Understanding Customer JTBD (4 of 8) in Healthcare (Jobs to be Done)

In our next installment of this 8-part series, we delved into the Jobs to be done (JTBD) portion of the modelH Customer Discovery Process. This process is instrumental in answering the crucial questions that complete the JTBD portion of the modelH canvas. Our aim in this series is to assist you in refining your understanding of your customers, thereby confirming the alignment of your value proposition with your customers' needs. This alignment, known as Product-Market Fit, is the cornerstone of a successful healthcare product. In this post, we will also explore Product-Market Fit and how to do it right.

We have a few objectives today:?

• Understanding Jobs to be Done
• Define the questions to ask on the canvas for the JTBD building block
• Get help on how to create healthcare JTBD
• Get help on how to get Problem-Feedback from Customers

Understanding Healthcare Jobs-to-be-done (JTBD)

A "job to be done" is a high-level goal that a person is trying to accomplish. Another way to say it is that "Jobs" describe the things your customers are trying to get done in their work or life. A customer's job could be the tasks they are trying to perform and complete, the problems they are trying to solve, or the needs they are trying to satisfy.

This idea is simple - with profound implications.? Understanding a consumer’s job to be done requires that you resist thinking in terms of your product and service and what you must do to sell, service, or provide it. Instead, think in terms of what the consumer is trying to accomplish. Or, think of it as a promise of value to be delivered and a belief from the Customer Segment that it will be experienced.?

By understanding healthcare jobs to be done (JTBD), we can create a tailored value proposition and an intentional experience. The single most important JTBD in healthcare is “health” itself. Our health JTBD, or some derivative of it, drives the industry. Even with this clarifying fact, and as simple as it sounds, it is difficult to identify a User’s/Buyer’s health JTBD. For example, in physical health alone, there are four sub-categories: wellness, episodic, accurate, and chronic. Health comprises much more than physical health, so we must also incorporate the Social Determinants of Health.?

A reasonable basis for identifying a User’s health JTBD is the Washington State University Wellbeing Model, which breaks health dimensions into financial, emotional, intellectual, social, physical, occupational, environmental, and spiritual dimensions. In this model, “Health” (or, as they call it, well-being) is the combination of the related JTBD from across these categories. In this model, any single health JTBD is drawn from several dimensions. This complexity is why so many healthcare business model Value Propositions fall short.

Clayton Christensen, who developed the JTBD concept, noted that users don't want drill bits; they want holes. However, a Customer Segment defining their JTBD as “wanting to drill a hole" is misleading. The verb is a factor in the JTBD, but the final state is the most accurate answer being sought. In this case, the User might want the hole to make their spouse happy, to be paid by their client, to show off their artwork, or for other reasons. Suffice it to say, the User wants the hole and the mental value and rewards that the hole provides them. The danger in this thinking when applied to healthcare lies in the limited knowledge of the User in defining their JTBD.

In healthcare, this is demonstrated by a patient stating that their JTBD is to "get well.”? Based on their malady (episodic, acute, or chronic), the Value Proposition needed to produce this “end state” can be pretty significant. For example, for a Type 2 diabetic to “get well,” they need a lifelong commitment to blood sugar monitoring, healthy eating, regular exercise, and possibly diabetes medication or insulin therapy.? Any Value Proposition short of this complete regimen would fail the patient and lead to long-term issues elsewhere.?

We also know healthcare is a multi-sided ecosystem with many users and many interdependent jobs to be done. Due to disparate systems and outdated technology, healthcare businesses need help efficiently and accurately servicing different stakeholders and their personal needs. Each stakeholder, such as a member, patient, provider, payer, and employer, requires different services and has preferred channels. In addition, these stakeholders are interconnected and need to share common data securely when relevant.

Here are some examples of healthcare JTBD.

• Member: As a member, I want to understand my coverage. I have questions like, "Do my benefits include chiropractic and acupuncture coverage?" This understanding is crucial to my healthcare decisions.
• Patient: As a patient, I want to be an active member of my care team. I need to easily engage with my providers for things like understanding my treatment plan or even rescheduling a home health visit due to a last-minute vacation.?
• Provider: As a provider, I want to know quickly the status of my patient's care. I want to find information on a patient's pre-authorization request status or what a care manager works on outside our office visits.?
• Payer: As a health plan leader, I want to use data to ensure that my team delivers appropriate care at the lowest cost.?
• Employer: As an employer, I want to provide benefits that allow my employees to stay healthy or even improve their health. Their well-being is important to the health of our business.?

The standard format for writing a "Job to be Done" (JTBD) statement is as follows: When [situation], I want to [motivation] so I can [expected outcome].

This format clearly and concisely articulates the circumstances, desired outcomes, and underlying motivation behind a person's actions, instilling confidence in one's ability to communicate user needs effectively.

Here is a breakdown of each element:

• When [situation]: This describes the job's context.
• I want to [motivation]: This specifies the specific goal or desired outcome the person is trying to achieve.
• So I can [expected outcome]: This clarifies the ultimate reason behind the motivation, highlighting the overall benefit the person seeks.

JTBD are also comprised of pains (and pain relievers) and gains (and gain creators).?

• Without [pain reliever]: This can be added to identify any specific challenges or obstacles the person wants to avoid while completing the job.
• With [gain creator]: This can be added to identify any specific “sweeteners” the person wants to ensure happens while completing the job.

Let's look at the pains and gains in more detail.?

Defining Pains & Pain Relievers

Pains describe anything that annoys your customers before, during, and after trying to get a job done or prevents them from getting a job done. Pains also describe risks, that is, potential bad outcomes related to getting a job poorly done or not at all. When defining the pains (and pain relievers), you will want to understand these aspects.?

Cost and Effort:

• How do they perceive the balance between price, time commitment, and results?
• Are there solutions that seem too expensive, time-consuming, or require too much effort?

Frustrations and Annoyances:

• What aspects of your current offerings cause frustration, inconvenience, or confusion?
• Are there features missing or performance issues hindering their experience?

Difficulties and Challenges:

• Do they need help understanding or using your products/services effectively?
• Are there tasks they find difficult or resist due to specific reasons?

Negative Experiences and Risks:

• What social anxieties or concerns might customers have regarding their experience (loss of reputation, trust, etc.)?
• What financial, technical, or social risks do they perceive when using your solution?

Worries and Concerns:

• What keeps them up at night regarding their JTBD?
• What are their biggest anxieties related to the JTBD?

Barriers to Adoption:

• What obstacles prevent customers from adopting your value proposition?
• Are upfront costs, a complex learning curve, or other factors hindering them?

Common Mistakes:

• Are there common ways customers misuse your products/services, leading to inefficiencies?

Defining Gains & Gain Creators

Gain Creators are a roadmap for crafting your value proposition. They outline how your products deliver benefits beyond function, considering the social cache, emotional satisfaction, and cost savings your customers desire. They ultimately paint a picture of the positive outcomes you create. You will want to understand these aspects when defining the gains (and gain creators).?

Adoption:

• How do they want to save time, money, and effort?
• How do they want to make their work or life easier (improved usability, accessibility, additional services, or lower ownership costs)?
• What aspects make it easy for them to adopt a new solution (lower cost, reduced investment, lower risk, better quality/performance/design)?

Expectations:

• What outcomes do they expect? How do they define "better results" (higher quality, more features, reduced problems)?
• What features, performance, or quality aspects would outperform existing solutions and delight them?

Impact:

• What positive consequences would enhance their social status or image?
• What specific desires do they want to be fulfilled (better design, guarantees, particular features)?

Questions to Ask on the Canvas for the JTBD Block

Now that you understand them take the time to incorporate your “best guess” into the JTBD Block of your modelH business model canvas. Whether your business model is aimed at Patients, Providers, Payers, or Purveyors, creating accurate JTBD greatly improves your Value Proposition and its chance of Customer Segment adoption.

What questions should be answered when developing?JTBD for a healthcare business model?

• JTBD: What is the job to be done?? I want to … action words + object of action + context.
• Current Approach: What is their current approach to solving their JTBD now?
• Benchmark(s): What do they compare their current approach to – good or bad?
• Performance Criteria: What criteria do they use to judge both the effort and experience of their current approach?
• Barriers: What prevents them from trying a different approach?
• Behaviors: What Key Behaviors are needed to drive completion of their JTBD?
• Data: What Platform (data) is needed to drive the completion of their JTBD?
• Value: ?What creates value in their minds regarding their JTBD?
• Pains: What pains (and pain relievers) do they want to avoid in the JTBD?
• Gains: What gains (and gain creators) do they want to experience in the JTBD?

Understanding Problem-Market Fit

Now that we have defined the JTBD Block on the model Canvas, we can further document what your customers need and want in the context of your business idea. This work will make your Customer Segment Personas more than abstract concepts—they will become natural to us and guide our work. We will create an ideal customer definition using a technique called Personas. These Personas will be our compass, leading us towards the right decisions and improvements for our canvas.?

Remember, this is all part of our primary goal to validate the Customer, their Jobs to be done (JTBD), your Value Proposition, and the Channels you will use to serve them. It will take us some time to understand how these pieces fit together, but you can make better decisions when you do.?

Note: We will discuss the Value Proposition and the Channels in a later post.

Problem-Market Fit, though often used interchangeably with Product-Market Fit, is a distinct concept in the early stages of business model development. Here is how Problem-Market Fit is different:

• It Focuses on the Problem: While Product-Market Fit looks at how well your product matches market needs, Problem-Market Fit validates if you're even addressing a significant problem in the first place.
• It is done at an Earlier Stage: This concept applies to the initial stages of business ideation, even before you build a product. It's about ensuring you're solving a real customer pain point with a sizable market. If you already have a product and are not killing it in the market, I suggest you revisit whether you even have a market.?

Problem-Market Fit asks: "Are we solving the right problem for a big enough market?" This question is a crucial first step before you can focus on Product-Market Fit, which asks: "Is our existing product the right solution, and are we effectively reaching the target market?"

This workstream explores the following questions (without answering them all just yet):

• Who is my Buyer, and what are their Jobs-to-be-done, pains, and gains?
• Who is my User?? What are the Key Behaviors to complete their Job?
• What are my Users’ motivators and detractors?
• How well does my business model fit my customers’ needs?

Deliverables for this workstream include the User/Buyer Personas from the previous step to:?

• Create Interview Questions for each Persona.?
• Source Interviewees for each Persona.?
• Conduct 15 Interviews for each Persona.
• Summarize Findings for each Persona.

How to Build a Healthcare Job-to-be-done

It is important to note that in healthcare, every JTBD is comprised of two parts: utility and mentality. A utility JTBD is the high-level goal that a person is trying to accomplish. The mentality JTBD is the set of Key Behaviors needed to complete the utility JTBD.

Note: We will discuss Key Behaviors in a later post.?

So, how do you define a healthcare JTBD that can effectively serve to refine your business model’s Value Proposition?

First, start with the concept of "Treasure Mapping" the User’s JTBD through the various states of completeness. This work involves identifying where a User is right now ("You are here") in their JTBD, as well as where the User would like to be ("X marks the spot") as part of their ultimate “end state.” An example would be a User with a JTBD of “lowering their blood pressure.” Before taking medication, this JTBD needs a Value Proposition that includes a change in diet to include less salt and more water, a regular exercise regimen, and limiting the amount of alcohol consumed.? Treasure Mapping, where the User needs to start and progress through to lower their blood pressure, is an excellent way to construct their JTBD.? Remember that most Users do not have a complete picture of all the points along their JTBD treasure map. You must account for this in constructing your Value Proposition from their JTBD and delivering it through your Channels and Customer Relationships.

Second, identify the driver(s) behind the User’s JTBD. Most Users are dragged through the healthcare system kicking and screaming, which makes both patient and provider miserable. Understanding the User’s capacity to engage in solving their JTBD is critical to delivering your Value Proposition. These driver(s), or Key Behaviors, are essential to designing a healthcare JTBD. There are countless models to use, from Maslow to Prochaska. Suppose you can identify what mentality JTBD needs to be solved in parallel with the tangible Utility JTBD. In that case, you have a better picture of how a solution should look and how to deliver your Value Proposition.? It is important to note that this point may overlap with the Customer Relationship building block but is entirely independent. Customer Relationships are built on a shared purpose between the business and the Customer Segment. Key Behaviors are solely the User’s. Key Behaviors are required to make the business model work. For example, on the provider's part, the Key Behavior might be a bedside manner and communication vehicle that can completely and comfortably educate the patient on the condition. Another example on the part of the patient, the Key Behavior is a willingness to embrace and execute on their utility JTBD by overcoming any mentality JTBD that would prevent it.

Getting the Data Needed to Support the Healthcare JTBD

No matter what the JTBD (utility or mentality) is, there will always be a need for the Buyer and User to enter or allow access to specific data so the Value Proposition can be tailored to their JTBD.? An increased understanding of the User is critical to discovering their ongoing JTBD and building a lifelong relationship.? A JTBD can be derived from your own experience and assumptions but is best when they are supported by data that has been market-validated.

To access this Buyer and User data, the business model must present a legitimate reason for every data element requested or accessed and be transparent with the Buyer and User regarding what data is used for and why.? Within a JTBD, a small amount of information can go a long way toward tailoring a Value Proposition. It is important to the business model to determine the right and wrong amount of information needed to help the User achieve their JTBD goals.? This work is done through the business model’s Platform.

Note: We will discuss Platform in a later post.?

How your business model’s Platform obtains the data is as important to the JTBD as the Customer Relationship is to the Customer Segment. Most of your JTBD progress data should be automatically updated. However, your model should also allow the User to self-report their JTBD progress on your Platform. This onus gives the User a way to achieve their mentality JTBD by contributing to tailoring their utility JTBD.?

In addition to the observed facts of the JTBD progress, another part of the necessary Platform data is understanding Buyer and user preferences. Understanding these preferences enables your business model to deliver the Value Proposition in a manner consistent with their choosing. Preferences consist of the frequency of communication, communication channels, and tone of communication. Preferences are best gained by asking about their need for deviations from recommended communication frequencies, channels, and tone.??

Defining Jobs to be done in your Personas

Now, you are ready for the final step of creating your baseline Personas by performing JTBD Canvassing. A job-to-be-done, or JTBD, is the high-level goal that a person is trying to accomplish. This concept is a simple idea with profound implications.??

Once you add the JTBD details, you can print your reviewed Personas for everyone to see. Be sure to communicate them across the company and ask for feedback from anyone outside the development process.?

Problem-Feedback Customer Discovery

In this next step, it is time to interview sample customers (users/buyers) to obtain Problem-Feedback. These interviews uncover a customer’s “pain points” and “wishes” for a specific JTBD and validate how accurate your persona is to the genuine users/buyers.

My suggestions are adapted from the modelH process and Ash Maurya’s Problem Interview Script in his "Running Lean" book. However, we are veering somewhat from the prescribed approach in Running Lean. This change is because it is designed to help startups find and define new markets. We are working with a known market problem and a defined solution for our work. A modified Customer Discovery is, therefore, required.?

Remember, you are trying to validate Problem-Market Fit, so concentrate discovery on a specific market problem. Get your team out “into the market” to interview ~15 to 50 ideal “buyers” to gather initial insights on customer jobs to be done. Use scripted in-person and telephonic interviews with real people similar to your “ideal” User/Buyer Persona. Initiate conversation with an unbiased question or comment. Engage the discussion around customer interests for a genuine and productive interview.?

In these interviews, distinguish between behavior and feedback by seeking answers that describe their behaviors to your questions. You are not trying to get direct feedback or usability insights on a specific product or prototype (yet!). You want to find out what the interviewee “feels” about the problem space and, if they have tried to solve it in the past, how they go about it. Encourage the participant to do most of the talking.?

You want to find out three things:

1. Problem: What problem is your business model trying to solve, and how do potential customers define and rank the top 3 pains/gains associated with this JTBD?
2. Existing Alternatives: Who is the viable competition in solving this JTBD problem, and how do customers solve it today? How badly do customers want this problem solved? Are they willing to pay, pay more, or pay someone else?
3. Customer Segment(s): Is there a viable customer segment for this JTBD, and what does it look like? For start-ups, who is the prototypical early adopter? For existing companies, how can you create a segmentation model that you can dominate?

Problem-Feedback Interview Questions

To do this, develop a set of Problem-Feedback Interview Questions and employ various observation techniques to learn directly from target users/buyers served by the concept. Interviewees should be prompted to share their “day in the life” related to the JTBD you are addressing in your business model. Ask them how they solve this JTBD to uncover their needs and motivations. Do not try to sell them an idea. Record and analyze what causes them “pains” in accomplishing their JTBD. Ask them about the “gains” they may be looking for in a solution to this JTBD.

Use the modleH Value Proposition Canvas during all stages of the interview process to guide, record, and keep the questions on track. Note that sections are available for brainstorming directly on Canvas. Afterward, organize potential pain relievers and gain creators using the Value Map on the left side of the Canvas. Report all findings to gather concrete evidence to support the actual actions of potential customers.??

Here are my guidelines for generating compelling interviews:

1. Begin by highlighting the crucial role of the customer in the interview process. Their pains and gains are the compass that guides the conversation. Actively listen and meticulously record their feedback,? making them feel at ease and able to express themselves freely. The aim is to deeply understand their pains and gains, areas not functioning optimally, and where they are searching for a solution that simplifies their lives. It's a promising beginning when they open up about a problem to you (the interviewer). Refrain from interjecting your value proposition or solutions.? Once the conversation is flowing, focus on listening and building trust.

2. Use direct job-to-be-done questions: Have you ever had this specific job-to-be-done? Have you recently purchased a product for this solution?? Did it effectively solve the problem?? These questions encourage the identification of a particular problem.? Avoid open-ended questions that elicit opinions, such as: What would you do?? How did you feel?? Only discuss solutions after all of the customer's pains have been uncovered.??

3. Direct questions towards facts for comparative results and reports.? Provide options for interviewers that have concrete meaning.? For instance, inquire about purchasing a product if it were 50% off right now.? Would the same person try it if it were only 20% off the price?? This quantitative measurement provides concise data for solving a specific value proposition.

4. Conclude the interview by providing follow-up information for future interviews that align with the current theme.? Expanding on a previous interview with new pain relievers and gain creators can be a productive next step in the process.

Sample Interview Agenda

• INTRODUCTION: Set the Stage (1 min)
• DEMOGRAPHICS: Test the Customer Segment (5 min)
• STORY: Set the Problem Context (2 min)
• RANKING: Test the Problem (7 min)
• EXPLORATION: Test the Problem (13 min)
• CONCLUSION: Wrap Up and Ask (2 min)
• DOCUMENTATION: Record & Transcribe (thank you, AI!!!)

What is Next?

Next, we will examine how Intermediaries fit into the complex and multi-sided world of healthcare. Then, we will wrap up our mini-series on the Customer Segment part of modelH - the "Who" of your healthcare business model.

Interested in what I am doing and want to learn more? You can read all about modelH business model innovation for healthcare on Medium.?

to your health,

- Kevin Riley