Customer Discovery
Not a Lie, but Not the Truth
Why people are unreliable narrators, and what the best companies are doing to shatter hypotheses and uncover truths that become the difference for their teams, products, and, ultimately, customer satisfaction.
Companies that invest the resources to deeply understand their target audience’s behaviors, preferences, and pain points are primed to create innovative products that stand out and win in today’s market. If discovery is table stakes and insights are the currency of innovation, then the detail and depth of an insight make it highly valuable.
When we’re trying to fully understand a process, workflow, or behavior, we find that certain discovery approaches more reliably uncover nuanced and surprising insights than others. One of our best discovery tactics is ethnographic research.
The Method
Ethnography involves hands-on, on-the-scene learning — and it is relevant whenever we are trying to learn about a process or how a certain audience behaves. Ethnographers observe life as it happens, instead of trying to recreate situations or rely on descriptions of events. In business, this can look like researchers watching how target audiences conduct their work in the field, how consumers browse and make decisions while shopping, or how people interact with existing products and technology.
“We Know The Process”
While ethnography is extremely valuable at excavating the details of real behaviors, it can be easily overlooked. Companies typically think that they understand the processes that they are improving. This is a reasonable bias; after all, stakeholders have built their entire company around a believed understanding of their target audience and the problem they are solving. While they may have a good understanding of the fundamental process — and even if they began as a member of the target audience themselves — they are likely now quite removed from the day-to-day, hour-to-hour realities of their customers and their workflows. Plus, behaviors might have changed over time, often due to technological advances.
We see it as our job to view our stakeholders’ understanding of a process or set of behaviors as hypotheses that we can either prove or disprove. As outside observers, we bring an unbiased, beginner’s mindset to the experience and allow our observations to follow where our subjects guide us rather than look for what we expect to find.
Why Not Interviews?
Interviews can be an extremely valuable research tactic when used strategically; however, we have to recognize the truth — people are unreliable narrators. Think about this: the interview itself is an interaction with social dynamics at play. People want to seem trustworthy and competent, so they create coherent, rational narratives. Whether conscious or not, they want to make sense of how they behave and convey it in a way that the interviewer can easily understand and agree with.
People also leave out details about their experiences. The intricate nature of activities makes them hard to explain — try explaining how to tie shoelaces. They might also feel that by getting too in the weeds, they’ll lose the interest of their interviewer. Even in an interview, people are storytellers and entertainers.
This is why we need ethnography — first, to get an untranslated view of a target audience’s behaviors and secondly, to see the details and nuance of a process (noticing that a person is standing up rather than sitting while doing this work could be a huge insight).
During ethnography, we don’t want to disrupt the person in their environment. We take notes and allow them to guide the experiences. Interviews then become extremely valuable after ethnography as a means to ask people why they do something a certain way, how they are feeling in a certain moment/situation, or what they would want to be different. We can also then use interviews to validate what we have seen during ethnography across a wider swath of the target audience.
Ethno in Action: A Home Health Startup
Recently, a home health agency came to us interested in using AI to innovate their business. Through stakeholder discovery, we learned their team’s hypothesis was that the process for nurses to write a visit narrative after providing care for a patient — a Medicare requirement — was the biggest pain point in their workflow. It seemed like a perfect use case for an LLM-powered solution.
Both our team and the client wanted to explore this hypothesis – Was this truly the greatest pain point or were there others? To identify the right problem to tackle, our team needed to understand the intricacies of the entire care delivery journey, from intaking a new patient to billing. That included deeply understanding home health nurses’ experiences and processes, as well as other agency employee workflows.
Getting into the details
Over several days, our team took a deep dive to observe employees in their day-to-days, cataloging nearly every minute through audio, photos and videos. We also collected hundreds of artifacts, such as patient records, handwritten notes, and policy manuals.
One day, we rode along with a home health nurse as she conducted start-of-care visits (the first time a nurse sees a new patient). Our researchers started that morning by meeting the nurse at her office, hopping in her Jeep, and taking a 20-minute drive down rural dirt roads to reach a patient's home. We spent an hour sitting with the nurse on the front porch of the patient’s home, observing how she assessed the patient, what information she wrote down, and how she interacted with her tablet, which housed the home health agency’s assessment software.
After the visit, we traveled back to the nurse’s office to observe how she completed the start-of-care documentation. We recorded the hour-long process, jotted down notes, and asked questions along the way. We noticed that throughout this process, the nurse frequently had to answer the same question multiple times. “I feel like we are constantly doing the same thing over and over again,” the nurse commented.
Over subsequent days, our team observed roughly a dozen employees’ workflows--intake coordinators, billing specialists, coding specialists, QA, authorization coordinators, managers, and other field nurses--recording how each of them navigated their software, and discussing the pain points they encountered.
Finding a new focus
Through ethnographic research, we uncovered that it was not, in fact, the visit narrative -- the original hypothesized pain point -- that was the biggest burden. Most nurses could document those narratives in around 5 minutes.
It was actually the federally-required start-of-care (SOC) documentation that was the biggest pain point, for both the field nurses and other home health employees back at the office. This SOC visit required 2 to 3 hours of assessment documentation and each nurse did as many as four SOC visits each week.
Further, because nurses spend their day caring for patients, they often didn’t have time to complete the documentation until the evening — outside of their regular working hours. Home-health nurses were getting burnt out, not from caring for patients--a job they are passionate about--but rather from these late nights completing paperwork.
Transforming Day-to-Day Reality
Without conducting ethnographic research, it’s unlikely our team would have uncovered these key insights. In initial interviews with agency staff, they highlighted minor issues, such as inconveniences with their software program. They likely didn’t recognize how significant of a pain point the patient assessment was, as it was so ingrained in their day-to-day life and had become routine for them. They just thought that it was understood.
Our findings had massive implications on the direction of the product and digital strategy, leading us to develop a first-of-its-kind, AI-power product and a brand entirely focused on the nurse’s experience.
Instead of removing a minor inconvenience like the post-visit narrative, we were able to focus our MVP development on slashing the time it takes to complete SOC documentation down to the bare minimum--from 2 to 3 hours on average to 15 minutes.
Even in its early stages, the impact of this product has been transformative. In the words of one nurse: “I can tell this was designed for nurses. It’s like Apricot read my mind and gave me exactly what I need.”
Ethnography: One of the Biggest Assumption-Busting Methods
Ethnography is a powerful tool. When you’re looking for opportunities to innovate a current workflow, when you need to understand how your product is actually being used, when you recognize that there are key assumptions around your customers and their needs,, or any time that you have a question about a process or behavior--ethnography is likely the answer.
In almost every case a team with outside perspective will notice things about your audience’s experiences that you overlook, downplay, or ignore. Ethnography can be the most powerful tactic in the researcher’s toolkit, especially so when supported by market research, customer surveying, and customer interviews.
Our best advice for a team feeling stalled? Get out into the field.
