Over Thanksgiving, I found my copy of the book If Disney Ran Your Hospital. When rereading the book, I remembered an interesting story from Disney World that really drove home the power of understanding human behavior. 

Many people don’t think about the placement of trash cans, but Disney did. Employees watched Park guests to see how far they’d walk holding trash before just tossing it on the ground. They then took the average number of steps people took, and placed the trash cans that far apart throughout the Parks. Now, there’s virtually no litter at Disney World. Why? Because Disney observed and then designed a solution around their consumers’ behaviors. As a result, they immediately saw the results they expected. 

Observing and acting upon consumer behavior seems like a simple enough process. Yet many organizations, and health care is no exception, implement changes and solutions to problems based on what executives believe customers will do or use, rather than what their behavior demonstrates. 

Jobs Theory and ethnography

The theory of Jobs To Be Done looks at why people do or do not make certain decisions. People “hire” or “fire” products or services based on the specific progress, or job, they want to make in a given situation. Disney guests “hired” littering, or conversely “fired” taking the time to find a trash can, for a specific reason; for example, the job in this case could have been “I want to enjoy as much of my Disney trip as possible,” and taking the time to find a trash can just did not help advance that job. 

Assessing a patient’s Job To Be Done involves a lot of communication and knowing how to ask the right questions to accurately assess their job. But even absent an in-depth jobs screening, knowledge of consumer behavior patterns can provide helpful insights into what can, and should, be done to help individuals hire new, healthy behaviors. 

Ethnography, the scientific description of the customs of individual peoples and cultures, is one pathway to uncover this knowledge. In health care, ethnography involves observing and understanding patients within the rhythm of their lives, not just within the exam room. This understanding enables providers to tailor services and programming for each individual based on how they live their lives in the community.

There are health care providers who do this well. CityBlock Health, for example, builds  their health clinics as community centers, or what they call “community hubs”, to better understand their patients by providing an environment that isn’t solely clinical. Each patient is assigned a Community Health partner, who is hired from the community and gets to know each patient on a deeper level. Together they work to design care plans that specifically meet the individual’s social and health care needs. 

When it comes to developing programming to positively address patient social and clinical needs, it is not enough for innovators to establish solutions based on perceived outcomes from assumed behavior. Simply assuming that people will act in a certain way does not accurately address why someone will act accordingly, or desire the opposite. Making or taking away specific programming without actually taking the time to understand consumer behavior can create a situation where the intended results are not realized; it can even create unintended negative results. Disney did this themselves; when seeing the trend in online shopping, they closed down all physical Disney Store locations. However this decision neglected the convenience of local stores and the influence that those had on driving park visitation. 

Health care falls victim to this as well, particularly in efforts to address the drivers of health. One health care provider in Philadelphia noticed an alarming rate of missed appointments, and assumed (maybe fairly so) that the issue was a lack of transportation; so the provider implemented a program to give patients access to transportation to and from appointments. But transportation wasn’t the main issue—in fact, it was such a non-issue that the no-show rate virtually remained unchanged. 

Disney’s trash can example is just one example of how tuning into consumer behavior can improve consumer experience. The beauty of this example, in my opinion, is its simplicity. When looking to solve a consumer problem, Disney went right to the source to devise a solution. Implementing health care programming is, admittedly, far more complex than installing trash cans. But the underlying principle is the same: looking at what consumers do, and why they do it, is a powerful tool in program design.

For more on how to execute this approach, check out these resources on jobs interviewing and ethnography.


  • Jessica Plante
    Jessica Plante