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Double Jobs Case Study

Case Study: Omer and Transcendent Endeavors

How to apply Customer Jobs theory to create a new product

I met Omer Yariv at the Customer Jobs Meetup I run here in New York City. At the time, he was vice president of engineering and product at a start-up called Simplist — its product helps you search for specific people within your social network. I particularly enjoy talking with Omer. We share a background in writing, engineering, and, of course, Customer Jobs.

Omer joined Transcendent Endeavors (TE) in 2014 and is senior product manager now. Many of TE’s products are about facilitating communication between nurses, doctors, and patients. Omer is in charge of a new-product initiative for helping hospitals improve patient care. He shared with me how he’s using Customer Jobs principles to create a product from scratch.

Omer knew which customers he needed to talk with, how to unpack their desire to evolve, and how to figure out what kind of solution would or wouldn’t help them make progress.

How Customer Jobs helped Omer get started. Omer’s first task at TE was to develop a solution to prevent adverse events at hospitals — that is, circumstances in which someone’s condition declines because of something other than what brought him or her in for care. Examples are falls, infections, and bedsores.

When he started, Omer didn’t know very much about the health-care industry, but that didn’t concern him much. He was confident that he could create a successful product; all he had to do was find a group of people who were struggling to get a Job Done. Who struggled the most with adverse events? He looked for answers. Who had the most to lose when adverse events happened? Who had the most to gain by preventing them? Who was putting the most energy — the most effort — into finding a solution that helped prevent adverse events? Omer believes that finding this energy is imperative to discovering a JTBD:

When I interview potential customers, I look for evidence of a struggle. I’m looking for an energy to tap into. That’s how I know a struggling moment exists and that there’s an opportunity to create something. If a group of people is not struggling — if I can’t feel that energy — then there’s probably no opportunity there.

How does Customer Jobs help you create a product that people actually want to use? At this point, Omer didn’t have very much to go on. All he knew was that adverse events happen at hospitals and that nobody wants them to happen. He said,

Hospitals don’t want adverse events. It costs them money. It costs them time. It costs them reputation. Patients don’t want adverse events. Who wants to get sicker? Nurses don’t want adverse events because they’re there to take care of patients. Nobody in the system wants adverse events to happen. How come they still happen? Where’s the gap there? What’s missing?

Omer was wrestling with a tough question. Why do adverse events happen, even though so many people don’t want them to? The fact that so many people were affected by adverse events made it hard to know where to start. Omer knew he couldn’t build a solution for everyone. Not only would it be expensive and difficult, but there was no guarantee that all the people would actually use it.

Omer’s experience as an innovator had taught him an important lesson: many products fail simply because no one wants them. Of course, he wanted to make something people would actually use. He narrowed his focus on one group of people who struggled the most (who suffered the greatest consequences at any adverse event) and those who were in a position to prevent adverse events.

How do you figure out who struggles the most? Omer needed to find out who had the most emotional motivation to prevent adverse events, for they would most likely use whatever product he created. He began by casting a wide net:

I wanted to interview potential users [those who will use it] and potential customers [those who will pay for it]. But I had to find the right ones to interview. I wanted to talk with those who had the most energy — who had the most motivation to solve the problem. So, I started creating surveys for the different people involved in adverse events, such as nurses and medical office managers.

Omer asked such employees how long they had worked in the field, how often they saw (and managed) adverse events, and whether they thought adverse events were preventable. He began to see who might be best to interview in more depth:

We learned that we needed to talk with nurses who had a lot of patients — and who had to deal with high turnover of those patients. These two conditions ruled out intensive care units [ICUs] and oncology [cancer treatment]. In ICUs, you have only one or two patients to watch over. There is also a high turnover of those patients. You’re dealing with a limited number of patients, and you’re not in charge of them for very long. In oncology, you might have ten patients, but you work with them over a long period of time. You get to know them. But with nurses involved in med/surg [medical/surgical], there seemed to be an opportunity there.

Nurses in medical/surgical face a different challenge compared with other nurses. Medical/surgical nurses watch over at least four or five patients at a time, and these turn over within a few days. It’s a tough situation; patients constantly come and go. Nurses learn about their patients’ conditions and needs and care for them for a few days. But just as nurses get to know patients better, new patients take their place. These working conditions are why nurses in medical/surgical deal with the most adverse events. Omer concluded that medical/surgical nurses desired the most change and would be the most likely to use whatever product his team ended up creating.

Omer’s next step was to dive into the struggle this particular group of nurses faced. In interviews, he would ask what the struggle was like. Were the nurses trying to prevent adverse events? If so, how?

Discover a customer’s JTBD through an interview by looking for the energy of a desire to evolve. Learn how the customer wants life to be. Omer’s first interviews asked broad questions:

  1. Does your hospital talk about adverse events?
  2. Are there incentives if the number of adverse events goes up or down?
  3. How would you describe your daily life as a nurse? What are your routines?
  4. What is it like when adverse events happen on your watch?

But grabbing just any old data from interviews can make things worse instead of better. To avoid that, Omer looked for signs that these nurses were struggling to make progress:

All through those questions, I’m always looking for energy. If they describe their struggle using a particular solution, or if they describe having any emotional motivation to make things better, I would know that I needed to dig into it more. I was always looking for energy.

Omer kept looking for “energy” around a desire for change. Was there any change in body language or how the nurses talked while describing dealing with adverse events? Did some express frustration with procedures or products they used that left them feeling powerless? What was giving them the most anxiety and stress? What were the forces of progress (i.e., push, pull, anxiety, and habit)? Sure enough, Omer’s persistent search for energy paid off:

I finally started to get an idea of the struggle they faced as a nurse — and in particular when dealing with adverse events. For example, I had no idea that nurses don’t always get along; they don’t always like one another. The situation the hospital puts them in leads them to feel that they’re alone against everybody.

The “situation” Omer refers to is how hospitals decide who is liable when an adverse event happens. Nurses generally suffer any consequences, even when an event is not their fault. For example, if a doctor prescribes the wrong medication and the nurse administers it, the nurse is liable, although he or she was not the source of the problem. Such an adverse event goes on a nurse’s permanent record, and he or she could lose a job, lose a license, or be sued. All this can happen because of someone else’s mistake.

If all that stress isn’t enough, there’s the social stigma that nurses can face when an adverse event happens on their watch. Omer said,

There’s a very strong feeling of ‘I don’t want to be that nurse that all the other nurses are talking about.’ That’s another very big motivation to make a change. All these struggles create a lot of energy to change things for the better. It’s a JTBD.

You found a struggle for progress. Now what? Learn how customers imagine their lives being better. Omer had found a struggle: nurses were afraid of being held liable for adverse events happening on their watch. But he wanted to learn more. How did these nurses want things to be? What would their lives be like if this struggle were resolved? He said,

Even with all this struggle they face, you kind of wonder, why do they want to be a nurse? The answer they gave was always the same: They’re there because they feel like they can make a change. They feel like they’re helping people. That’s the thing that keeps them going — the feeling that you’re helping someone.

These nurses want to help people, and that’s why they became nurses in the first place. This was an important piece of their JTBD puzzle.

Armed with these two insights — (1) the struggle and consequences nurses face regarding adverse events and (2) nurses’ desire to feel as if they are helping other people — Omer now had a pretty good idea of what Job these customers were struggling with and what their lives would be like when it got Done.

Omer now needed to learn what these nurses valued in a solution. This would help guide his team in designing one to fit the JTBD.

How do you learn what customers want in a solution for a JTBD? Even though Omer had a pretty good idea of these nurses’ JTBD, he didn’t know what they would expect in a solution. A JTBD describes the customer’s problem and only hints at what a solution should be. Omer needed to learn the following:

  1. How nurses currently handled adverse events
  2. What solutions they had tried
  3. What they did and didn’t value in each solution
  4. Whether they were expressing compensatory behaviors
  5. Whether they were using a combination of solutions because no single solution was good enough

The answers proved fruitful:

The story here is that nurses have a lot of things to remember. They want to get them right. There’s a lot at stake if a mistake is made. Nurses take care of people, they run around, they get interrupted, and then they have to put everything into the documentation later.
They currently handle all this in two ways. One is memory. Some of them say, “Yeah, I remember.” Other nurses take notes. It can be a little bit on their notes app on their iPhone, or sometimes they just jot down notes on their clipboard and put them in their pockets. But they make notes all the time. They make notes, and then they update the notes. They cross them out and make more notes. In a few cases, we heard about a product called Rover. It’s an iPhone app that connects to the hospital’s documentation system.

The diversity of these solutions — and how the nurses used them differently — gave Omer an idea of what the nurses wanted in a solution. But his biggest breakthrough came when he interviewed one nurse who had created her own solution.

One nurse I talked with — she started by taking notes on her hand. She would write everything on her hand with a pen, then she would wash her hands, and the notes would go away. So, then she started writing notes on a pad. But as she wrote down more notes, it became hard to keep track of them all.
Then, she came up with her own solution. She created worksheets that used a grid system to track all the beds and patients. She would use that to write what she needs to do. Even more interesting was that the other nurses saw this and liked it. So, she started creating photocopies and giving them to other nurses. That was her evolution of a solution for her Job to Be Done. That was great to hear.

Learning about other solutions gave him valuable information about what these nurses did and didn’t like in one. First, he learned about critical pain points that made a nurse realize that the way he or she was doing things wasn’t working. Next, he learned about what would attract nurses to one solution versus another. Finally, he learned how nurses innovated on their own.

It was time to create a solution. Omer first broke down the key moments that would prompt nurses to reach for a solution for their JTBD. He wrote short stories to encapsulate such struggling moments. For example:

When I get my handoff, and I need to remember what I need to do, I want to assign beds and interventions quickly so I can get back to work and not get bogged down.

When I’m done with an emergency and I’ve forgotten what I was last doing, I want to catch up with my scheduled interventions so I can pick up on what I missed and not worry about skipping any patients.

When I finish an intervention, I want to mark it as done quickly so I can make sure I don’t double-administer treatments.

Omer described how he got these Job stories and how they helped him innovate: “These struggling moments came after I interviewed nurses and when I started working on a prototype. I wanted those situations documented so that I could make sure I was focusing on the right thing.”

Where’s the project now? At the time of this writing, Omer’s team is still in production. They’ve developed prototypes and are now testing, shooting for a 2016 release date.

What’s the JTBD?

Omer described some great data about a JTBD these nurses faced. The struggles for progress these nurses faced seemed to be the following:

More about: avoiding adverse events, not being the nurse everyone talks about, losing my nursing license, protecting myself from liability, being unfairly blamed, feeling like I’m helping people, pride in my work as a nurse

Less about: protecting the hospital, protecting other nurses

Based on what Omer told us, I would describe the progress, the JTBD, these nurses expressed as follows:

Arm me with what I need to manage my interventions, so I can focus on helping my patients.

There are a few reasons why I like this:

This JTBD can be solved with a change in hospital procedures and processes. Nurses don’t have to be buying their own solutions for it. This demonstrates the idea that competition for a JTBD can come from anywhere.

It shows how these “needs” are not intrinsic to these nurses. Rather, they are a product of the health-care system these nurses interact with. These nurses wouldn’t face this struggle if management had designed better processes in the first place.

I get a good sense of what life is like when these nurses’ Job is Done.

Put it to work

Begin by identifying a struggle. Start wide, and get progressively narrow. The first thing Omer did in creating a new product from scratch was to identify a struggling moment. He started by casting a wide net as he sent surveys to doctors, nurses, and hospital administrators. As he learned more, he focused more. Eventually, he ended up doing one-on-one interviews with nurses who worked within a particular department (medical/surgical). These were the people who were struggling the most. These were his potential customers.

Understanding the struggling moment is a crucial part of JTBD. In a previous chapter, we saw how the creators of the chotuKool didn’t focus on a struggling moment. They also jumped to a solution — perhaps because they believed they understood their struggling customers. Don’t do what they did. Instead, emulate Omer: start with an open mind and resolve to stop discovery only after you uncover a customer’s struggling moment.

Find innovation opportunities when customers exhibit compensatory behaviors. Omer discovered a nurse who shifted between various solutions for her JTBD. She moved from writing on her hand to writing notes on a pad, and then she created her own worksheet system. It was so helpful that other nurses had asked her to make copies of it so they could use it as well.

Innovation opportunities exist when customers exhibit compensatory behaviors. The edge cases in which customers use your product might also represent innovation opportunities.

Always keep an eye out for customers who use a product in novel ways, combine products into solutions, or create their own solutions for a JTBD. They have all the trade-offs, necessities, struggles, and ways to progress in their minds. Why not take advantage when they choose to express them?

Learn more

This story is an excerpt from the book When Coffee and Kale Compete. You can download it as a free PDF, or buy it in paperback & kindle right here.

If you have more questions about Jobs to be Done, or want help applying JTBD concepts to your business or startup, contact me.

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How Ann got “unstuck” from the corporate world.

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Ann’s career, however, was going down a much different path. After graduating from a User Interface Design program in Barcelona, she worked as a project manager for a few big multinationals. “It was really limiting. I had a job description I was supposed to stick to and achieve my goals.”

Ann stuck to her job description by day. But on nights and weekends, she started building businesses to help achieve her dream.

  • A catering company in Barcelona doing Scandinavian tapas.
  • Selling T-shirts online.
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Ann became a web & graphic designer for expat entrepreneurs and tech startups in Switzerland, landing her first $3,500 contract in week one.

“I’ve had 35 clients this year…”

In her previous businesses, Ann would start with a lot of energy. Getting excited about the branding, designing a logo and making business cards. She’d land clients… but lose momentum, and eventually shut the business down.

Then, she found in Earn1K a systematic method of building her business — my referral technique and scripts — that allowed her to sustain the momentum.

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Between asking for referrals and delivering great service, Ann’s results are very good. “I’ve had 35 clients this year, and 80% comes from referrals – many without me even asking for them. The clients are really satisfied, so they are happy to pass along my contact information.”

In six months Ann has earned over $40,000, and 10% of her work is free to nonprofits. Three months after starting Earn1K she was finally been able to quit her corporate job and focus on what she loves. Ann is charging $140 an hour and in June earned $10,000 – double her old corporate salary with half the hours worked.

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“Start freelancing. It’s a really great way to start a business. If you have a plan to build a big business, start with clients one-on-one, face to face. Maybe you can start to introduce products eventually, like Ramit’s information products or write a book. Services are good because you can earn money first, enjoy that, and have the challenge of building something bigger.”


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