Elizabeth Lorenzana, a research intern at the Clayton Christensen Institute and undergraduate student at Bryn Mawr College, contributed to the primary research for this article. We also thank Bob Moesta of the Rewired Group for his guidance on the theory and methodology discussed here.

shutterstock_57608926A friend of ours woke up at 4 a.m. on January 7 with a sharp pain in her stomach. Sasha’s discomfort was substantial, but she was scheduled to volunteer at a local shelter that morning and decided to go anyway. That is, until a staffer told her: “Go home. You look sick.” She suffered at home through the afternoon and was forced to cancel a dinner appointment later that night. Finally, she called a CVS retail clinic and showed up at the clinic 20 minutes later. In a small exam room, the nurse practitioner asked a few questions before diagnosing her with GI obstruction. She prescribed a medication, with instructions to visit the ER if the pain worsened. Sasha went home with some pills and her symptoms went away a few hours later.

On the surface, the episode seems straightforward enough. Sasha felt sick, then felt worse, sought medical care, got a remedy, and felt better: end of story. But a deeper look at her behavior unearths some important questions. First, why did she visit a retail clinic instead of a doctor or emergency room? Traditional marketers would say it was because of convenience or low cost. But if time was so important, then why did she wait 14 hours to seek medical care?

It turns out there’s a theory of consumer behavior called “jobs to be done” that is extremely helpful in framing and giving answers to these and similar questions. In this framework, consumers act because they have a very specific, real-time “job” that needs fixing. Everything around them is a tool that they could “hire” to solve it. It’s been only just beginning to be used to study healthcare, so we tried it to see what it could reveal about Sasha’s experience.

We sat Sasha down and asked her to recreate her story. Beginning with the illness, and working both forwards and backwards in time, we developed a “documentary” of Sasha’s behavior. From her detailed story, we learned the following:

  • This wasn’t the first time Sasha had felt this particular pain. It had happened 3 or 4 times before. She always did stretches and drank tea hoping that would help. Before the pain had subsided quickly, but this time it persisted. She was worried it could be something more severe.
  • Sasha’s pain stayed relatively constant over the course of the day, but her energy decreased.
  • Sasha did not start deviate from her normal schedule until someone told her she looked sick.
  • Instead of dealing directly with the problem after coming home that morning, she watched TV and hoped it would go away.
  • She did not decide to visit the retail clinic until after she canceled dinner. Once she canceled, she called to check on the availability, and went to the clinic almost immediately.
  • Sasha made a calculated decision not the visit the ER. She had been thinking about a good friend of hers who had recently visited the ER and ended up “trapped” in inpatient care for a week. She didn’t want to go through that process unless it was absolutely necessary.
  • Because she didn’t know what her problem was, Sasha didn’t know what to do. Instead of deciding to go the ER herself, she decided that although she’d never been to the retail clinic before, they could help her make that decision.
  • Sasha did think about cost, but that wasn’t her main concern. Her insurance was very good and would have covered most of the costs at the hospital or anywhere else.

With this added detail, we were able to better understand the circumstances and value code that created Sasha’s purchasing behavior. It turns out, it was a social impetus that both helped her acknowledge her sickness and seek treatment. She didn’t deviate from a normal course of action until her ability to function socially was compromised. She didn’t start behaving like she was sick until someone told her she should be sick.

Why did she visit the retail clinic? Sasha had anxieties about the ER based on experiences of people close to her. The cons of visiting the ER outweighed the pros of peace of mind that it wasn’t a severe illness, which is why she waited for so long to pull the trigger on getting help. When the pain did not subside, she seemed to realize that she could no longer be responsible for the treatment decision and determined to outsource it to someone else. If we were to approximate Sasha’s “job to be done” in this event, it would be:

Make the decision for me about whether to take a more aggressive treatment strategy for my condition, but don’t make an unnecessarily big deal of it.

For her, the retail clinic perfectly matched that job. It was easy to get in and out, nonbinding, nondramatic (down to a very small room size) and had a trained medical professional who could help diagnose her problem in case it had severe implications. It wasn’t so much the “stop-and-go” or even low cost attribute of the retail clinic that motivated her to go there, so much as the fact that it wasn’t the ER.

It turns out that Sasha was hiring the retail clinic for a very different set of reasons than a traditional marketer might have predicted.

Similar, but different patterns held true for other interviews we conducted around retail clinics. Each “job” has common elements to others, but combines them in unique ways for segments of customers. We can see, for instance, that another common “job” for which a retail clinic is hired is to avoid work or other stressful responsibilities. These patients are, well, quite patient! They are willing to wait hours to get treatment because it both validates their sickness and gives them an excuse to “get out of” unwanted obligations. Another element to their “job” can be to avoid talking with seemingly extraneous people about their condition. These consumers preferred the retail clinic because they could sign in with a computer, thus avoiding the receptionist and/or physician’s assistant at the doctor’s office.

With only a handful of individuals, the “jobs to be done” methodology can begin to uncover the often-misunderstood causes of why patients make the decisions they do. In turn, this can better inform product, business model and marketing design desperately needed in healthcare. Consumers rarely know how to solve their “jobs” upfront—but a well placed product or service that takes into account their habits and anxieties can shorten the time to treatment.

In an effort to fundamentally change how entrepreneurs and providers meet patient needs, we look forward to expanding our application of jobs theory in healthcare. This will illuminate new, powerful insights about why patients do what they do, and enable us to improve or design new services that meet their needs more exactly.


  • Michael Devonas
    Michael Devonas