0:00:00.136,0:00:02.756
I've got a great idea[br]that's going to change the world.

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It's fantastic, it's going[br]to blow your mind.

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It's my beautiful baby.

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Here's the thing:[br]everybody loves a beautiful baby.

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I mean, I was a beautiful baby.

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Here's me and my dad[br]a couple days after I was born.

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So in the world of product design,

0:00:15.204,0:00:17.572
the beautiful baby's like the concept car.

0:00:17.596,0:00:19.482
It's the knockout.

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You see it and you go, "Oh, my God.[br]I'd buy that in a second!"

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So why is it that this year's new cars

0:00:25.064,0:00:28.328
look pretty much exactly[br]like last year's new cars?

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(Laughter)

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What went wrong between[br]the design studio and the factory?

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Today, I don't want to talk[br]about beautiful babies,

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I want to talk about the awkward[br]adolescence of design --

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those sort of dorky teenage years

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where you're trying to figure out[br]how the world works.

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I'm going to start with an example

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from some work that we did[br]on newborn health.

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So here's a problem:

0:00:52.074,0:00:56.089
four million babies around the world,[br]mostly in developing countries,

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die every year[br]before their first birthday,

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even before their first month of life.

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It turns out half of those kids,

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or about 1.8 million newborns[br]around the world,

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would make it if you could[br]just keep them warm

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for the first three days,[br]maybe the first week.

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So this is a newborn intensive care unit[br]in Kathmandu, Nepal.

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All of these kids in blankets[br]belong in incubators --

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something like this.

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This is a donated Japanese Atom incubator

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that we found in a NICU in Kathmandu.

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This is what we want.

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Probably what happened is a hospital[br]in Japan upgraded their equipment

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and donated their old stuff to Nepal.

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The problem is, without technicians,[br]without spare parts,

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donations like this[br]very quickly turn into junk.

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So this seemed like a problem[br]that we could do something about.

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Keeping a baby warm for a week --[br]that's not rocket science.

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So we got started.

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We partnered with a leading medical[br]research institution here in Boston.

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We conducted months[br]of user research overseas,

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trying to think like designers,[br]human-centered design --

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"Let's figure out what people want."

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We killed thousands of Post-it notes.

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We made dozens of prototypes[br]to get to this.

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So this is the NeoNurture[br]infant incubator,

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and this has a lot of smarts[br]built into it, and we felt great.

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So the idea here is,[br]unlike the concept car,

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we want to marry something beautiful

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with something that actually works.

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And our idea is that this design

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would inspire manufacturers[br]and other people of influence

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to take this model and run with it.

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Here's the bad news:

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the only baby ever actually put[br]inside the NeoNurture incubator

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was this kid during a Time[br]magazine photo shoot.

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So recognition is fantastic.

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We want design to get out[br]for people to see it.

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It won lots of awards.

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But it felt like a booby prize.

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We wanted to make beautiful things

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that are going to make[br]the world a better place,

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and I don't think this kid was even[br]in it long enough to get warm.

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So it turns out that design [br]for inspiration doesn't really ...

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I guess what I would say is,[br]for us, for what I want to do,

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it's either too slow or it just[br]doesn't work, it's ineffective.

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So, really, I want to design for outcomes.

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I don't want to make beautiful stuff;[br]I want to make the world a better place.

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So when we were designing NeoNurture,

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we paid a lot of attention to the people[br]who are going to use this thing,

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for example, poor families, rural doctors,

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overloaded nurses,[br]even repair technicians.

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We thought we had all our bases[br]covered, we'd done everything right.

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Well, it turns out there's this[br]whole constellation of people

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who have to be involved[br]in a product for it to be successful:

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manufacturing, financing,[br]distribution, regulation.

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Michael Free at PATH[br]says you have to figure out

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who will "choose, use and pay the dues"

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for a product like this.

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And I have to ask the question[br]that VCs always ask:

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"Sir, what is your business,[br]and who is your customer?"

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Who is our customer?

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Well, here's an example.

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This is a Bangladeshi hospital director[br]outside his facility.

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It turns out he doesn't buy[br]any of his equipment.

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Those decisions are made[br]by the Ministry of Health

0:04:03.267,0:04:04.591
or by foreign donors,

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and it just kind of shows up.

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Similarly, here's a multinational[br]medical-device manufacturer.

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It turns out they've got to fish[br]where the fish are.

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So it turns out that in emerging[br]markets -- where the fish are --

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are the emerging middle class[br]of these countries --

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diseases of affluence:[br]heart disease, infertility.

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So it turns out that design[br]for outcomes in one aspect

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really means thinking about design[br]for manufacture and distribution.

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OK, that was an important lesson.

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Second, we took that lesson and tried[br]to push it into our next project.

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So we started by finding a manufacturer,

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an organization called MTTS in Vietnam,

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that manufactures newborn-care[br]technologies for Southeast Asia.

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Our other partner is East Meets West,

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an American foundation[br]that distributes that technology

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to poor hospitals around that region.

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So we started with them, saying,[br]"Well, what do you want?

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What's a problem you want to solve?"

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And they said, "Let's work[br]on newborn jaundice."

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So this is another one of these[br]mind-boggling global problems.

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Jaundice affects two-thirds[br]of newborns around the world.

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Of those newborns, one in 10 roughly,

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if it's not treated,[br]the jaundice gets so severe

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that it leads to either[br]a life-long disability,

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or the kids could even die.

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There's one way to treat jaundice,

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and that's what's called[br]an exchange transfusion.

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So as you can imagine, that's expensive[br]and a little bit dangerous.

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There is another cure.

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It's very technological,[br]it's very complex, a little daunting.

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You've got to shine blue light on the kid.

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(Laughter)

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Bright blue light on as much[br]of the skin as you can cover.

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How is this a hard problem?

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I went to MIT. OK, we'll figure that out.

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(Laughter)

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So here's an example.

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This is an overhead phototherapy device[br]that's designed for American hospitals,

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and here's how it's supposed to be used.

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It's over the baby,[br]illuminating a single patient.

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Take it out of an American hospital,

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send it overseas[br]to a crowded facility in Asia,

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here's how it's actually used.

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The effectiveness of phototherapy[br]is a function of light intensity.

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These dark blue squares show you[br]where it's effective phototherapy.

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Here's what it looks[br]like under actual use.

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So those kids on the edges aren't actually[br]receiving effective phototherapy.

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But without training,[br]without some kind of light meter,

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how would you know?

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We see other examples[br]of problems like this.

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Here's a neonatal intensive care unit,

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where moms come in to visit their babies.

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And keep in mind that Mom[br]maybe just had a C-section,

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so that's already kind of a bummer.

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Mom's visiting her kid.

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She sees her baby naked,[br]lying under some blue lights,

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looking kind of vulnerable.

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It's not uncommon for Mom[br]to put a blanket over the baby.

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From a phototherapy standpoint,[br]maybe not the best behavior.

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In fact, that sounds kind of dumb.

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Except, what we've learned is that[br]there's no such thing as a dumb user --

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there are only dumb products.

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We have to think like existentialists:

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it's not the painting[br]we would have painted,

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it's the painting[br]that we actually painted.

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It's the use -- designed for actual use.

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How are people actually going to use this?

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So, similarly, when we think[br]about our partner MTTS,

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they've made some amazing technologies[br]for treating newborn illnesses.

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So here's an overhead warmer and a CPAP.

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They're inexpensive, really rugged.

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They've treated 50,000 kids[br]in Vietnam with this technology.

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But here's the problem:

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Every doctor in the world,[br]every hospital administrator,

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has seen TV -- curse those "ER" reruns!

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Turns out they all know what a medical[br]device is supposed to look like.

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They want Buck Rogers,[br]they don't want effective.

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It sounds crazy, it sounds dumb,

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but there are actually hospitals[br]who would rather have no equipment

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than something that looks[br]cheap and crummy.

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So again, if we want[br]people to trust a device,

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it has to look trustworthy.

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So thinking about outcomes,

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it turns out appearances matter.

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We took all that information together.

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We tried, this time, to get it right.

0:08:04.654,0:08:06.042
And here's what we developed.

0:08:06.066,0:08:08.002
This is the Firefly phototherapy device,

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except this time,[br]we didn't stop at the concept car.

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From the very beginning, we started[br]by talking to manufacturers.

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Our goal is to make[br]a state-of-the-art product

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that our partner MTTS[br]can actually manufacture.

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Our goal is to study how they work,[br]the resources they have access to,

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so that they can make this product.

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So that's the design[br]for manufacture question.

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When we think about actual use,

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you'll notice that Firefly[br]has a single bassinet.

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It only fits a single baby,

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and the idea here is it's obvious[br]how you ought to use this device.

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If you try to put more than one kid in,

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you're stacking them on top of each other.

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(Laughter)

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So the idea here is you want[br]to make it hard to use wrong.

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In other words, you want to make[br]the right way to use it

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the easiest way to use it.

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Another example -- again, silly Mom.

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Silly Mom thinks her baby looks cold,[br]wants to put a blanket over the baby.

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That's why we have lights[br]above and below the baby in Firefly,

0:09:02.780,0:09:04.817
so if Mom does put a blanket[br]over the baby,

0:09:04.841,0:09:07.792
it's still receiving effective[br]phototherapy from below.

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Last story here:

0:09:09.978,0:09:11.873
I've got a friend in India who told me

0:09:11.897,0:09:14.878
that you haven't really tested[br]a piece of electronic technology

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for distribution in Asia,

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until you've trained a cockroach[br]to climb in and pee

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on every single little[br]component on the inside.

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(Laughter)

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You think it's funny.

0:09:25.104,0:09:27.318
I had a laptop in the Peace Corps,

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and the screen had all these[br]dead pixels on it.

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And one day I looked in --[br]they were all dead ants

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that had gotten[br]into my laptop and perished.

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Those poor ants.

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(Laughter)

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So with Firefly, what we did is --[br]the problem is electronics get hot,

0:09:40.794,0:09:43.516
and you have to put in vents[br]or fans to keep them cool --

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in most products.

0:09:44.808,0:09:49.593
We decided we can't put a "Do not enter"[br]sign next to the vent.

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We actually got rid of all that stuff.

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So Firefly's totally sealed.

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These are the kinds of lessons --

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as awkward as it was[br]to be a pretty goofy teenager,

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much worse to be a frustrated designer.

0:09:59.648,0:10:02.758
So I was thinking, "What I really[br]want to do is change the world.

0:10:02.782,0:10:05.525
I have to pay attention[br]to manufacturing and distribution.

0:10:05.549,0:10:09.540
I have to pay attention to how people[br]are actually going to use a device.

0:10:09.564,0:10:12.580
I actually have to pay attention.[br]There's no excuse for failure.

0:10:12.604,0:10:14.478
I have to think like an existentialist.

0:10:14.502,0:10:17.742
I have to accept that there[br]are no dumb users, only dumb products."

0:10:17.766,0:10:20.136
We have to ask ourselves hard questions.

0:10:20.160,0:10:22.486
Are we designing[br]for the world that we want?

0:10:23.240,0:10:25.518
Are we designing[br]for the world that we have?

0:10:25.906,0:10:28.020
Are we designing[br]for the world that's coming,

0:10:28.044,0:10:29.338
whether we're ready or not?

0:10:29.362,0:10:32.381
I got into this business[br]designing products.

0:10:32.762,0:10:36.425
I've since learned that if you really want[br]to make a difference in the world,

0:10:36.449,0:10:38.212
you have to design outcomes.

0:10:38.236,0:10:39.777
And that's design that matters.

0:10:39.801,0:10:40.953
Thank you.

0:10:40.977,0:10:44.595
(Applause)