In this episode of Jobs-to-be-Done Radio, Chris Spiek and Ervin Folks travel to the Children’s Medical Center in Dallas to meet two guests leading the application of Jobs-to-be-Done in healthcare: John Dzivak and Anthony Pearson, both with Children’s Medical Center. The conversation moves from rolling out enterprise software in a hospital to the difference between the Big Hire and the Little Hire, and into some remarkable stories from the operating room.
Listen in for the real challenges of applying JTBD in a high-stakes clinical setting, why a struggling moment can be hard to surface when clinicians are focused on the patient, and how emerging tools like Leap Motion gesture control and Google Glass are being tested in the OR. Read on for the key takeaways and the full transcript, organized by topic with short explainers of the core concepts.
Key takeaways
- Enterprise rollouts fail when nobody pulls the product into their life. Social collaboration platforms have very high failure rates because they are not purpose-built apps. The job has to be clear enough that people actively want it.
- The Big Hire and the Little Hire are two different jobs. A CFO or IT department makes the purchase decision, but the ultimate consumer has to choose to use it every day. Both jobs have to be understood, and they may diverge.
- Stop asking about the future. Ask how the job gets done today. Instead of asking clinicians what they want a tool to do, watch how they get the work done now, including all the manual printing, scanning, and faxing they no longer think about.
- Struggle is hard to surface when the work is mission-critical. Clinicians get the job done regardless of the tools, so the emotion around any single tool can be low. Surfacing the struggle takes refining the conversation to reach real energy.
- Small changes can have a big impact. Cutting the number of times an anesthesiologist has to rotate away from a patient to enter data frees up brain cycles for the task at hand.
- Healthcare is uniquely ready for new input methods. A high-transaction, high-stakes industry has more latitude to adopt gesture control and wearables like Google Glass where they help get the job done with less effort and higher safety.
Welcome to the latest edition of Jobs to be Done Radio, where we discuss how to apply the jobs to be done framework to understand why consumers switch from one product to another. And ultimately, how to get more customers to switch to your product. And here are your hosts.
Welcome from Dallas and Children’s Medical Center
Chris: So welcome to the latest edition of Jobs to be Done Radio. I’m Chris Spiek, I’m joined by Ervin Folks.
Ervin: Hi, Chris.
Chris: And, this is an exciting week for us. So we are in Dallas right now recording at Children’s Medical Center and we’re joined by John Dzivak and Anthony Pearson. Hey guys.
The hosts open by catching up on alumni stories, including a recent Switch workshop attendee from Morgan Stanley applying the framework in financial services, and the healthcare work happening in Dallas.
Ervin: Absolutely. Also, yesterday we were at the health care walk cater. I’m not sure if I’m saying it right but Dr. Zaychek’s group, and I’ll let John talk a little more about that, but that was really exciting. Some of the things we’re doing down here in Dallas, in the healthcare field are just kinda mind blowing.
The online interviewing class and interviewing in pairs
The hosts mention upcoming Switch workshops and the launch of an online version of the Jobs-to-be-Done interviewing class, a close proximity to what the live Switch workshop teaches, designed to get people up to speed on the interview techniques quickly.
Chris: There’s some minor differences there but it’s a good way to get up to speed quickly on the interview techniques. So our plan is to launch that soon, we’re currently in beta. We’ve got people going through it and helping us refine and tell us what we’re missing and what we need to improve on.
One reason the online class matters: workshop graduates often return to a company where no one else has the method. The class gives them a way to bring colleagues up to speed, which also supports the practice of interviewing in pairs.
Chris: I think often times people come to the Switch workshop, there’s more than one person for me to accompany there. But then there’s also the solo people that come, and we say, “you gotta go interview with somebody,” and they get back to their company and say nobody else knows the technique so I’m kind of alone. So I think that, that online course will be a good opportunity to get somebody else up to speed within your organization that you can start interviewing.
Concept · The Switch Interview
Why we interview in pairs
The Switch Interview reconstructs the timeline of a real decision so you can hear the push, pull, anxiety, and habit in the customer’s own words. Running it in pairs is core to the method: one person leads while the other listens for threads to pull, which is exactly why bringing a second colleague up to speed matters so much.
There is a catalog of actual interviews along with analysis available here.
How John found Jobs-to-be-Done
John explains how he came across the framework: through years of following Clay Christensen, including the MIT series and the podcast where Bob and Clay discussed the milkshake story.
The project that drove his interest was a social collaboration platform deployment, a category with a notoriously high failure rate.
John: So I was hoping that we could use the Jobs to be Done framework to help identify what people are doing in departments that they’re really struggling with, that might be a good fit and win for the platform. Because they have to pull it in, and I’ve learned that. I’ve tried setting appointments, and it didn’t matter how much benefit I thought they were going to get from it, if they weren’t sold on it, if it wasn’t clear to them, it just hasn’t taken off.
Concept · The basics
People have to pull a solution into their lives
A job is the progress a person is trying to make in a particular circumstance. No amount of pushing benefits onto people creates a sale. They have to pull the solution in, and they only do that when it clearly makes the progress they care about. That is why John’s deployments stalled until the job got clear.
The Big Hire and the Little Hire in enterprise software
Chris: Yeah, so this gets back to, so we’ve introduced recently the concept of what we’re calling the Big Hire and the Little Hire. So I think this is prevalent in any enterprise software purchase and roll out, is that you’ve got either an individual, a CFO, a purchasing department, or an IT department, somebody or some group in charge of actually purchasing the software. And then you’ve got a group in charge of implementing, and ultimately you’ve got a consumer, right, so this happens in CRM and you see VP of sales rolling up CRM and you see sales people complaining about how hard it is to input data and how much of their time wastes.
The guest agrees that both jobs have to be understood. The buyer who signs off is putting a professional reputation on the line, while the day-to-day user has to fit the tool into how they actually work.
John: Because we need to do both, we need to understand the little hire like you just stated. We need to understand the ultimate consumer and how they’ll use it and bring it into their life. But we also need for that CFO, that person has a job that he has to do as well.
“You have to understand what he’s trying to accomplish and ultimately what the consumer is trying to accomplish, because they may diverge and not be the exact same thing.”John Dzivak
Stop asking about the future. Ask how the job gets done today.
A central theme of the conversation is moving away from asking people to envision a future product, which often results in building exactly to spec only to find the tool sitting unused. The better approach is to study the present.
John: So it’s starting to, really not even talk about that future but instead, how are you getting this done today. How many people is it taking you guys to get this done?
That shift surfaces the messy reality of how work actually happens, the printing, scanning, faxing, and shuttling data between Excel and Access that people no longer notice, and it keeps the focus on real problems rather than things that already work fine.
John: Lets find something that this is good for that’s a real problem.
When the struggling moment is hard to surface
Chris names a specific challenge of doing this work in a clinical setting. Because clinicians are compelled to use whatever tools are in front of them and stay focused on the patient, the emotion around any one tool can be very low.
Chris: So when you ask then, are you struggling, could this be better? It’s almost like, it’s low emotions, it’s almost like this is just an ancillary aspect of the job. Of the task at hand. So when you ask them to describe all the intricacies, and how can I make this better and how are you struggling it’s like, you know, it works, I use it. It’s hard to dig into. So I think we’re going to have to spend some time refining the conversations and have to get to that level of energy that we need to design.
Concept · The struggling moment
Surfacing struggle when emotions run low
Innovation lives in the struggling moment, the point where a current approach stops working and the energy to change appears. In a hospital that energy can be muted, because clinicians push through with whatever tools they are given. Finding the struggle here means refining the conversation until real energy surfaces, rather than accepting a flat “it works, I use it.”
Going into context: watching the work, not asking for opinions
Chris and the team describe prototyping work that simplifies a single task rather than launching an entire system across a hospital network.
Chris: How do I take one simple task that the clinician has to accomplish and use the technology and start from there. Can I just use move this image backwards and forwards, or make it brighter, darker and zoom it in and is that all we really need to do?
The contrast with the old approach is the heart of the method: instead of asking a doctor what would help, go into the context and watch.
John: But what I saw you actually went into the context, you said OK, this is where we were, this is the environment that you operate at. And then you were right there with them, show me how you do it now, tell me about the last time you had to look at an x-ray, and then from there the research I saw you pulled out is how you’re actually looking ,to find the solution properly. I think that’s where you nailed it at, where a lot of people kind of missed the boat on.
Getting the time of busy pediatric heart specialists is its own challenge, which is why the team filmed cases at seven in the morning, both to see the work and to relay it to collaborators as far away as Stockholm.
Anxiety of the new solution
The conversation turns to the forces that pull people away from a new solution even when they are drawn to it. The advice from the guests is to involve clinicians from the very beginning.
John: So that’s, that’s not any different. That experience isn’t any different I think in medicine than in any other field, where if you involve them in the beginning and through the whole journey then you don’t get that. It’s when, yeah so we bought this and we built it and it’s going to be the best thing for you, and lets go, I think that’s where you get a lot of it.
Concept · The Four Forces of Progress
Anxiety is part of every switch
Two forces drive change, the push of the situation and the pull of a new solution. Two forces hold it back, the anxiety of the new and the habit of the present. Even a clearly better clinical tool triggers anxiety. Involving people throughout the journey, rather than handing them a finished thing, is how that anxiety gets defused.
Meet Anthony Pearson: translating between clinical and technical
Anthony: I can do that. I am a registered nurse, been at Children’s since late in 2006. My background at the bedside is as a pediatric emergency nurse. And in that capacity I took care of kiddos from sniffles to trauma and critical care. I’ve always been a geek, that’s a long time diagnosis, I’ve known that for a while. And within the last two and a half or so years I was recruited over to my current position in clinical informatics.
Anthony describes the heart of clinical informatics as translation: bridging what clinicians want and need and the way technical people hear, understand, and produce those wants and needs.
Anthony: The great limiting factor is often the translation piece.
Gesture recognition and the Stockholm project
John walks through the gesture-control work that began with Leap Motion, a controller that senses gesture movement more granularly than a Kinect, brought to his attention by anesthesiologist William Jones.
John: We were really hoping to leverage it and see if we could use it in the OR for post surgical infection improvement. And if the theory being that if the anesthesiologist didn’t have to touch a keyboard to perform documentation that it can have a possible positive impact.
The idea spread to surgeons and to a hackathon in Stockholm, where programmers from across Europe spent 72 hours making real progress getting Leap Motion to recognize gesture movements, part of a broader move to broaden input beyond mice and keyboards.
Chris: So one of the examples was, if you have an anesthesiologist working on a patient and they have to rotate 180 to touch a display to input a piece of data, it’s like, can we cut that number in half. How could you have just reorienting something, or introducing this gesture, and I think you always describe it really well, just freeing up the brain cycles to be able to focus the tasks at hand as opposed to be doing data entry or managing your work space and how you’re positioned in it.
Health tech incubators in Dallas
The hosts visited a healthcare tech incubator event the night before, tied to a network including UT Southwestern, UTD, and Children’s. The model: thirty thousand dollars of investment for eight percent equity and ninety days working alongside mentors drawn from the hospital network, the business side, and practicing clinicians.
The guest frames the opportunity for hospitals to shape what gets built.
John: And if we can get that information up front we may be able to, maybe something that we could bring in here and hopefully it would do the job that we needed to get done exactly the way that we needed to get done.
The encouragement for founders is direct: get in front of the mentors early rather than waiting until the application is perfect, because the network moves fast and the stakes are real.
Google Glass in the operating room
The episode’s most striking stories center on testing Google Glass in a pediatric hospital, where the volume of activity is enormous.
John: We’ve got thousands of procedures that are performed every day with 200 kids comes through our ED in a 24 hour period, I mean, it’s just a tremendous amount of kinetic activity.
The job is safety and speed: getting the right medication to the right patient at the right time with less effort. Today that means bar code scanning and verbal read-backs, and a heads-up display that recognizes the patient and what is being administered could help get that job done.
“And if it can help get that job done with less effort and higher safety, it’s a no brainer.”John Dzivak
There is also a clear-eyed view that Glass would arrive in addition to existing tools, not as a wholesale replacement of the cart that rolls into each room. Mainframes never fully went away, and the rolling workstation will likely remain as a fallback.
Anthony adds a savings angle, imagining medications that are clean and unopened being flagged for return as a clinician walks the floor, with information transmitted to a pharmacy runner. That sits alongside an active project putting RTLS tags on equipment so the location of a stat CT order can be known instantly.
Why healthcare has more latitude for new tools
Anthony makes the case that medicine can adopt tools that might look too far out for other fields.
Anthony: Because medicine, nursing, the health sciences have long been a mix of art and science. And so I think that gives you a little bit more latitude, you might scratch your head and think, well they wouldn’t be using them if they weren’t producing some kind of benefit for me, or to my experience or to that of my child.
In a high-stakes, fast-moving clinical environment, function comes first and appearance matters far less.
Anthony: So function is priority, and you really could care less what it looks like. It really could look better, but that’s not going to prevent use.
The cost pressure behind it all
Underneath every one of these experiments is a hard economic reality that makes the job urgent.
John: Because there’s, we have to lower our cost of providing care. Our reimbursements are going through the floor. We need to be able to do more with the staff that we have and I think that’s a really good looking opportunity.
The closing reflection ties it back to people: the hospital manages a thousand strangers a day, all arriving under anxiety, and any tool that helps clinicians serve them with less friction is worth testing.
Chris: So great, this is kind of their first go around with them. John I just want to thank you, for everyone listening, for getting us down here, for orchestrating this whole thing. We’re really excited to be involved with Children.
John: I’m glad that you guys came down, and I really think that Jobs has the potential to help us do better here and just do a better job and provide more value.
Anthony: Absolutely, I know it does because John has always got these great applications, he’s always talking about Jobs. Every once in a while he needs to be pulled down out of the clouds, but it’s always got a root in a job that has been identified and we’re trying to find the right solution. And the instinct is right and the focus is in the right area. Kudos, keep it up.
Chris: Thanks guys. Thanks for coming on, and we’ll be back soon.