Jobs to be done in health

I have a love-hate relationship with home medicines reviews. On one hand, I find the work incredibly fulfilling. It is such a privilege to be allowed into someone’s home and spend time with them, listening to their experiences and bearing witness to their lives. There’s also a real intellectual satisfaction when you use abductive reasoning and are able to describe how the medication regimen is contributing to their problems. It can be fun making sense of messy situation.

But honestly, the system kind of sucks. The challenges involved in getting referrals for the patients who need it most. The absence of collaboration and collegial discussion with the referring medical practitioner. The amount of non-billable work involved. It can feel a bit disheartening at times.

I don’t think this is unique to HMRs, I think it’s pretty common in many areas of primary care. We know people could benefit from what we have to offer. But the inverse care law is ever present - those who could benefit the most are least likely to receive it.

So how do we improve on this? More awareness? More resources? More money?

I think one of the ways we improve on it is going deeper to understand what value we’re actually offering people. Not value from our perspective (risk reduction and all that usual rhetoric) but value from the individual who is faced with the prospect of using the service, be it the clinician making the referral or the patient deciding if they’ll agree to it.

This short video talks about this in terms of understanding the job to be done. It uses the example of McDonald’s wanting to improve their sales of milkshakes.

McDonalds had all sorts of data on their milkshake customers and did all kinds of research to inform improvements to their milkshakes, but it never made any difference to their sales. So they decided to take a different approach…they conducted research that understood the broader context in addition to customer demographics.

They realised that most milkshakes were sold early in the morning as a sole item. Wanting to understand this further they asked the milkshake customers “what job arose in your life that brought you here at 6:30 in the morning to hire this milkshake?”.

A bit of a confusing question if you ask me. And it seems it was for the respondents too. They needed to rephrase it, and asked them to think of the last time they were in a similar situation as the one that led them to buy this milkshake, but they did something else instead.

Turns out the thing people had in common was that they were at the start of their long and boring drive to work. They wanted something to occupy them along the way and keep them engaged throughout the drive. It was also good to have something to eat that would keep them full til 10 o’clock. If they didn’t come for their milkshake they tried other things like donuts or bananas, but each had it’s drawbacks when compared to the milkshake.

If McDonald’s wanted to increase their sales, it wasn’t just about getting the existing milkshake sales from Burger King and other direct competitors. They could have much greater impact by focusing on tactics that would convert a greater proportion of the people who had the same job to be done, but were choosing something else altogether.

There’s so much tribal warfare and turf wars within primary care about competition for patients at the moment and I don’t think it’s serving us well. Maybe we’d be better off if we stopped focusing on one another as competitors and started thinking about how we could engage those who aren’t utilising primary care services at all.

What are the jobs to be done that lead people to utilise primary care services and attain value from them? How can we understand this better to achieve better utilisation of health services across the broader population, including those who don’t typically engage with healthcare services?