Over the last 50 years, the healthcare industry has undergone a gradual shift from a paternalistic “doctor knows best” attitude, to a recognition that providers and patients must share responsibility in the quest to improve patient health. To help patients do their part in this new paradigm, providers must work with them to design treatments and self-care processes, or health solutions, that patients can realistically incorporate into their lives.
The Theory of Jobs to Be Done is a helpful tool toward this end. Based on our research on consumer purchase decision-making, it explains that everything we do (including doing nothing) we do for a reason that’s valid to us, even when our behavior may seem self-defeating to others. That reason is to make progress according to our own priorities, in a particular set of circumstances. That is, to do a “job.”
The theory further tells us that each job is actually a bundle of functional, social and emotional needs and aspirations, all of which serve as “hiring” criteria for potential solutions. For instance, a retired couple with the job, “downsize our home” won’t just be looking at potential properties’ functional specifications, such as square footage and number of parking spaces. They’ll likely also be considering whether they “feel at home” in a given space, and checking out the surrounding neighborhood to determine whether it offers the sense of community and type of leisure activities they seek.
In a healthcare context, Jobs Theory asserts that the way to unleash people’s potential to better manage their health is not by trying to get them to prioritize health goals over the life jobs they’ve already deemed most critical to do. It’s by understanding those jobs, and helping patients find ways to do them that enhance their health, rather than detract from it.
As a very simple example, a man with the job, “feel less lonely” might hire a smoke break with colleagues each hour at work, log more hours on Instagram, adopt a cat, or join a walking group. Each of these solutions could increase his feelings of connectedness. And each has health consequences, ranging from positive to negative, that he may or may not recognize. Jobs Theory gives patients and providers a framework they can use together to identify, design, and facilitate patients’ adoption of solutions to their life jobs that have positive health consequences.
Iora Health, an innovative primary care provider operating across the U.S., implicitly takes a jobs-based approach to care. As Iora’s Dr. Andrew Schutzbank explains, this approach shifts the content of the provider-patient relationship from, “Here’s what you need to do, or else!” to “How can we help you live your life to solve more than one problem at a time?” And it transforms the interactions between provider and patient from a string of (often inefficient) transactions into a continuous, collaborative exploration of the patient’s circumstances, beliefs, values and capabilities.
This exploration opens up a whole new universe of realistic health improvement opportunities that the provider, working in context of an innovative business model, can help the patient pursue over time. It also puts provider and patient on genuinely equal footing. Patients are expert in the primary realm of inquiry: their Jobs to Be Done, the success metrics for those jobs, the solutions they’re currently hiring to do them, and the kind of support they’d need to adopt healthier ones. Providers possess (or can develop) the scientific and practical expertise to help patients understand the patterns in, and health consequences of, their behavior, and to design health solutions that do patients’ jobs, while driving improvement in important clinical metrics.
Finally, stepping from the individual level to the system level of care delivery, Jobs Theory provides a “true North” for design of institutional processes, from resource allocation and performance measurement, to employee and external partnership development. When these are aligned with a jobs-based approach to care delivery, it’s not only a system’s health solutions that help patients make the progress they seek in life. Patients’ every encounter with the system contributes to that end as well.
It may be tempting to believe that health behavior is mainly a matter of priorities: People who really care about their health will do whatever it takes to maintain or improve it, and people who fail to must not really care. Jobs Theory helps explain why that’s not the case, and how providers can work with–not against–patients’ values and circumstances to help them gain competence in health self-management.
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