Mitigating the scourge of chronic disease, which afflicts more than half of Americans and consumes 86% of our nation’s healthcare expenditures, depends heavily on patients’ ability to improve their health behaviors. Yet individuals are often blamed and shamed for not adhering to prescribed regimens that are constructed with little consideration of the unique barriers they pose to adoption.

In Health for hire: Unleashing patient potential to reduce chronic disease costs, my colleagues Clayton Christensen, Andrew Waldeck, and I propose a framework providers can use to take patients’ individual circumstances, values and priorities into account, and thereby create treatments and regimens they actually have the capacity to embrace. The key to this framework, according to our research, is uncovering patients’ Jobs to Be Done—that is, the life progress they’re trying to make at a given moment in time.

In the United Kingdom, the 30-year-old Bromley by Bow Centre illustrates the potential of this framework. Located just outside London in one of England’s most deprived boroughs, the Centre is home to a primary care practice, a church, a café, and over 100 locally-owned social enterprises offering locals everything from job training and financial counseling to childcare and low-rent art studios. It has a simple, yet ambitious goal: to help residents of the borough “build up the skills and confidence they need to progress in life.”

The Bromley by Bow Centre recognizes that all individuals have a unique definition of progress. For this reason, physicians and social advocates at the Centre use its many community touchpoints to get to know residents’ Jobs to Be Done.

Taking the time to understand residents’ jobs enables physicians and social advocates to connect them with health and social services that address their particular problems; and to tap their passions in a way that serves their personal aspirations, as well as their community. The Centre also serves as a hub for integration across social services, by hosting programs like a monthly breakfast for community service providers.

Even the physical space at the center invites connection and collaboration. The small, attractive campus is built around the Centre’s popular public café and gardens. The tenants’ help desk for local public housing is co-located within the primary care practice, creating opportunities for physicians and tenants to engage on health and social needs topics, with the latter’s permission. And winding pathways throughout encourage conversations between staff and community, while subtly suggesting the full range of supportive services available to all.

Despite high poverty and other extreme challenges to health and social welfare in the population the Bromley by Bow Centre serves, health outcomes for its primary care practice patients meet or exceed U.K. averages. Healthcare innovators tackling chronic disease can learn from the way the Centre uses careful, integrated design of services and space to discover the life progress residents seek, and support them in making it through improved health and welfare.


  • Rebecca Fogg
    Rebecca Fogg