Design for people not awards Timothy Prestero

I’ve got a great idea it’s gonna change

the world it’s fantastic it’s gonna 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 babies like the

concept car it’s it’s the knockout you

know you see and you go oh my god I buy

that in a second so so why is it that

this year’s new cars look pretty much

exactly like last year’s new cars what

went wrong between the design studio in

the factory see today I don’t want to

talk about beautiful babies I want to

talk about the awkward adolescence of

design those dorky teenage years where

you’re trying to figure out how the

world works I’m gonna start with an

example from some work that we did on

newborn health so here’s the problem 4

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 wouldn’t 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 and kathmandu-nepal all of these

kids and blankets belong in incubators

something like this so this is a donated

Japanese atom incubator that we found in

a NICU in Katmandu this is what we want

probably what happened as a hospital in

Japan upgraded their equipment and

donated their old stuff to 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 I mean keeping a baby

warm for a week that’s not you know

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 you know

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

nurture 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 sort of take this

model and run with it here’s the bad

news the only baby ever actually put

inside the neo nurture incubator was

this kid during a Time magazine photo

shoot so you know recognition is

fantastic we want design to get out you

know for people to see it at won lots of

awards but it felt like a booby prize I

mean I we wanted to make beautiful

things that are gonna make the world a

better place that are gonna make the

world a better place and I don’t think

this kid was even in it long enough to

get warm so so it turns out that design

for inspiration it doesn’t doesn’t

really I guess I guess what I would say

is it 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

near nursery we paid a lot of attention

to the people who are gonna use this

thing for example poor families rural

doctors overloaded nurses even repair

technicians we thought we had all our

bases covered we’ve 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 it

passes you have to figure out who will

choose use and pay the dues for a

product like this and I that’s a

question you know VC’s always asked well

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 turns out they got a

fish where the fish are so it turns out

that in emerging markets where the fish

are are sort of the emerging middle

class for these countries diseases

effluents heart disease infertility so

turns out that designed 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 manufacturing organization

called MTTs in Vietnam that manufactures

newborn care technologies for Southeast

Asia our other partners 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 like mind-boggling global

problems so jaundice affects two-thirds

of newborns around the world of those

newborns one in ten roughly if it’s not

treated the jaundice gets so severe that

it leads to either lifelong 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 it’s very

technological it’s very complex a little

daunting

you got a 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 so you know I went to MIT you know

okay we’ll figure that out

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 it a signal patient

take it out in American Hospital send it

overseas to a crowded facility an agent

here’s how it’s actually used the

effectiveness of photo therapy 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 the neonatal intensive care unit

where moms come in to visit their babies

and keep in mind that mom maybe just had

a c-section okay 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 from mom to put a

blanket over the baby from a photo

therapy standpoint maybe not the best

behavior in fact that sounds kind of

dumb except what we’ve learned is it

there’s no such thing as a dumb user

really is what we’ve learned they’re

only dumb products we have to think like

existentialist it’s not the painting we

would have painted it’s the painting

that we actually paint it’s it’s the use

design for actual use how are people

actually gonna 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 you know curse

those whatever er re-runs 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 it would rather

have no equipment than something that

looks cheap and crummy so again if we

want people to trust the device it has

to look trustworthy so thinking about

outcomes turns out appearances matter so

we took all that information together we

tried this time to get it right

and here’s where 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 like

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 that

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 noticed a

Firefly has a single bassinet it only

fits a single baby and the idea here is

it it’s obvious how you ought to use

this device if you try to put more than

one kid and you’re kind of stacking them

on top of each other so the idea here is

we say you want to make it 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 it’s again

silly mom you know 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 and

Firefly so if mom does put a blanket

over the baby 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 in asia until you’ve

trained a cockroach to climb in and pee

on every single little component on the

inside it’s 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 their all dead ants this

sort of 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 okay i can’t put a do not enter

sign next to the vent you know this kind

of thing we actually got rid of all that

stuff so Firefly is totally sealed these

are the kind of lessons I mean as

awkward as it was to be a pretty goofy

teenager much worse to be a frustrated

designer so thinking about okay what I

really want to do is change the world I

have to pay attention to manufacturing

and distribution I have to pay attention

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 there’s only dumb products we have

to ask

hard questions are we designing for the

world that we want are we designing for

the world that we have 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