Design for people, not awards

Timothy Prestero thought he'd designed the perfect incubator for newborns in the developing world -- but his team learned a hard lesson when it failed to go into production. A manifesto on the importance of designing for real-world use, rather than accolades. (Filmed at TEDxBoston.)

I've got a great idea that's going to change the world.

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

It's my beautiful baby.

Here's the thing, everybody loves a beautiful baby.

I mean, I was a beautiful baby.

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

So in the world of product design,

the beautiful baby's like the concept car.

It's the knock-out.

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

So why is it that this year's new cars

look pretty much exactly like last year's new cars?

(Laughter)

What went wrong between the design studio and the factory?

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

I want to talk about the awkward adolescence of design --

those sort of dorky teenage years

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

I'm going to start with an example from some work that we did on newborn health.

So here's a problem:

Four million babies around the world,

mostly in developing countries,

die every year before their first birthday,

even before their first month of life.

It turns out half of those kids, or about 1.8 million newborns around the world,

would make it if you could just keep them warm

for the first three days, maybe the first week.

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

All of these kids in blankets belong in incubators --

something like this. So this is a donated Japanese Atom incubator

that we found in [unclear] in Kathmandu.

This is what we want.

Probably what happened is a hospital in Japan upgraded their equipment

and donated their old stuff to Nepal.

The problem is, without technicians, without spare parts,

donations like this very quickly turn into junk.

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

Keeping a baby warm for a week,

that's not rocket science.

So we got started.

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

We conducted months of user research overseas,

trying to think like designers, human-centered design.

Let's figure out what people want.

We killed thousands of Post-it notes.

We made dozens of prototypes to get to this.

So this is the NeoNurture Infant Incubator,

and this has a lot of smarts built into it. And we felt great.

So the idea here is, unlike the concept car,

we want to marry something beautiful

with something that actually works.

And our idea is that this design

would inspire manufacturers and other people of influence

to take this model and run with it.

Here's the bad news:

The only baby ever actually put inside the NeoNurture Incubator

was this kid during a Time magazine photo shoot.

So recognition is fantastic.

We want design to get out for people to see it.

It won lots of awards.

But it felt like a booby prize.

We wanted to make beautiful things that are going to make the world a better place,

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

So it turns out that design for inspiration

doesn't really --

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

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

So really I want to design for outcomes.

I don't want to make beautiful stuff.

I want to make the world a better place.

So when we were designing NeoNurture,

we paid a lot of attention to the people who are going to use this thing --

for example, poor families, rural doctors,

overloaded nurses, even repair technicians.

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

Well it turns out there's this whole constellation of people

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

manufacturing, financing, distribution, regulation.

Michael Free at PATH says you have to figure out who will "choose, use and pay the dues"

for a product like this.

And I have to ask the question --

VC's always ask, "Sir, what is your business, and who is your customer?"

Who is our customer? Well here's an example.

This is a Bangladeshi hospital director outside his facility.

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

Those decisions are made by the Ministry of Health

or by foreign donors,

and it just kind of shows up.

Similarly, here's a multinational medical device manufacturer.

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

So it turns out that in emerging markets, where the fish are,

are the emerging middle class of these countries --

diseases of affluence: heart disease, infertility.

So it turns out that design for outcomes in one aspect

really means thinking about design for manufacture and distribution.

Okay, that was an important lesson.

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

So we started by finding a manufacturer,

an organization called MTTS in Vietnam,

that manufactures newborn care technologies for Southeast Asia.

Our other partner is East Meets West.

This is an American foundation that distributes that technology

to poor hospitals around that region.

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

What's a problem you want to solve?"

And they said, "Well let's work on newborn jaundice."

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

So jaundice affects two-thirds of newborns around the world.

Of those newborns, one in 10 roughly,

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

that it leads to either a life-long disability,

or the kids could even die.

There's one way to treat jaundice,

and that's what's called an exchange transfusion.

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

There is another cure.

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

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

bright blue light on as much of the skin as you can cover.

How is this a hard problem?

So I went to MIT,

Okay, we'll figure that out. (Laughter)

So here's an example. This is an overhead phototherapy device

that's designed for American hospitals.

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

So it's over the baby, illuminating a single patient.

Take it out of an American hospital,

send it overseas to a crowded facility in Asia,

here's how it's actually used.

The effectiveness of phototherapy is a function of light intensity.

So these dark blue squares show you where it's effective phototherapy.

Here's what it looks like under actual use.

So those kids on the edges

aren't actually receiving effective phototherapy.

But without training, without some kind of light meter,

how would you know?

We see other examples of problems like this.

So here's a neonatal intensive care unit

where moms come in to visit their babies.

And keep in mind, Mom maybe just had a C-section,

so that's already kind of a bummer.

Mom's visiting her kid.

She sees her baby naked, lying under some blue lights,

looking kind of vulnerable.

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

From a phototherapy standpoint, maybe not the best behavior.

In fact that sounds kind of dumb.

Except, what we've learned

is that there's no such thing as a dumb user -- really is what we've learned.

There are only dumb products.

We have to think like existentialists.

It's not the painting we would have painted,

it's the painting that we actually painted.

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

How are people actually going to use this?

So similarly, when we think about our partner MTTS,

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

So here's an overhead warmer and a CPAP.

They're inexpensive, really rugged.

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

But here's the problem:

Every doctor in the world, every hospital administrator,

has seen TV -- curse those "E.R." reruns.

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

They want Buck Rogers, they don't want effective.

It sounds crazy, it sounds dumb,

but there are actually hospitals who would rather have no equipment

than something that looks cheap and crummy.

So again, if we want people to trust a device,

it has to look trustworthy.

So thinking about outcomes,

it turns out appearances matter.

So we took all that information together.

We tried, this time, to get it right.

And here's what we developed.

So this is the Firefly Phototherapy Device,

except this time we didn't stop at the concept car.

So from the very beginning we started by talking to manufacturers.

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

that our partner MTTS can actually manufacture.

So our goal is to study how they work, the resources they have access to,

so that they can make this product.

So that's the design for manufacture question.

When we think about actual use,

you'll notice that Firefly has a single bassinet.

It only fits a single baby.

And the idea here is it's obvious how you ought to use this device.

If you try to put more than one kid in,

you're stacking them on top of each other.

(Laughter)

So the idea here is we say, you want to make hard to use wrong.

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

the easiest way to use it.

Another example: Again, silly mom.

Silly mom thinks her baby looks cold, wants to put a blanket over the baby.

Well that's why we have lights above and below the baby in Firefly.

So if mom does put a blanket over the baby,

it's still receiving effective phototherapy from below.

Last story here:

I've got a friend in India who told me

that you haven't really tested a piece of electronic technology

for distribution in Asia

until you've trained a cockroach to climb in

and pee on every single little component on the inside.

(Laughter)

You think it's funny.

I had a laptop in the Peace Corps,

and the screen had all these dead pixels on it.

And one day I looked in, they were all dead ants

that had gotten into my laptop and perished --

those poor ants!

So with Firefly, what we did is --

the problem is electronics get hot

and you have to put in vents or fans to keep them cool --

in most products.

We decided that I can't put a "do not enter" sign next to the vent.

We actually got rid of all of that stuff.

So Firefly's totally sealed.

These are the kinds of lessons --

as awkward as it was to be a pretty goofy teenager,

much worse to be a frustrated designer.

So I was thinking about, what I really want to do is change the world.

I have to pay attention to manufacturing and distribution.

I have to pay attention to how people are actually going to use a device.

I actually have to pay attention. Really, there's no excuse for failure.

I have to think like an existentialist.

I have to accept that there are no dumb users,

that there's only dumb products.

We have to ask ourselves hard questions.

Are we designing for the world that we want?

Are we designing for the world that we have?

Are we designing for the world that's coming,

whether we're ready or not?

I got into this business designing products.

I've since learned that if you really want to make a difference in the world,

you have to design outcomes.

And that's design that matters.

Thank you.

(Applause)