1
00:00:00,136 --> 00:00:02,756
I've got a great idea
that's going to change the world.

2
00:00:02,780 --> 00:00:05,174
It's fantastic, it's going
to blow your mind.

3
00:00:05,198 --> 00:00:06,599
It's my beautiful baby.

4
00:00:06,623 --> 00:00:09,052
Here's the thing:
everybody loves a beautiful baby.

5
00:00:09,076 --> 00:00:11,017
I mean, I was a beautiful baby.

6
00:00:11,041 --> 00:00:13,517
Here's me and my dad
a couple days after I was born.

7
00:00:13,541 --> 00:00:15,180
So in the world of product design,

8
00:00:15,204 --> 00:00:17,572
the beautiful baby's like the concept car.

9
00:00:17,596 --> 00:00:19,482
It's the knockout.

10
00:00:19,506 --> 00:00:22,645
You see it and you go, "Oh, my God.
I'd buy that in a second!"

11
00:00:22,669 --> 00:00:25,040
So why is it that this year's new cars

12
00:00:25,064 --> 00:00:28,328
look pretty much exactly
like last year's new cars?

13
00:00:28,352 --> 00:00:30,124
(Laughter)

14
00:00:30,148 --> 00:00:32,966
What went wrong between
the design studio and the factory?

15
00:00:32,990 --> 00:00:35,394
Today, I don't want to talk
about beautiful babies,

16
00:00:35,418 --> 00:00:38,159
I want to talk about the awkward
adolescence of design --

17
00:00:38,183 --> 00:00:42,761
those sort of dorky teenage years

18
00:00:42,785 --> 00:00:45,728
where you're trying to figure out
how the world works.

19
00:00:46,307 --> 00:00:47,942
I'm going to start with an example

20
00:00:47,966 --> 00:00:50,394
from some work that we did
on newborn health.

21
00:00:50,418 --> 00:00:52,050
So here's a problem:

22
00:00:52,074 --> 00:00:56,089
four million babies around the world,
mostly in developing countries,

23
00:00:56,113 --> 00:00:58,474
die every year
before their first birthday,

24
00:00:58,498 --> 00:01:00,326
even before their first month of life.

25
00:01:00,350 --> 00:01:02,010
It turns out half of those kids,

26
00:01:02,034 --> 00:01:04,248
or about 1.8 million newborns
around the world,

27
00:01:04,272 --> 00:01:07,160
would make it if you could
just keep them warm

28
00:01:07,184 --> 00:01:09,906
for the first three days,
maybe the first week.

29
00:01:09,930 --> 00:01:13,631
So this is a newborn intensive care unit
in Kathmandu, Nepal.

30
00:01:13,655 --> 00:01:16,364
All of these kids in blankets
belong in incubators --

31
00:01:16,388 --> 00:01:18,037
something like this.

32
00:01:18,061 --> 00:01:20,857
This is a donated Japanese Atom incubator

33
00:01:20,881 --> 00:01:23,554
that we found in a NICU in Kathmandu.

34
00:01:24,125 --> 00:01:25,291
This is what we want.

35
00:01:25,315 --> 00:01:28,649
Probably what happened is a hospital
in Japan upgraded their equipment

36
00:01:28,673 --> 00:01:32,102
and donated their old stuff to Nepal.

37
00:01:32,126 --> 00:01:35,191
The problem is, without technicians,
without spare parts,

38
00:01:35,215 --> 00:01:38,634
donations like this
very quickly turn into junk.

39
00:01:39,253 --> 00:01:42,491
So this seemed like a problem
that we could do something about.

40
00:01:42,958 --> 00:01:46,732
Keeping a baby warm for a week --
that's not rocket science.

41
00:01:46,756 --> 00:01:48,139
So we got started.

42
00:01:48,163 --> 00:01:52,034
We partnered with a leading medical
research institution here in Boston.

43
00:01:52,058 --> 00:01:54,974
We conducted months
of user research overseas,

44
00:01:54,998 --> 00:01:57,704
trying to think like designers,
human-centered design --

45
00:01:57,728 --> 00:01:59,801
"Let's figure out what people want."

46
00:02:00,575 --> 00:02:02,668
We killed thousands of Post-it notes.

47
00:02:02,692 --> 00:02:06,115
We made dozens of prototypes
to get to this.

48
00:02:06,139 --> 00:02:09,107
So this is the NeoNurture
infant incubator,

49
00:02:09,131 --> 00:02:12,805
and this has a lot of smarts
built into it, and we felt great.

50
00:02:12,829 --> 00:02:15,143
So the idea here is,
unlike the concept car,

51
00:02:15,167 --> 00:02:17,021
we want to marry something beautiful

52
00:02:17,045 --> 00:02:19,524
with something that actually works.

53
00:02:19,548 --> 00:02:21,635
And our idea is that this design

54
00:02:21,659 --> 00:02:25,122
would inspire manufacturers
and other people of influence

55
00:02:25,146 --> 00:02:27,655
to take this model and run with it.

56
00:02:28,516 --> 00:02:31,173
Here's the bad news:

57
00:02:31,197 --> 00:02:35,171
the only baby ever actually put
inside the NeoNurture incubator

58
00:02:35,195 --> 00:02:38,438
was this kid during a Time
magazine photo shoot.

59
00:02:39,068 --> 00:02:41,271
So recognition is fantastic.

60
00:02:41,295 --> 00:02:43,970
We want design to get out
for people to see it.

61
00:02:43,994 --> 00:02:45,860
It won lots of awards.

62
00:02:45,884 --> 00:02:48,146
But it felt like a booby prize.

63
00:02:48,906 --> 00:02:50,606
We wanted to make beautiful things

64
00:02:50,630 --> 00:02:53,767
that are going to make
the world a better place,

65
00:02:53,791 --> 00:02:57,445
and I don't think this kid was even
in it long enough to get warm.

66
00:02:57,469 --> 00:03:03,176
So it turns out that design 
for inspiration doesn't really ...

67
00:03:03,200 --> 00:03:06,726
I guess what I would say is,
for us, for what I want to do,

68
00:03:06,750 --> 00:03:10,160
it's either too slow or it just
doesn't work, it's ineffective.

69
00:03:10,184 --> 00:03:13,221
So, really, I want to design for outcomes.

70
00:03:13,245 --> 00:03:16,941
I don't want to make beautiful stuff;
I want to make the world a better place.

71
00:03:16,965 --> 00:03:18,750
So when we were designing NeoNurture,

72
00:03:18,774 --> 00:03:22,215
we paid a lot of attention to the people
who are going to use this thing,

73
00:03:22,239 --> 00:03:24,842
for example, poor families, rural doctors,

74
00:03:24,866 --> 00:03:28,022
overloaded nurses,
even repair technicians.

75
00:03:28,046 --> 00:03:31,258
We thought we had all our bases
covered, we'd done everything right.

76
00:03:31,282 --> 00:03:34,148
Well, it turns out there's this
whole constellation of people

77
00:03:34,172 --> 00:03:37,035
who have to be involved
in a product for it to be successful:

78
00:03:37,059 --> 00:03:39,749
manufacturing, financing,
distribution, regulation.

79
00:03:39,773 --> 00:03:42,026
Michael Free at PATH
says you have to figure out

80
00:03:42,050 --> 00:03:44,684
who will "choose, use and pay the dues"

81
00:03:44,708 --> 00:03:45,998
for a product like this.

82
00:03:46,022 --> 00:03:48,466
And I have to ask the question
that VCs always ask:

83
00:03:48,490 --> 00:03:51,340
"Sir, what is your business,
and who is your customer?"

84
00:03:51,364 --> 00:03:52,637
Who is our customer?

85
00:03:53,129 --> 00:03:54,297
Well, here's an example.

86
00:03:54,321 --> 00:03:57,592
This is a Bangladeshi hospital director
outside his facility.

87
00:03:57,616 --> 00:04:00,453
It turns out he doesn't buy
any of his equipment.

88
00:04:00,477 --> 00:04:03,243
Those decisions are made
by the Ministry of Health

89
00:04:03,267 --> 00:04:04,591
or by foreign donors,

90
00:04:04,615 --> 00:04:05,996
and it just kind of shows up.

91
00:04:06,339 --> 00:04:09,830
Similarly, here's a multinational
medical-device manufacturer.

92
00:04:09,854 --> 00:04:12,764
It turns out they've got to fish
where the fish are.

93
00:04:12,788 --> 00:04:16,125
So it turns out that in emerging
markets -- where the fish are --

94
00:04:16,149 --> 00:04:19,244
are the emerging middle class
of these countries --

95
00:04:19,268 --> 00:04:22,722
diseases of affluence:
heart disease, infertility.

96
00:04:22,746 --> 00:04:27,224
So it turns out that design
for outcomes in one aspect

97
00:04:27,248 --> 00:04:30,772
really means thinking about design
for manufacture and distribution.

98
00:04:30,796 --> 00:04:32,602
OK, that was an important lesson.

99
00:04:33,007 --> 00:04:37,173
Second, we took that lesson and tried
to push it into our next project.

100
00:04:37,197 --> 00:04:39,706
So we started by finding a manufacturer,

101
00:04:39,730 --> 00:04:42,028
an organization called MTTS in Vietnam,

102
00:04:42,052 --> 00:04:45,450
that manufactures newborn-care
technologies for Southeast Asia.

103
00:04:45,474 --> 00:04:47,358
Our other partner is East Meets West,

104
00:04:47,382 --> 00:04:50,008
an American foundation
that distributes that technology

105
00:04:50,032 --> 00:04:52,682
to poor hospitals around that region.

106
00:04:52,706 --> 00:04:55,389
So we started with them, saying,
"Well, what do you want?

107
00:04:55,413 --> 00:04:57,142
What's a problem you want to solve?"

108
00:04:57,166 --> 00:04:59,671
And they said, "Let's work
on newborn jaundice."

109
00:04:59,695 --> 00:05:03,757
So this is another one of these
mind-boggling global problems.

110
00:05:03,781 --> 00:05:07,520
Jaundice affects two-thirds
of newborns around the world.

111
00:05:07,544 --> 00:05:12,068
Of those newborns, one in 10 roughly,

112
00:05:12,092 --> 00:05:14,572
if it's not treated,
the jaundice gets so severe

113
00:05:14,596 --> 00:05:17,269
that it leads to either
a life-long disability,

114
00:05:17,293 --> 00:05:19,834
or the kids could even die.

115
00:05:20,330 --> 00:05:22,049
There's one way to treat jaundice,

116
00:05:22,073 --> 00:05:24,613
and that's what's called
an exchange transfusion.

117
00:05:24,637 --> 00:05:28,481
So as you can imagine, that's expensive
and a little bit dangerous.

118
00:05:28,505 --> 00:05:30,290
There is another cure.

119
00:05:30,314 --> 00:05:35,957
It's very technological,
it's very complex, a little daunting.

120
00:05:35,981 --> 00:05:38,203
You've got to shine blue light on the kid.

121
00:05:38,227 --> 00:05:39,289
(Laughter)

122
00:05:39,313 --> 00:05:42,764
Bright blue light on as much
of the skin as you can cover.

123
00:05:42,788 --> 00:05:44,669
How is this a hard problem?

124
00:05:44,693 --> 00:05:50,334
I went to MIT. OK, we'll figure that out.

125
00:05:50,358 --> 00:05:51,794
(Laughter)

126
00:05:51,818 --> 00:05:52,985
So here's an example.

127
00:05:53,009 --> 00:05:57,517
This is an overhead phototherapy device
that's designed for American hospitals,

128
00:05:57,541 --> 00:05:59,519
and here's how it's supposed to be used.

129
00:05:59,543 --> 00:06:03,412
It's over the baby,
illuminating a single patient.

130
00:06:04,166 --> 00:06:05,905
Take it out of an American hospital,

131
00:06:05,929 --> 00:06:08,138
send it overseas
to a crowded facility in Asia,

132
00:06:08,162 --> 00:06:09,614
here's how it's actually used.

133
00:06:09,638 --> 00:06:12,861
The effectiveness of phototherapy
is a function of light intensity.

134
00:06:12,885 --> 00:06:16,292
These dark blue squares show you
where it's effective phototherapy.

135
00:06:16,316 --> 00:06:18,347
Here's what it looks
like under actual use.

136
00:06:18,371 --> 00:06:22,052
So those kids on the edges aren't actually
receiving effective phototherapy.

137
00:06:22,076 --> 00:06:25,502
But without training,
without some kind of light meter,

138
00:06:25,526 --> 00:06:26,844
how would you know?

139
00:06:27,336 --> 00:06:29,397
We see other examples
of problems like this.

140
00:06:29,421 --> 00:06:31,243
Here's a neonatal intensive care unit,

141
00:06:31,267 --> 00:06:33,229
where moms come in to visit their babies.

142
00:06:33,253 --> 00:06:35,748
And keep in mind that Mom
maybe just had a C-section,

143
00:06:35,772 --> 00:06:37,638
so that's already kind of a bummer.

144
00:06:37,662 --> 00:06:39,035
Mom's visiting her kid.

145
00:06:39,059 --> 00:06:42,194
She sees her baby naked,
lying under some blue lights,

146
00:06:42,218 --> 00:06:44,333
looking kind of vulnerable.

147
00:06:44,357 --> 00:06:47,369
It's not uncommon for Mom
to put a blanket over the baby.

148
00:06:48,214 --> 00:06:52,088
From a phototherapy standpoint,
maybe not the best behavior.

149
00:06:52,112 --> 00:06:53,986
In fact, that sounds kind of dumb.

150
00:06:54,010 --> 00:06:58,800
Except, what we've learned is that
there's no such thing as a dumb user --

151
00:06:58,824 --> 00:07:01,486
there are only dumb products.

152
00:07:01,510 --> 00:07:03,348
We have to think like existentialists:

153
00:07:03,372 --> 00:07:05,436
it's not the painting
we would have painted,

154
00:07:05,460 --> 00:07:07,475
it's the painting
that we actually painted.

155
00:07:07,499 --> 00:07:10,009
It's the use -- designed for actual use.

156
00:07:10,033 --> 00:07:12,033
How are people actually going to use this?

157
00:07:12,477 --> 00:07:15,557
So, similarly, when we think
about our partner MTTS,

158
00:07:15,581 --> 00:07:19,009
they've made some amazing technologies
for treating newborn illnesses.

159
00:07:19,033 --> 00:07:21,342
So here's an overhead warmer and a CPAP.

160
00:07:21,366 --> 00:07:24,111
They're inexpensive, really rugged.

161
00:07:24,135 --> 00:07:26,972
They've treated 50,000 kids
in Vietnam with this technology.

162
00:07:26,996 --> 00:07:28,353
But here's the problem:

163
00:07:28,377 --> 00:07:31,180
Every doctor in the world,
every hospital administrator,

164
00:07:31,204 --> 00:07:36,456
has seen TV -- curse those "ER" reruns!

165
00:07:36,480 --> 00:07:40,129
Turns out they all know what a medical
device is supposed to look like.

166
00:07:40,637 --> 00:07:43,668
They want Buck Rogers,
they don't want effective.

167
00:07:44,049 --> 00:07:45,807
It sounds crazy, it sounds dumb,

168
00:07:45,831 --> 00:07:48,998
but there are actually hospitals
who would rather have no equipment

169
00:07:49,022 --> 00:07:51,078
than something that looks
cheap and crummy.

170
00:07:51,102 --> 00:07:54,396
So again, if we want
people to trust a device,

171
00:07:54,420 --> 00:07:55,828
it has to look trustworthy.

172
00:07:55,852 --> 00:07:57,343
So thinking about outcomes,

173
00:07:57,367 --> 00:07:59,744
it turns out appearances matter.

174
00:07:59,768 --> 00:08:02,275
We took all that information together.

175
00:08:02,299 --> 00:08:04,630
We tried, this time, to get it right.

176
00:08:04,654 --> 00:08:06,042
And here's what we developed.

177
00:08:06,066 --> 00:08:08,002
This is the Firefly phototherapy device,

178
00:08:08,026 --> 00:08:10,878
except this time,
we didn't stop at the concept car.

179
00:08:11,687 --> 00:08:14,941
From the very beginning, we started
by talking to manufacturers.

180
00:08:14,965 --> 00:08:18,109
Our goal is to make
a state-of-the-art product

181
00:08:18,133 --> 00:08:20,815
that our partner MTTS
can actually manufacture.

182
00:08:20,839 --> 00:08:24,926
Our goal is to study how they work,
the resources they have access to,

183
00:08:24,950 --> 00:08:27,156
so that they can make this product.

184
00:08:27,505 --> 00:08:29,996
So that's the design
for manufacture question.

185
00:08:30,020 --> 00:08:31,855
When we think about actual use,

186
00:08:31,879 --> 00:08:34,188
you'll notice that Firefly
has a single bassinet.

187
00:08:34,212 --> 00:08:36,085
It only fits a single baby,

188
00:08:36,109 --> 00:08:40,143
and the idea here is it's obvious
how you ought to use this device.

189
00:08:40,167 --> 00:08:42,040
If you try to put more than one kid in,

190
00:08:42,064 --> 00:08:44,093
you're stacking them on top of each other.

191
00:08:44,117 --> 00:08:45,749
(Laughter)

192
00:08:45,773 --> 00:08:48,544
So the idea here is you want
to make it hard to use wrong.

193
00:08:48,568 --> 00:08:51,235
In other words, you want to make
the right way to use it

194
00:08:51,259 --> 00:08:53,197
the easiest way to use it.

195
00:08:53,221 --> 00:08:56,233
Another example -- again, silly Mom.

196
00:08:56,257 --> 00:08:59,810
Silly Mom thinks her baby looks cold,
wants to put a blanket over the baby.

197
00:08:59,834 --> 00:09:02,756
That's why we have lights
above and below the baby in Firefly,

198
00:09:02,780 --> 00:09:04,817
so if Mom does put a blanket
over the baby,

199
00:09:04,841 --> 00:09:07,792
it's still receiving effective
phototherapy from below.

200
00:09:08,636 --> 00:09:09,954
Last story here:

201
00:09:09,978 --> 00:09:11,873
I've got a friend in India who told me

202
00:09:11,897 --> 00:09:14,878
that you haven't really tested
a piece of electronic technology

203
00:09:14,902 --> 00:09:16,944
for distribution in Asia,

204
00:09:16,968 --> 00:09:19,413
until you've trained a cockroach
to climb in and pee

205
00:09:19,437 --> 00:09:21,889
on every single little
component on the inside.

206
00:09:21,913 --> 00:09:23,697
(Laughter)

207
00:09:23,721 --> 00:09:25,080
You think it's funny.

208
00:09:25,104 --> 00:09:27,318
I had a laptop in the Peace Corps,

209
00:09:27,342 --> 00:09:29,546
and the screen had all these
dead pixels on it.

210
00:09:29,570 --> 00:09:32,355
And one day I looked in --
they were all dead ants

211
00:09:32,379 --> 00:09:34,443
that had gotten
into my laptop and perished.

212
00:09:34,467 --> 00:09:35,618
Those poor ants.

213
00:09:35,642 --> 00:09:37,182
(Laughter)

214
00:09:37,206 --> 00:09:40,770
So with Firefly, what we did is --
the problem is electronics get hot,

215
00:09:40,794 --> 00:09:43,516
and you have to put in vents
or fans to keep them cool --

216
00:09:43,540 --> 00:09:44,784
in most products.

217
00:09:44,808 --> 00:09:49,593
We decided we can't put a "Do not enter"
sign next to the vent.

218
00:09:49,617 --> 00:09:51,616
We actually got rid of all that stuff.

219
00:09:51,640 --> 00:09:53,004
So Firefly's totally sealed.

220
00:09:53,365 --> 00:09:54,957
These are the kinds of lessons --

221
00:09:54,981 --> 00:09:57,617
as awkward as it was
to be a pretty goofy teenager,

222
00:09:57,641 --> 00:09:59,624
much worse to be a frustrated designer.

223
00:09:59,648 --> 00:10:02,758
So I was thinking, "What I really
want to do is change the world.

224
00:10:02,782 --> 00:10:05,525
I have to pay attention
to manufacturing and distribution.

225
00:10:05,549 --> 00:10:09,540
I have to pay attention to how people
are actually going to use a device.

226
00:10:09,564 --> 00:10:12,580
I actually have to pay attention.
There's no excuse for failure.

227
00:10:12,604 --> 00:10:14,478
I have to think like an existentialist.

228
00:10:14,502 --> 00:10:17,742
I have to accept that there
are no dumb users, only dumb products."

229
00:10:17,766 --> 00:10:20,136
We have to ask ourselves hard questions.

230
00:10:20,160 --> 00:10:22,486
Are we designing
for the world that we want?

231
00:10:23,240 --> 00:10:25,518
Are we designing
for the world that we have?

232
00:10:25,906 --> 00:10:28,020
Are we designing
for the world that's coming,

233
00:10:28,044 --> 00:10:29,338
whether we're ready or not?

234
00:10:29,362 --> 00:10:32,381
I got into this business
designing products.

235
00:10:32,762 --> 00:10:36,425
I've since learned that if you really want
to make a difference in the world,

236
00:10:36,449 --> 00:10:38,212
you have to design outcomes.

237
00:10:38,236 --> 00:10:39,777
And that's design that matters.

238
00:10:39,801 --> 00:10:40,953
Thank you.

239
00:10:40,977 --> 00:10:44,595
(Applause)