Over the past few days, I've been re-reading Paco Underhill's brilliant book, "Why We Buy." He is a cultural anthropologist who goes out to the field (e.g., shopping malls) and uses ethnographic tools to understand how retail customers actually buy things. It turns out that most retail organizations do not have the faintest idea of what creates customer satisfaction, and Underhill has a deservedly lucrative consulting practice in telling them.

I mention all this, because it occurs to me (yet again) that nonprofit organizations do not have much insight into how to structure their services so that they will satisfy their clients, constituents, donors, and volunteers - not to mention how to serve the needs of staff members, who are key stakeholders and whose job satisfaction is an important factor in the delivery of high quality services.

Perhaps another way in which nonprofit sector should be run more like the for-profit is that we should be availing ourselves of Paco Underhill's ethnographic insights about what it is like to be on the receiving end of an organization's services.

And now for a not-very-random example from my own experience:

My primary care physician practices at a city hospital that is also a teaching hospital for a large medical school. There's no lack of brains or of orientation to public sevice in this organization.

Several years ago, the hospital undertook a major renovation and built a new wing. After being housed in makeshift quarters for all of those years, the primary care center was finally relocated in a space specially designed for it in the new wing.

Entering the new primary care center for the first time, I noted that there was no place for patients to hang up their coats and umbrellas. (This is in Massachusetts, where we use coats and umbrellas approximately eight months a year.) I pointed this out to my physician, adding that it was quite easy to see that this hospital was not run for the convenience of the patients. His response was that he didn't know whose convenience was being served but it certainly wasn't that of the physicians, either.

What went wrong there? Why didn't the hospital bring in someone (such as Paco Underhill) to stand around for days at a time, watching and listening to patients and staff actually navigating their way though office visits and medical procedures?

Can it really be that it's more cost-effective to skip that step, and then to have members of every stakeholder category nursing an implicit or explicit grievance about the way things are structured?

And how often do we make that mistake in nonprofit technology?