WEBVTT 00:00:00.136 --> 00:00:02.712 I've got a great idea that's going to change the world. 00:00:02.712 --> 00:00:04.423 It's fantastic, it's going to blow your mind. 00:00:04.423 --> 00:00:06.623 It's my beautiful baby. 00:00:06.623 --> 00:00:08.859 Here's the thing, everybody loves a beautiful baby. 00:00:08.859 --> 00:00:10.660 I mean, I was a beautiful baby. 00:00:10.660 --> 00:00:12.882 Here's me and my dad a couple days after I was born. NOTE Paragraph 00:00:12.882 --> 00:00:14.531 So in the world of product design, 00:00:14.531 --> 00:00:17.596 the beautiful baby's like the concept car. 00:00:17.596 --> 00:00:18.997 It's the knock-out. 00:00:18.997 --> 00:00:21.764 You see it and you go, "Oh, my God. I'd buy that in a second!" 00:00:21.764 --> 00:00:25.064 So why is it that this year's new cars 00:00:25.064 --> 00:00:28.352 look pretty much exactly like last year's new cars? NOTE Paragraph 00:00:28.352 --> 00:00:29.974 (Laughter) NOTE Paragraph 00:00:29.974 --> 00:00:32.599 What went wrong between the design studio and the factory? 00:00:32.599 --> 00:00:35.198 Today I don't want to talk about beautiful babies, 00:00:35.198 --> 00:00:38.183 I want to talk about the awkward adolescence of design -- 00:00:38.183 --> 00:00:42.182 those sort of dorky teenage years 00:00:42.182 --> 00:00:45.698 where you're trying to figure out how the world works. NOTE Paragraph 00:00:45.698 --> 00:00:49.815 I'm going to start with an example from some work that we did on newborn health. 00:00:49.815 --> 00:00:51.799 So here's a problem: 00:00:51.799 --> 00:00:54.333 Four million babies around the world, 00:00:54.333 --> 00:00:55.532 mostly in developing countries, 00:00:55.532 --> 00:00:58.498 die every year before their first birthday, 00:00:58.498 --> 00:01:00.350 even before their first month of life. 00:01:00.350 --> 00:01:03.829 It turns out half of those kids, or about 1.8 million newborns around the world, 00:01:03.829 --> 00:01:06.465 would make it if you could just keep them warm 00:01:06.465 --> 00:01:09.565 for the first three days, maybe the first week. NOTE Paragraph 00:01:09.565 --> 00:01:13.215 So this is a newborn intensive care unit in Kathmandu, Nepal. 00:01:13.215 --> 00:01:16.248 All of these kids in blankets belong in incubators -- 00:01:16.248 --> 00:01:20.881 something like this. So this is a donated Japanese Atom incubator 00:01:20.881 --> 00:01:23.048 that we found in [unclear] in Kathmandu. 00:01:23.048 --> 00:01:25.315 This is what we want. 00:01:25.315 --> 00:01:27.932 Probably what happened is a hospital in Japan upgraded their equipment 00:01:27.932 --> 00:01:31.532 and donated their old stuff to Nepal. 00:01:31.532 --> 00:01:35.215 The problem is, without technicians, without spare parts, 00:01:35.215 --> 00:01:38.820 donations like this very quickly turn into junk. NOTE Paragraph 00:01:38.820 --> 00:01:41.880 So this seemed like a problem that we could do something about. 00:01:41.880 --> 00:01:44.380 Keeping a baby warm for a week, 00:01:44.380 --> 00:01:46.380 that's not rocket science. 00:01:46.380 --> 00:01:48.163 So we got started. 00:01:48.163 --> 00:01:51.281 We partnered with a leading medical research institution here in Boston. 00:01:51.281 --> 00:01:54.998 We conducted months of user research overseas, 00:01:54.998 --> 00:01:57.632 trying to think like designers, human-centered design. 00:01:57.632 --> 00:02:00.575 Let's figure out what people want. 00:02:00.575 --> 00:02:02.529 We killed thousands of Post-it notes. 00:02:02.529 --> 00:02:05.462 We made dozens of prototypes to get to this. 00:02:05.462 --> 00:02:08.679 So this is the NeoNurture Infant Incubator, 00:02:08.679 --> 00:02:12.829 and this has a lot of smarts built into it. And we felt great. NOTE Paragraph 00:02:12.829 --> 00:02:15.029 So the idea here is, unlike the concept car, 00:02:15.029 --> 00:02:17.045 we want to marry something beautiful 00:02:17.045 --> 00:02:19.246 with something that actually works. 00:02:19.246 --> 00:02:21.162 And our idea is that this design 00:02:21.162 --> 00:02:25.146 would inspire manufacturers and other people of influence 00:02:25.146 --> 00:02:27.679 to take this model and run with it. NOTE Paragraph 00:02:27.679 --> 00:02:31.197 Here's the bad news: 00:02:31.197 --> 00:02:34.545 The only baby ever actually put inside the NeoNurture Incubator 00:02:34.545 --> 00:02:38.462 was this kid during a Time magazine photo shoot. 00:02:38.462 --> 00:02:40.894 So recognition is fantastic. 00:02:40.894 --> 00:02:43.994 We want design to get out for people to see it. 00:02:43.994 --> 00:02:45.228 It won lots of awards. 00:02:45.228 --> 00:02:47.276 But it felt like a booby prize. 00:02:47.276 --> 00:02:53.791 We wanted to make beautiful things that are going to make the world a better place, 00:02:53.791 --> 00:02:57.168 and I don't think this kid was even in it long enough to get warm. NOTE Paragraph 00:02:57.168 --> 00:03:00.067 So it turns out that design for inspiration 00:03:00.067 --> 00:03:02.585 doesn't really -- 00:03:02.585 --> 00:03:06.134 I guess what I would say is, for us, for what I want to do, 00:03:06.134 --> 00:03:10.184 it's either too slow or it just doesn't work, it's ineffective. 00:03:10.184 --> 00:03:12.984 So really I want to design for outcomes. 00:03:12.984 --> 00:03:14.484 I don't want to make beautiful stuff. 00:03:14.484 --> 00:03:16.218 I want to make the world a better place. 00:03:16.218 --> 00:03:18.568 So when we were designing NeoNurture, 00:03:18.568 --> 00:03:21.491 we paid a lot of attention to the people who are going to use this thing -- 00:03:21.491 --> 00:03:24.051 for example, poor families, rural doctors, 00:03:24.051 --> 00:03:27.701 overloaded nurses, even repair technicians. 00:03:27.701 --> 00:03:30.350 We thought we had all our bases covered, we'd done everything right. NOTE Paragraph 00:03:30.350 --> 00:03:33.300 Well it turns out there's this whole constellation of people 00:03:33.300 --> 00:03:36.400 who have to be involved in a product for it to be successful: 00:03:36.400 --> 00:03:39.101 manufacturing, financing, distribution, regulation. 00:03:39.101 --> 00:03:44.095 Michael Free at PATH says you have to figure out who will "choose, use and pay the dues" 00:03:44.095 --> 00:03:45.880 for a product like this. 00:03:45.880 --> 00:03:48.064 And I have to ask the question -- 00:03:48.064 --> 00:03:51.085 VC's always ask, "Sir, what is your business, and who is your customer?" NOTE Paragraph 00:03:51.098 --> 00:03:54.120 Who is our customer? Well here's an example. 00:03:54.120 --> 00:03:57.499 This is a Bangladeshi hospital director outside his facility. 00:03:57.499 --> 00:03:59.764 It turns out he doesn't buy any of his equipment. 00:03:59.764 --> 00:04:02.548 Those decisions are made by the Ministry of Health 00:04:02.548 --> 00:04:04.615 or by foreign donors, 00:04:04.615 --> 00:04:06.015 and it just kind of shows up. 00:04:06.015 --> 00:04:09.315 Similarly, here's a multinational medical device manufacturer. 00:04:09.315 --> 00:04:12.081 It turns out they've got to fish where the fish are. 00:04:12.081 --> 00:04:15.714 So it turns out that in emerging markets, where the fish are, 00:04:15.714 --> 00:04:18.915 are the emerging middle class of these countries -- 00:04:18.915 --> 00:04:22.416 diseases of affluence: heart disease, infertility. 00:04:22.416 --> 00:04:27.248 So it turns out that design for outcomes in one aspect 00:04:27.248 --> 00:04:30.365 really means thinking about design for manufacture and distribution. 00:04:30.365 --> 00:04:32.248 Okay, that was an important lesson. NOTE Paragraph 00:04:32.248 --> 00:04:37.131 Second, we took that lesson and tried to push it into our next project. 00:04:37.131 --> 00:04:39.730 So we started by finding a manufacturer, 00:04:39.730 --> 00:04:41.464 an organization called MTTS in Vietnam, 00:04:41.464 --> 00:04:44.931 that manufactures newborn care technologies for Southeast Asia. 00:04:44.931 --> 00:04:46.964 Our other partner is East Meets West. 00:04:46.964 --> 00:04:49.847 This is an American foundation that distributes that technology 00:04:49.847 --> 00:04:52.514 to poor hospitals around that region. NOTE Paragraph 00:04:52.514 --> 00:04:55.283 So we started with them saying, "Well what do you want? 00:04:55.283 --> 00:04:56.748 What's a problem you want to solve?" 00:04:56.748 --> 00:04:59.180 And they said, "Well let's work on newborn jaundice." 00:04:59.180 --> 00:05:02.617 So this is another one of these mind-boggling global problems. 00:05:02.617 --> 00:05:06.781 So jaundice affects two-thirds of newborns around the world. 00:05:06.781 --> 00:05:11.772 Of those newborns, one in 10 roughly, 00:05:11.772 --> 00:05:14.209 if it's not treated, the jaundice gets so severe 00:05:14.209 --> 00:05:17.293 that it leads to either a life-long disability, 00:05:17.293 --> 00:05:19.177 or the kids could even die. 00:05:19.177 --> 00:05:21.511 There's one way to treat jaundice, 00:05:21.511 --> 00:05:24.060 and that's what's called an exchange transfusion. 00:05:24.060 --> 00:05:27.396 So as you can imagine, that's expensive and a little bit dangerous. NOTE Paragraph 00:05:27.396 --> 00:05:29.760 There is another cure. 00:05:29.760 --> 00:05:35.160 It's very technological, it's very complex, a little daunting. 00:05:35.160 --> 00:05:38.127 You've got to shine blue light on the kid -- 00:05:38.127 --> 00:05:42.193 bright blue light on as much of the skin as you can cover. 00:05:42.193 --> 00:05:44.693 How is this a hard problem? 00:05:44.693 --> 00:05:48.173 So I went to MIT, 00:05:48.173 --> 00:05:51.410 Okay, we'll figure that out. (Laughter) NOTE Paragraph 00:05:51.410 --> 00:05:54.293 So here's an example. This is an overhead phototherapy device 00:05:54.293 --> 00:05:57.109 that's designed for American hospitals. 00:05:57.109 --> 00:05:59.543 And here's how it's supposed to be used. 00:05:59.543 --> 00:06:03.011 So it's over the baby, illuminating a single patient. 00:06:03.011 --> 00:06:05.243 Take it out of an American hospital, 00:06:05.243 --> 00:06:07.160 send it overseas to a crowded facility in Asia, 00:06:07.160 --> 00:06:09.026 here's how it's actually used. 00:06:09.026 --> 00:06:12.177 The effectiveness of phototherapy is a function of light intensity. 00:06:12.177 --> 00:06:15.477 So these dark blue squares show you where it's effective phototherapy. 00:06:15.477 --> 00:06:18.344 Here's what it looks like under actual use. 00:06:18.344 --> 00:06:19.461 So those kids on the edges 00:06:19.461 --> 00:06:22.076 aren't actually receiving effective phototherapy. 00:06:22.076 --> 00:06:24.811 But without training, without some kind of light meter, 00:06:24.811 --> 00:06:26.776 how would you know? NOTE Paragraph 00:06:26.776 --> 00:06:28.726 We see other examples of problems like this. 00:06:28.726 --> 00:06:30.443 So here's a neonatal intensive care unit 00:06:30.443 --> 00:06:32.810 where moms come in to visit their babies. 00:06:32.810 --> 00:06:35.375 And keep in mind, Mom maybe just had a C-section, 00:06:35.375 --> 00:06:37.259 so that's already kind of a bummer. 00:06:37.259 --> 00:06:38.560 Mom's visiting her kid. 00:06:38.560 --> 00:06:42.026 She sees her baby naked, lying under some blue lights, 00:06:42.026 --> 00:06:43.908 looking kind of vulnerable. 00:06:43.908 --> 00:06:47.043 It's not uncommon for Mom to put a blanket over the baby. 00:06:47.043 --> 00:06:51.010 From a phototherapy standpoint, maybe not the best behavior. 00:06:51.010 --> 00:06:54.010 In fact that sounds kind of dumb. 00:06:54.010 --> 00:06:56.176 Except, what we've learned 00:06:56.176 --> 00:06:59.844 is that there's no such thing as a dumb user -- really is what we've learned. 00:06:59.844 --> 00:07:01.510 There are only dumb products. NOTE Paragraph 00:07:01.510 --> 00:07:03.193 We have to think like existentialists. 00:07:03.193 --> 00:07:04.708 It's not the painting we would have painted, 00:07:04.708 --> 00:07:06.708 it's the painting that we actually painted. 00:07:06.708 --> 00:07:10.033 It's the use -- designed for actual use. 00:07:10.033 --> 00:07:11.382 How are people actually going to use this? NOTE Paragraph 00:07:11.382 --> 00:07:15.581 So similarly, when we think about our partner MTTS, 00:07:15.581 --> 00:07:18.975 they've made some amazing technologies for treating newborn illnesses. 00:07:18.975 --> 00:07:20.931 So here's an overhead warmer and a CPAP. 00:07:20.931 --> 00:07:23.747 They're inexpensive, really rugged. 00:07:23.747 --> 00:07:26.863 They've treated 50,000 kids in Vietnam with this technology. 00:07:26.863 --> 00:07:27.930 But here's the problem: 00:07:27.930 --> 00:07:30.498 Every doctor in the world, every hospital administrator, 00:07:30.498 --> 00:07:35.414 has seen TV -- curse those "E.R." reruns. 00:07:35.414 --> 00:07:39.779 Turns out they all know what a medical device is supposed to look like. 00:07:39.779 --> 00:07:43.313 They want Buck Rogers, they don't want effective. 00:07:43.313 --> 00:07:45.831 It sounds crazy, it sounds dumb, 00:07:45.831 --> 00:07:48.216 but there are actually hospitals who would rather have no equipment 00:07:48.216 --> 00:07:50.682 than something that looks cheap and crummy. 00:07:50.682 --> 00:07:54.149 So again, if we want people to trust a device, 00:07:54.149 --> 00:07:55.852 it has to look trustworthy. NOTE Paragraph 00:07:55.852 --> 00:07:57.367 So thinking about outcomes, 00:07:57.367 --> 00:07:59.768 it turns out appearances matter. 00:07:59.768 --> 00:08:02.085 So we took all that information together. 00:08:02.085 --> 00:08:04.367 We tried, this time, to get it right. 00:08:04.367 --> 00:08:05.768 And here's what we developed. 00:08:05.768 --> 00:08:07.853 So this is the Firefly Phototherapy Device, 00:08:07.853 --> 00:08:10.902 except this time we didn't stop at the concept car. 00:08:10.902 --> 00:08:14.534 So from the very beginning we started by talking to manufacturers. 00:08:14.534 --> 00:08:17.602 Our goal is to make a state-of-the-art product 00:08:17.602 --> 00:08:20.435 that our partner MTTS can actually manufacture. 00:08:20.435 --> 00:08:24.335 So our goal is to study how they work, the resources they have access to, 00:08:24.335 --> 00:08:26.918 so that they can make this product. NOTE Paragraph 00:08:26.918 --> 00:08:30.020 So that's the design for manufacture question. 00:08:30.020 --> 00:08:31.285 When we think about actual use, 00:08:31.285 --> 00:08:33.768 you'll notice that Firefly has a single bassinet. 00:08:33.768 --> 00:08:35.834 It only fits a single baby. 00:08:35.834 --> 00:08:40.167 And the idea here is it's obvious how you ought to use this device. 00:08:40.167 --> 00:08:41.685 If you try to put more than one kid in, 00:08:41.685 --> 00:08:43.218 you're stacking them on top of each other. NOTE Paragraph 00:08:43.218 --> 00:08:44.354 (Laughter) NOTE Paragraph 00:08:44.354 --> 00:08:48.568 So the idea here is we say, you want to make hard to use wrong. 00:08:48.568 --> 00:08:50.551 In other words, you want to make the right way to use it 00:08:50.551 --> 00:08:53.019 the easiest way to use it. 00:08:53.019 --> 00:08:55.951 Another example: Again, silly mom. 00:08:55.951 --> 00:08:58.951 Silly mom thinks her baby looks cold, wants to put a blanket over the baby. 00:08:58.951 --> 00:09:02.018 Well that's why we have lights above and below the baby in Firefly. 00:09:02.018 --> 00:09:04.102 So if mom does put a blanket over the baby, 00:09:04.102 --> 00:09:07.286 it's still receiving effective phototherapy from below. NOTE Paragraph 00:09:07.286 --> 00:09:09.284 Last story here: 00:09:09.284 --> 00:09:11.185 I've got a friend in India who told me 00:09:11.185 --> 00:09:14.467 that you haven't really tested a piece of electronic technology 00:09:14.467 --> 00:09:16.554 for distribution in Asia 00:09:16.554 --> 00:09:19.167 until you've trained a cockroach to climb in 00:09:19.167 --> 00:09:21.352 and pee on every single little component on the inside. NOTE Paragraph 00:09:21.352 --> 00:09:22.785 (Laughter) NOTE Paragraph 00:09:22.785 --> 00:09:24.919 You think it's funny. 00:09:24.919 --> 00:09:26.551 I had a laptop in the Peace Corps, 00:09:26.551 --> 00:09:29.167 and the screen had all these dead pixels on it. 00:09:29.167 --> 00:09:31.402 And one day I looked in, they were all dead ants 00:09:31.402 --> 00:09:33.901 that had gotten into my laptop and perished -- 00:09:33.901 --> 00:09:35.200 those poor ants! 00:09:35.200 --> 00:09:38.367 So with Firefly, what we did is -- 00:09:38.367 --> 00:09:40.101 the problem is electronics get hot 00:09:40.101 --> 00:09:43.201 and you have to put in vents or fans to keep them cool -- 00:09:43.201 --> 00:09:44.599 in most products. 00:09:44.599 --> 00:09:48.833 We decided that I can't put a "do not enter" sign next to the vent. 00:09:48.833 --> 00:09:50.800 We actually got rid of all of that stuff. 00:09:50.800 --> 00:09:52.633 So Firefly's totally sealed. NOTE Paragraph 00:09:52.633 --> 00:09:54.234 These are the kinds of lessons -- 00:09:54.234 --> 00:09:57.083 as awkward as it was to be a pretty goofy teenager, 00:09:57.083 --> 00:09:59.351 much worse to be a frustrated designer. 00:09:59.351 --> 00:10:02.401 So I was thinking about, what I really want to do is change the world. 00:10:02.401 --> 00:10:04.901 I have to pay attention to manufacturing and distribution. 00:10:04.901 --> 00:10:08.500 I have to pay attention to how people are actually going to use a device. 00:10:08.500 --> 00:10:12.517 I actually have to pay attention. Really, there's no excuse for failure. NOTE Paragraph 00:10:12.517 --> 00:10:14.067 I have to think like an existentialist. 00:10:14.067 --> 00:10:15.901 I have to accept that there are no dumb users, 00:10:15.901 --> 00:10:17.766 that there's only dumb products. 00:10:17.766 --> 00:10:19.910 We have to ask ourselves hard questions. 00:10:19.910 --> 00:10:23.240 Are we designing for the world that we want? 00:10:23.240 --> 00:10:25.394 Are we designing for the world that we have? 00:10:25.394 --> 00:10:27.427 Are we designing for the world that's coming, 00:10:27.427 --> 00:10:28.877 whether we're ready or not? NOTE Paragraph 00:10:28.877 --> 00:10:32.228 I got into this business designing products. 00:10:32.228 --> 00:10:35.527 I've since learned that if you really want to make a difference in the world, 00:10:35.527 --> 00:10:37.711 you have to design outcomes. 00:10:37.711 --> 00:10:39.327 And that's design that matters. NOTE Paragraph 00:10:39.327 --> 00:10:40.593 Thank you. NOTE Paragraph 00:10:40.593 --> 00:10:44.278 (Applause)