WEBVTT 00:00:00.136 --> 00:00:02.756 I've got a great idea that's going to change the world. 00:00:02.780 --> 00:00:05.174 It's fantastic, it's going to blow your mind. 00:00:05.198 --> 00:00:06.599 It's my beautiful baby. 00:00:06.623 --> 00:00:09.052 Here's the thing: everybody loves a beautiful baby. 00:00:09.076 --> 00:00:11.017 I mean, I was a beautiful baby. 00:00:11.041 --> 00:00:13.517 Here's me and my dad a couple days after I was born. NOTE Paragraph 00:00:13.541 --> 00:00:15.180 So in the world of product design, 00:00:15.204 --> 00:00:17.572 the beautiful baby's like the concept car. 00:00:17.596 --> 00:00:19.482 It's the knockout. 00:00:19.506 --> 00:00:22.645 You see it and you go, "Oh, my God. I'd buy that in a second!" 00:00:22.669 --> 00:00:25.040 So why is it that this year's new cars 00:00:25.064 --> 00:00:28.328 look pretty much exactly like last year's new cars? NOTE Paragraph 00:00:28.352 --> 00:00:30.124 (Laughter) NOTE Paragraph 00:00:30.148 --> 00:00:32.966 What went wrong between the design studio and the factory? 00:00:32.990 --> 00:00:35.394 Today, I don't want to talk about beautiful babies, 00:00:35.418 --> 00:00:38.159 I want to talk about the awkward adolescence of design -- 00:00:38.183 --> 00:00:42.761 those sort of dorky teenage years 00:00:42.785 --> 00:00:45.728 where you're trying to figure out how the world works. NOTE Paragraph 00:00:46.307 --> 00:00:47.942 I'm going to start with an example 00:00:47.966 --> 00:00:50.394 from some work that we did on newborn health. 00:00:50.418 --> 00:00:52.050 So here's a problem: 00:00:52.074 --> 00:00:56.089 four million babies around the world, mostly in developing countries, 00:00:56.113 --> 00:00:58.474 die every year before their first birthday, 00:00:58.498 --> 00:01:00.326 even before their first month of life. 00:01:00.350 --> 00:01:02.010 It turns out half of those kids, 00:01:02.034 --> 00:01:04.248 or about 1.8 million newborns around the world, 00:01:04.272 --> 00:01:07.160 would make it if you could just keep them warm 00:01:07.184 --> 00:01:09.906 for the first three days, maybe the first week. NOTE Paragraph 00:01:09.930 --> 00:01:13.631 So this is a newborn intensive care unit in Kathmandu, Nepal. 00:01:13.655 --> 00:01:16.364 All of these kids in blankets belong in incubators -- 00:01:16.388 --> 00:01:18.037 something like this. 00:01:18.061 --> 00:01:20.857 This is a donated Japanese Atom incubator 00:01:20.881 --> 00:01:23.554 that we found in a NICU in Kathmandu. 00:01:24.125 --> 00:01:25.291 This is what we want. 00:01:25.315 --> 00:01:28.649 Probably what happened is a hospital in Japan upgraded their equipment 00:01:28.673 --> 00:01:32.102 and donated their old stuff to Nepal. 00:01:32.126 --> 00:01:35.191 The problem is, without technicians, without spare parts, 00:01:35.215 --> 00:01:38.634 donations like this very quickly turn into junk. NOTE Paragraph 00:01:39.253 --> 00:01:42.491 So this seemed like a problem that we could do something about. 00:01:42.958 --> 00:01:46.732 Keeping a baby warm for a week -- that's not rocket science. 00:01:46.756 --> 00:01:48.139 So we got started. 00:01:48.163 --> 00:01:52.034 We partnered with a leading medical research institution here in Boston. 00:01:52.058 --> 00:01:54.974 We conducted months of user research overseas, 00:01:54.998 --> 00:01:57.704 trying to think like designers, human-centered design -- 00:01:57.728 --> 00:01:59.801 "Let's figure out what people want." 00:02:00.575 --> 00:02:02.668 We killed thousands of Post-it notes. 00:02:02.692 --> 00:02:06.115 We made dozens of prototypes to get to this. 00:02:06.139 --> 00:02:09.107 So this is the NeoNurture infant incubator, 00:02:09.131 --> 00:02:12.805 and this has a lot of smarts built into it, and we felt great. NOTE Paragraph 00:02:12.829 --> 00:02:15.143 So the idea here is, unlike the concept car, 00:02:15.167 --> 00:02:17.021 we want to marry something beautiful 00:02:17.045 --> 00:02:19.524 with something that actually works. 00:02:19.548 --> 00:02:21.635 And our idea is that this design 00:02:21.659 --> 00:02:25.122 would inspire manufacturers and other people of influence 00:02:25.146 --> 00:02:27.655 to take this model and run with it. NOTE Paragraph 00:02:28.516 --> 00:02:31.173 Here's the bad news: 00:02:31.197 --> 00:02:35.171 the only baby ever actually put inside the NeoNurture incubator 00:02:35.195 --> 00:02:38.438 was this kid during a Time magazine photo shoot. 00:02:39.068 --> 00:02:41.271 So recognition is fantastic. 00:02:41.295 --> 00:02:43.970 We want design to get out for people to see it. 00:02:43.994 --> 00:02:45.860 It won lots of awards. 00:02:45.884 --> 00:02:48.146 But it felt like a booby prize. 00:02:48.906 --> 00:02:50.606 We wanted to make beautiful things 00:02:50.630 --> 00:02:53.767 that are going to make the world a better place, 00:02:53.791 --> 00:02:57.445 and I don't think this kid was even in it long enough to get warm. NOTE Paragraph 00:02:57.469 --> 00:03:03.176 So it turns out that design for inspiration doesn't really ... 00:03:03.200 --> 00:03:06.726 I guess what I would say is, for us, for what I want to do, 00:03:06.750 --> 00:03:10.160 it's either too slow or it just doesn't work, it's ineffective. 00:03:10.184 --> 00:03:13.221 So, really, I want to design for outcomes. 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. 00:03:16.965 --> 00:03:18.750 So when we were designing NeoNurture, 00:03:18.774 --> 00:03:22.215 we paid a lot of attention to the people who are going to use this thing, 00:03:22.239 --> 00:03:24.842 for example, poor families, rural doctors, 00:03:24.866 --> 00:03:28.022 overloaded nurses, even repair technicians. 00:03:28.046 --> 00:03:31.258 We thought we had all our bases covered, we'd done everything right. NOTE Paragraph 00:03:31.282 --> 00:03:34.148 Well, it turns out there's this whole constellation of people 00:03:34.172 --> 00:03:37.035 who have to be involved in a product for it to be successful: 00:03:37.059 --> 00:03:39.749 manufacturing, financing, distribution, regulation. 00:03:39.773 --> 00:03:42.026 Michael Free at PATH says you have to figure out 00:03:42.050 --> 00:03:44.684 who will "choose, use and pay the dues" 00:03:44.708 --> 00:03:45.998 for a product like this. 00:03:46.022 --> 00:03:48.466 And I have to ask the question that VCs always ask: 00:03:48.490 --> 00:03:51.340 "Sir, what is your business, and who is your customer?" NOTE Paragraph 00:03:51.364 --> 00:03:52.637 Who is our customer? 00:03:53.129 --> 00:03:54.297 Well, here's an example. 00:03:54.321 --> 00:03:57.592 This is a Bangladeshi hospital director outside his facility. 00:03:57.616 --> 00:04:00.453 It turns out he doesn't buy any of his equipment. 00:04:00.477 --> 00:04:03.243 Those decisions are made by the Ministry of Health 00:04:03.267 --> 00:04:04.591 or by foreign donors, 00:04:04.615 --> 00:04:05.996 and it just kind of shows up. 00:04:06.339 --> 00:04:09.830 Similarly, here's a multinational medical-device manufacturer. 00:04:09.854 --> 00:04:12.764 It turns out they've got to fish where the fish are. 00:04:12.788 --> 00:04:16.125 So it turns out that in emerging markets -- where the fish are -- 00:04:16.149 --> 00:04:19.244 are the emerging middle class of these countries -- 00:04:19.268 --> 00:04:22.722 diseases of affluence: heart disease, infertility. 00:04:22.746 --> 00:04:27.224 So it turns out that design for outcomes in one aspect 00:04:27.248 --> 00:04:30.772 really means thinking about design for manufacture and distribution. 00:04:30.796 --> 00:04:32.602 OK, that was an important lesson. NOTE Paragraph 00:04:33.007 --> 00:04:37.173 Second, we took that lesson and tried to push it into our next project. 00:04:37.197 --> 00:04:39.706 So we started by finding a manufacturer, 00:04:39.730 --> 00:04:42.028 an organization called MTTS in Vietnam, 00:04:42.052 --> 00:04:45.450 that manufactures newborn-care technologies for Southeast Asia. 00:04:45.474 --> 00:04:47.358 Our other partner is East Meets West, 00:04:47.382 --> 00:04:50.008 an American foundation that distributes that technology 00:04:50.032 --> 00:04:52.682 to poor hospitals around that region. NOTE Paragraph 00:04:52.706 --> 00:04:55.389 So we started with them, saying, "Well, what do you want? 00:04:55.413 --> 00:04:57.142 What's a problem you want to solve?" 00:04:57.166 --> 00:04:59.671 And they said, "Let's work on newborn jaundice." 00:04:59.695 --> 00:05:03.757 So this is another one of these mind-boggling global problems. 00:05:03.781 --> 00:05:07.520 Jaundice affects two-thirds of newborns around the world. 00:05:07.544 --> 00:05:12.068 Of those newborns, one in 10 roughly, 00:05:12.092 --> 00:05:14.572 if it's not treated, the jaundice gets so severe 00:05:14.596 --> 00:05:17.269 that it leads to either a life-long disability, 00:05:17.293 --> 00:05:19.834 or the kids could even die. 00:05:20.330 --> 00:05:22.049 There's one way to treat jaundice, 00:05:22.073 --> 00:05:24.613 and that's what's called an exchange transfusion. 00:05:24.637 --> 00:05:28.481 So as you can imagine, that's expensive and a little bit dangerous. NOTE Paragraph 00:05:28.505 --> 00:05:30.290 There is another cure. 00:05:30.314 --> 00:05:35.957 It's very technological, it's very complex, a little daunting. 00:05:35.981 --> 00:05:38.203 You've got to shine blue light on the kid. NOTE Paragraph 00:05:38.227 --> 00:05:39.289 (Laughter) NOTE Paragraph 00:05:39.313 --> 00:05:42.764 Bright blue light on as much of the skin as you can cover. 00:05:42.788 --> 00:05:44.669 How is this a hard problem? 00:05:44.693 --> 00:05:50.334 I went to MIT. OK, we'll figure that out. NOTE Paragraph 00:05:50.358 --> 00:05:51.794 (Laughter) NOTE Paragraph 00:05:51.818 --> 00:05:52.985 So here's an example. 00:05:53.009 --> 00:05:57.517 This is an overhead phototherapy device that's designed for American hospitals, 00:05:57.541 --> 00:05:59.519 and here's how it's supposed to be used. 00:05:59.543 --> 00:06:03.412 It's over the baby, illuminating a single patient. 00:06:04.166 --> 00:06:05.905 Take it out of an American hospital, 00:06:05.929 --> 00:06:08.138 send it overseas to a crowded facility in Asia, 00:06:08.162 --> 00:06:09.614 here's how it's actually used. 00:06:09.638 --> 00:06:12.861 The effectiveness of phototherapy is a function of light intensity. 00:06:12.885 --> 00:06:16.292 These dark blue squares show you where it's effective phototherapy. 00:06:16.316 --> 00:06:18.347 Here's what it looks like under actual use. 00:06:18.371 --> 00:06:22.052 So those kids on the edges aren't actually receiving effective phototherapy. 00:06:22.076 --> 00:06:25.502 But without training, without some kind of light meter, 00:06:25.526 --> 00:06:26.844 how would you know? NOTE Paragraph 00:06:27.336 --> 00:06:29.397 We see other examples of problems like this. 00:06:29.421 --> 00:06:31.243 Here's a neonatal intensive care unit, 00:06:31.267 --> 00:06:33.229 where moms come in to visit their babies. 00:06:33.253 --> 00:06:35.748 And keep in mind that Mom maybe just had a C-section, 00:06:35.772 --> 00:06:37.638 so that's already kind of a bummer. 00:06:37.662 --> 00:06:39.035 Mom's visiting her kid. 00:06:39.059 --> 00:06:42.194 She sees her baby naked, lying under some blue lights, 00:06:42.218 --> 00:06:44.333 looking kind of vulnerable. 00:06:44.357 --> 00:06:47.369 It's not uncommon for Mom to put a blanket over the baby. 00:06:48.214 --> 00:06:52.088 From a phototherapy standpoint, maybe not the best behavior. 00:06:52.112 --> 00:06:53.986 In fact, that sounds kind of dumb. 00:06:54.010 --> 00:06:58.800 Except, what we've learned is that there's no such thing as a dumb user -- 00:06:58.824 --> 00:07:01.486 there are only dumb products. NOTE Paragraph 00:07:01.510 --> 00:07:03.348 We have to think like existentialists: 00:07:03.372 --> 00:07:05.436 it's not the painting we would have painted, 00:07:05.460 --> 00:07:07.475 it's the painting that we actually painted. 00:07:07.499 --> 00:07:10.009 It's the use -- designed for actual use. 00:07:10.033 --> 00:07:12.033 How are people actually going to use this? NOTE Paragraph 00:07:12.477 --> 00:07:15.557 So, similarly, when we think about our partner MTTS, 00:07:15.581 --> 00:07:19.009 they've made some amazing technologies for treating newborn illnesses. 00:07:19.033 --> 00:07:21.342 So here's an overhead warmer and a CPAP. 00:07:21.366 --> 00:07:24.111 They're inexpensive, really rugged. 00:07:24.135 --> 00:07:26.972 They've treated 50,000 kids in Vietnam with this technology. 00:07:26.996 --> 00:07:28.353 But here's the problem: 00:07:28.377 --> 00:07:31.180 Every doctor in the world, every hospital administrator, 00:07:31.204 --> 00:07:36.456 has seen TV -- curse those "ER" reruns! 00:07:36.480 --> 00:07:40.129 Turns out they all know what a medical device is supposed to look like. 00:07:40.637 --> 00:07:43.668 They want Buck Rogers, they don't want effective. 00:07:44.049 --> 00:07:45.807 It sounds crazy, it sounds dumb, 00:07:45.831 --> 00:07:48.998 but there are actually hospitals who would rather have no equipment 00:07:49.022 --> 00:07:51.078 than something that looks cheap and crummy. 00:07:51.102 --> 00:07:54.396 So again, if we want people to trust a device, 00:07:54.420 --> 00:07:55.828 it has to look trustworthy. NOTE Paragraph 00:07:55.852 --> 00:07:57.343 So thinking about outcomes, 00:07:57.367 --> 00:07:59.744 it turns out appearances matter. 00:07:59.768 --> 00:08:02.275 We took all that information together. 00:08:02.299 --> 00:08:04.630 We tried, this time, to get it right. 00:08:04.654 --> 00:08:06.042 And here's what we developed. 00:08:06.066 --> 00:08:08.002 This is the Firefly phototherapy device, 00:08:08.026 --> 00:08:10.878 except this time, we didn't stop at the concept car. 00:08:11.687 --> 00:08:14.941 From the very beginning, we started by talking to manufacturers. 00:08:14.965 --> 00:08:18.109 Our goal is to make a state-of-the-art product 00:08:18.133 --> 00:08:20.815 that our partner MTTS can actually manufacture. 00:08:20.839 --> 00:08:24.926 Our goal is to study how they work, the resources they have access to, 00:08:24.950 --> 00:08:27.156 so that they can make this product. NOTE Paragraph 00:08:27.505 --> 00:08:29.996 So that's the design for manufacture question. 00:08:30.020 --> 00:08:31.855 When we think about actual use, 00:08:31.879 --> 00:08:34.188 you'll notice that Firefly has a single bassinet. 00:08:34.212 --> 00:08:36.085 It only fits a single baby, 00:08:36.109 --> 00:08:40.143 and the idea here is it's obvious how you ought to use this device. 00:08:40.167 --> 00:08:42.040 If you try to put more than one kid in, 00:08:42.064 --> 00:08:44.093 you're stacking them on top of each other. NOTE Paragraph 00:08:44.117 --> 00:08:45.749 (Laughter) NOTE Paragraph 00:08:45.773 --> 00:08:48.544 So the idea here is you want to make it hard to use wrong. 00:08:48.568 --> 00:08:51.235 In other words, you want to make the right way to use it 00:08:51.259 --> 00:08:53.197 the easiest way to use it. 00:08:53.221 --> 00:08:56.233 Another example -- again, silly Mom. 00:08:56.257 --> 00:08:59.810 Silly Mom thinks her baby looks cold, wants to put a blanket over the baby. 00:08:59.834 --> 00:09:02.756 That's why we have lights above and below the baby in Firefly, 00:09:02.780 --> 00:09:04.817 so if Mom does put a blanket over the baby, 00:09:04.841 --> 00:09:07.792 it's still receiving effective phototherapy from below. NOTE Paragraph 00:09:08.636 --> 00:09:09.954 Last story here: 00:09:09.978 --> 00:09:11.873 I've got a friend in India who told me 00:09:11.897 --> 00:09:14.878 that you haven't really tested a piece of electronic technology 00:09:14.902 --> 00:09:16.944 for distribution in Asia, 00:09:16.968 --> 00:09:19.413 until you've trained a cockroach to climb in and pee 00:09:19.437 --> 00:09:21.889 on every single little component on the inside. NOTE Paragraph 00:09:21.913 --> 00:09:23.697 (Laughter) NOTE Paragraph 00:09:23.721 --> 00:09:25.080 You think it's funny. 00:09:25.104 --> 00:09:27.318 I had a laptop in the Peace Corps, 00:09:27.342 --> 00:09:29.546 and the screen had all these dead pixels on it. 00:09:29.570 --> 00:09:32.355 And one day I looked in -- they were all dead ants 00:09:32.379 --> 00:09:34.443 that had gotten into my laptop and perished. 00:09:34.467 --> 00:09:35.618 Those poor ants. NOTE Paragraph 00:09:35.642 --> 00:09:37.182 (Laughter) NOTE Paragraph 00:09:37.206 --> 00:09:40.770 So with Firefly, what we did is -- the problem is electronics get hot, 00:09:40.794 --> 00:09:43.516 and you have to put in vents or fans to keep them cool -- 00:09:43.540 --> 00:09:44.784 in most products. 00:09:44.808 --> 00:09:49.593 We decided we can't put a "Do not enter" sign next to the vent. 00:09:49.617 --> 00:09:51.616 We actually got rid of all that stuff. 00:09:51.640 --> 00:09:53.004 So Firefly's totally sealed. NOTE Paragraph 00:09:53.365 --> 00:09:54.957 These are the kinds of lessons -- 00:09:54.981 --> 00:09:57.617 as awkward as it was to be a pretty goofy teenager, 00:09:57.641 --> 00:09:59.624 much worse to be a frustrated designer. 00:09:59.648 --> 00:10:02.758 So I was thinking, "What I really want to do is change the world. 00:10:02.782 --> 00:10:05.525 I have to pay attention to manufacturing and distribution. 00:10:05.549 --> 00:10:09.540 I have to pay attention to how people are actually going to use a device. 00:10:09.564 --> 00:10:12.580 I actually have to pay attention. There's no excuse for failure. NOTE Paragraph 00:10:12.604 --> 00:10:14.478 I have to think like an existentialist. 00:10:14.502 --> 00:10:17.742 I have to accept that there are no dumb users, only dumb products." 00:10:17.766 --> 00:10:20.136 We have to ask ourselves hard questions. 00:10:20.160 --> 00:10:22.486 Are we designing for the world that we want? 00:10:23.240 --> 00:10:25.518 Are we designing for the world that we have? 00:10:25.906 --> 00:10:28.020 Are we designing for the world that's coming, 00:10:28.044 --> 00:10:29.338 whether we're ready or not? NOTE Paragraph 00:10:29.362 --> 00:10:32.381 I got into this business designing products. 00:10:32.762 --> 00:10:36.425 I've since learned that if you really want to make a difference in the world, 00:10:36.449 --> 00:10:38.212 you have to design outcomes. 00:10:38.236 --> 00:10:39.777 And that's design that matters. NOTE Paragraph 00:10:39.801 --> 00:10:40.953 Thank you. NOTE Paragraph 00:10:40.977 --> 00:10:44.595 (Applause)