the consultant, are in a special position to provide it. The only caution is to do it in a supportive and nonpunishing manner. (There is guidance on appropriate feedback language in Chapter 13.) DATA ON INTERPERSONAL DIMENSIONS ORGANIZATION CONSULTANT