Kristine Chen, Mechanical Engineering Design Fellow
My favorite part of the design process is prototyping. The process of actualizing a concept that you’ve developed forwards and backwards is incredibly gratifying and magical. The act of creating almost always deepens my connection to the project in a significant way.
This project was a rapid-fire crash course in design research and product development. The aspect of conducting interviews with experts and testing virtual concepts was new to me. The latter half of the project, which was focused on producing a prototype, was much more familiar to me. I had been enrolled in several university courses with a similar structure and similar deliverables. I wanted to work with Design that Matters specifically because nonprofit organizations in the medical technology sector are so rare – particularly nonprofit organizations that focus on low-resource settings in the developing world.
Most companies that develop medical equipment are either large corporations or for-profit social enterprises, so it was interesting to see what this niche business model would look like. Its non-profit status allows DtM to be intellectually open with its designs and ideas. Coming from a highly collaborative university environment, I was hoping to see the same sort of openness at play in ‘industry.’ I was able to speak to multiple medical professionals in American hospitals and gain their perspectives on neonatal care so I could and compare and contrast them with the perspectives of medical professionals who work in under-resourced areas. The project also increased my confidence in my ability to apply skills that I had learned in school to products that would make it into the hands of actual users.
In 3 years’ time I hope to be working in the biomedical technology sector, preferably at a company that works with exoskeletons or active orthoses.
Karan Mudgal, Industrial Design Fellow
From the get-go I was eager to get into fabrication. Having spent many years away from working on physical products, I was very excited by the opportunity to return to this work. This internship was a great chance to use many different prototyping methods -- from CNC mold making, to laser cutting and 3D printing custom hardware -- to develop our alpha Otter.
DtM has long been in my sights as a place I would love to work. While finishing my degree in industrial design, I felt quite anxious at the thought of working on phone cases or other plastic trinkets. DtM’s work is a solid example of what it means to truly listen to what users are asking for, and designing in such a way that anyone anywhere would be proud to own the product. I have always felt that we all deserve products that we are proud to own, no matter our socioeconomic status. We can’t simply expect the poor to be okay with a product because they can’t afford anything else. Everyone has a sense of pride about the things they wear, the objects they use, and the places they inhabit. DtM truly understands this.
In three years’ time I hope to be back in graduate school, earning a multi-disciplinary degree in design, engineering, and business. Working on this collaborative team has really demonstrated the value of having a strong grasp on engineering principles in product design to maximize efficiency and create something truly robust. I know I will take these learnings forward and incorporate them in the next products that I have the chance to work on.
Malory Johnson, Industrial Design Fellow
My favorite part of the design process is at the earliest stages, parsing an ambiguous problem into a plan of attack. While this step was already completed for Otter, and therefore not within our scope for the summer, I loved poring over the existing research documents and using what I found to establish a plan for validating or falsifying previous assumptions. The plan provides a clear and healthy view through which we can evaluate each design decision as successful, or in need of improvement.
During my last year in college, I became interested in design within the context of non-profit and social benefit organizations. I believe there is a tremendous unmet need within the social sector for context-appropriate design. I found Design that Matters and fell in love with the mission. Working here has broadened my understanding of qualitative research: Unlike many domestic design companies, DtM has a unique need to conduct interviews across linguistic and cultural barriers. Designed for low-resource, international contexts, the research methods we rely on are effective for design interviews in both international and domestic settings.
In three years, I hope to be working internationally, living and practicing human-centered design in a culture completely different from my own.
The process of prototype fabrication is really a series of problem-solving exercises. Slot A suddenly refuses to accept Tab B, the beautiful CAD model reveals monstrous qualities when it emerges from the 3D printer, the Arduino code refuses to compile. We always find ourselves doing lots of just-in-time self-education, reading product manuals and watching YouTube HOWTO videos.
In brief, here are some of the most valuable lessons learned from our summer design sprint.
Vacuum Forming Polycarbonate
Vacuum-forming clear quarter-inch thick polycarbonate sheets isn’t for amateurs! We milled molds out of stacked sheets of MDF (medium-density fiberboard), both to accommodate the limited z-height of the ShopBot CNC and to machine vacuum-channels in the middle layers. Before vacuum-forming, we had to bake the heavy polycarbonate sheets and the mold in a brick oven, or else it would develop thousands of little bubbles that made the material cloudy. Unfortunately, the MDF molds took a beating from the hot polycarbonate, and after a few pulls, the polycarbonate started tearing chunks out of the mold. No mold lasts forever--even the hardened steel tools that LEGO uses for injection molding eventually wear out. Next time, we might skip MDF and instead cut a tool from the more expensive but more robust renshape.
Cleaning 3D Printed Parts
Parts from the 3D printer often come out of the machine with scratchy surfaces or other imperfections, for example marks left by the “raft” or other support material. We’ve learned that if you plan to sand the part to make it smooth and more aesthetically appealing, you are essentially committing to covering the sanded part with bondo and finishing paint. Sanded parts, especially those made from light-colored PLA, just seem to magnetically attract grubbiness. It might be skin oil from handling, smudgy whatever from dirty surfaces, but the part soon looks dingy. If you don’t have the time to sand, bondo, prime and paint, we recommend you remove the unwanted material with a chisel, blade or other scraper.
Working With Nichrome Wire
The Otter prototype was an opportunity to learn a lot about nichrome heating wire. Here’s the challenge: you want to establish an electrical connection with a wire that immediately heats up when you introduce a current. Soldering this kind of wire won’t work (solder melts when it gets hot). Automotive crimp connectors, which have plastic housings, don’t work (think: melting plastic). In the end, we learned that the best connectors involve mechanical clamping, for example a bare metal butt crimp (which sounds like an awesome band name), or a screw terminal.
Powering Arduino With A Buck Converter
We’ve powered the countless little Arduino projects either directly from the computer through a USB cable, with a rechargeable lithium cellphone powerpack and a USB-B connector (Arduino Uno) or micro-USB connector (Arduino Micro), or a 5V alkaline battery pack wired to the Vin pin. For the Otter prototype, we needed the Arduino to control a relay that was sending 24V to the heater wires. It was easy to generate 24V using an off-the-shelf AC adapter power supply, but how could we also get 5V to power the Arduino without using a second power supply? Enter the humble and amazing buck converter--an inexpensive component that can efficiently generate an output of 3-12V given a 24V input. Presumably this is old hat to any electrical engineer. There exist countless varieties of “DC/DC step-down” or buck converters (ie Adafruit), so you ought to be able to find one that’s a perfect match for your project.
Cloud-Based CAD File Sharing
Autodesk’s cloud-based CAD server, called A360 (aka the web interface for Fusion360), is an amazing collaboration tool. We were able to generate CAD models on the big ThinkStation P910 desktop machines in the DtM studio, and then instantly open the same files on our ThinkPad P50 laptops when we were working at the CNC machine. Hooray for a cloud-storage system that actually works as advertised!
DON’T SHAVE THAT YAK!
Any kind of production rush can easily devolve into fun adventures in “yak shaving”: you were supposed to be testing the prototype thermal control system, and two hours later you find yourself wandering the aisles at Home Depot in search of T-handled allen wrenches.
This Fall, DtM will continue the momentum on our Otter Newborn Warmer project through a new partnership with students and faculty from Olin, Babson, and Wellesley Colleges on the widespread problem of premature infant death in developing countries.
Olin College and Babson College launched the Global Health track together late last year within their Affordable Design and Entrepreneurship (ADE) program. ADE is a collaborative course, funded in part by the Autodesk Foundation, in which students co-create new products and social ventures with communities around the world to address challenges endemic to poverty.
The ADE team of engineers and business students will focus on pushing Otter Warmer alpha prototype towards volume manufacture and scale. Challenges ahead of Otter include iterating on the user interface and temperature control system, ensuring that both are “hard to use wrong” and in compliance with international medical and regulatory standards. We will also examine the “bill of materials,” or the components that make Otter, to identify the best vendors and the most cost-effective manufacturing processes. The Olin and Babson team will visit Vietnam in January to interview both potential users in rural hospitals and the team at DtM’s manufacturing partner MTTS.
The course is lead by long-time DtM friend and Olin Professor of Design and Mechanical Engineering Benjamin Linder. We’re thrilled that DtM superstar alumni and former Firefly product manager Elizabeth Johansen will be the team’s lead mentor, which is like getting Einstein to coach you on your math homework. You can read some of Elizabeth’s insights on international development and social impact design on the DtM blog.
For six years, ADE has been inspiring and supporting students learning and engaging in design for impact by increasing their awareness of inequality and the need for social justice through design. DtM is thrilled to partner with the Olin team as part of the new global health track!
At the end of July, our focus on the Otter summer design sprint shifted from background research and product positioning to prototype fabrication. We have been drinking lots of coffee and racking up the miles, dividing our time between DtM’s Salem studio and the Autodesk BUILD Space in Boston.
Our goal remains the development of an “alpha prototype” of the Otter newborn warmer, which is to say the first generation prototype that integrates both how the product works (warming elements) and how the product looks (user interface and overall aesthetics). A successful prototype will help us test our most critical assumptions about product features, manufacturing methods and price point.
Fabrication is always a blast, second only to field research in the hierarchy of excellent things about working in social impact design. It’s an opportunity to escape our desks, and trade the abstractions of post-it notes and design frameworks for the satisfaction of creating tangible, physical things. Here’s a look at this summer’s build process.
Machining molds with a CNC
Vacuum forming the bassinets
Designing and testing the temperature control system
Over the years we’ve accumulated a collection of handy but inexpensive tools for supporting our 3D printers. These usually live in a couple coffee cups and IKEA silverware caddies mounted next to the machines.
From left to right:
- Super Lube synthetic grease for the build plate lead screw (the lube supplied with most machines gets used up quickly)
- Cutting pliers for trimming PLA spools
- Metal feeler gauge for consistent results when manually leveling the printer build plate (Makerbot Rep2 works best when 0.2mm gauge just fits between nozzle and build plate)
- UHU glue stick for securing prints to build plate (useful even with heated build plates). This works better and is more convenient than covering the build plate with blue painter's tape.
- Window scraper for removing glue residue and stubborn PLA deposits from build plate
- Cricut craft spatula for un-sticking prints. We'll create a little gap under the print with the window scraper, and then lever the rest of the print off the build plate with the craft spatula
- iFixit metal spudgers for scraping off and digging out printed support material and other defects
- Cheap dental picks for removing support material from internal cavities
- Steel tweezers for getting gunk off the extruder nozzle without melting fingers
We’ve mounted an appropriate set of Allen wrenches on a 3D-printed bracket attached to every machine. We also have a couple self-healing cutting mats taped to the table next to the machine so we can fuss around with scrapers without scarring the tabletops or damaging the build plates. To reduce filament-jams in our oldest machine, the trusty Replicator 2, we printed and mounted this filament guide from Thingiverse on the back of the machine.
For storing PLA, we were delighted to discover that even the big Makerbot-brand spools fit perfectly inside a standard 5-gallon bucket. To prevent humidity from spoiling the PLA, we snap a Gamma Seal Lid on top of the bucket and throw in a handful of silica gel desiccant packs before we screw it shut.
We’re still learning how to get the best results from our 3D printers for the least amount of effort. Some machines create rafts (print bases) that are tedious to remove. Although we’ve had success sanding parts with paper or a Dremel, the resulting smooth parts very quickly look grubby (something about dust and oil getting into the seams). For high-quality aesthetic models, we haven’t found an alternative to the laborious process of: bondo, sand, primer, paint, clear-coat.
Last month, we mentioned the clinicians and global health experts who generously donated their time and expertise to Project Otter background research. This month, we’re recognizing the technical experts who have answered countless questions and provided invaluable guidance as we raced through the Otter prototype fabrication.
For starters, a quick thank you to the library staff at Stanford University for helping us track down the elusive (and expensive) IEC specifications for conductive warming devices.
Kevin Abraham, the Engineering Manager at Janco Thermoforming in Dover, NH had some great general design critiques on the Otter bassinet and heater design. The Janco team fabricated the Firefly beta prototype bassinet mold in 2011. The Janco mold, which they recovered for us from their cavernous storage facility, served as an excellent reference for how to successfully vacu-form a complex shape in thick polycarbonate.
The Autodesk BUILD Space team in Boston have been superlative hosts, and they’ve repeatedly gone out of their way to help even as they simultaneously juggle the BUILD Space launch. Senior Director Rick Rundell and Programs Manager Bevin Lin helped us get set up in the space, and Rick even moonlighted as IT Support for the BUILD Space intranet.
Thank you to Operations Manager Adam Allard and his team for throwing down railroad tracks ahead of the Otter train, getting a bunch of fabrication machines set up and commissioned just as we needed them. We must recognize Adam’s superhuman patience as we generated piles of polycarbonate scraps, MDF sawdust and an assorted trail of wreckage across the formerly pristine workshop. Thank you to Tim Brinkerhoff and Athena Moore for getting us quickly through all safety trainings and for reminding us to wear our safety goggles and not to eat pizza inside the laser cutter. Thank you to Joe Aronis for the 3D printer training, and to Taylor Tobin for his help setting up the vacuum former and glass oven for heating polycarbonate sheets.
Thank you especially to Shop Supervisor Joshua Aigen for patiently guiding us on our journey through the CAD/CAM wilderness, and for helping us babysit the ShopBot while fabricating the Otter bassinet molds!
German mathematician David Hilbert said "a perfect formulation of a problem is already half its solution." What is true for math problems is also true for design challenges: without a well-framed problem statement, it’s easy for the industrial design and detail engineering stages of the product to move very quickly in the wrong direction.
Your framework for making decisions matters as much or more than the decisions themselves, because the "chaos" of the system makes most outcomes indeterminate (again, chaos theory: “long-term prediction [is] impossible in general”). [Andy Weissman, "The Chaos Theory of Startups"]
At DtM, our framework for making design decision is the “hypothesis of record.” For an early stage project like the Otter Warmer, there are a few critical elements of the product hypothesis.
The first component is the product “point of view” (POV), defined as follows by IDEO’s Diego Garcia:
A point of view is the set of conscious constraints a design thinker adopts in order to make a specific statement. [...] I submit to you that, as a rule, things that are remarkable are born from a strong point of view. Those that are not remarkable are often the result of a muddled point of view, or no point of view at all. Having a point of view requires making choices among many possible alternatives. Having a point of view means having a vision of what good looks like as a means to make those choices. You can feel it when something was created with that vision in mind. And when that vision was not in play, you can feel the lack of it. [Diego Garcia, "On Anathem and points of view”, Oct 2008]
A POV is almost more useful in how it defines what a product is NOT. Great products are very narrowly focused. During the product development process, there is an irresistible temptation to add new features, or to stretch the product’s role to cover more users and situations. The POV is one way to fight against scope-creep and the tendency for great narrow ideas to bloat into “one size fits all” garbage.
A DtM POV takes the form: this USER in this CONTEXT has this NEED. The goal isn’t to generate deathless prose, but rather a rigorous definition that we can use as a test to answer ambiguous design questions. After a couple weeks of research, here’s the latest Otter POV:
District-level hospitals in developing countries that admit newborn patients for 24-hour care, that have reliable electricity, that are staffed by care providers with limited training but who are able to visually assess newborn hyperthermia and hypothermia, that want to prevent hypothermia in newborns for observation or treatment in the neonatal intensive care unit
-- NEED --
a durable, wipe-clean, always-on single-infant warmer that will maintain a 36 degC conductive surface beneath the newborn, that has a user interface and temperature feedback control system that are "hard to use wrong," and that works both in complement with Firefly phototherapy, with conventional overhead phototherapy and as a stand-alone device.
The next component of our hypothesis framework is the product value proposition. Where the POV is concerned primarily with the user, context and needs, the value proposition address the competitive landscape. For DtM to claim that our product is “better”, we have to define “better than what”. Here is the latest Otter value proposition:
For district hospitals in resource poor areas who want to treat low birthweight newborns at birth rather than risk transporting them to crowded central facilities, Otter is a conductive warming bassinet for thermally stable newborns who are at-risk for hypothermia to maintain normothermia while undergoing other treatments.
Unlike devices that provide a regulated microclimate that are complicated to use and maintain (for example incubators and radiant warmers), Otter provides affordable active warming that is hard to use wrong and easy to clean.
For an excellent reference on writing value propositions, we recommend Geoffrey Moore’s Crossing the Chasm.
The final component of our current hypothesis framework are the “design principles”, a set of qualitative statements we use to guide product development. Where product requirements and specifications are prescriptive (guidelines to follow), design principles are intended to be generative and inspirational.
For example: Kurt Andersen and Graydon Carter created Spy Magazine to mock the pretensions and excesses of Eighties society and its obsession with wealth and social status. Kurt Andersen said that their mission statement for the magazine, aka their "design principles", were: "Smart, fun, funny, fearless." This framework inspired them to create stunts like mailing tiny checks to billionaires to see who would cash them. Bloomberg ignored the a dozen checks; Trump cashed every single one, including a check for $0.12.
With each design principle, we’ll include some examples that help to ground the idea. Our current design principles for Otter are:
Is effective: prevents hypothermia; improves clinical outcomes; meets international standards
Looks effective: looks like a trustworthy modern medical device; looks warm; appears intuitive
Context-friendly: compatible with both rural context (cost to buy, own) and other newborn clinical interventions
User-friendly: hard to use wrong, facilitates mother-child bonding, provides good patient visibility
Check back in a few weeks as we update other key components of the Otter hypothesis!
This summer, DtM is focused on developing an “alpha prototype” of the Otter newborn warmer, which is to say the first generation prototype that integrates both how the product works (warming elements) and how the product looks (user interface and overall aesthetics). A great alpha prototype anticipates both user needs expectations and product performance specifications, as well as manufacturing methods and the target price point. Here’s a quick summary of what we’ve been doing most recently!
Thank you to our hosts at MGH, St. Elizabeth’s Medical Center, and The Brigham and Women's Hospital. Special thanks to:
- Ryan Carroll, MD, MPH, Program Director for the MGH-MUST Collaborative in Uganda
- Steve Ringer, MD, PhD, Chief of Neonatology at Dartmouth-Hitchcock Medical Center
- Terri Gorman, MD at The Brigham and Women's Hospital
- Lilian O’Leary, Nurse at The Brigham and Women’s Hospital
- Silvia Testa, MD at St. Elizabeth’s Medical Center
- Elizabeth Johansen, DtM Alumni
- Luciano Moccia at Thrive Health and Greg Dajer at MTTS Asia
- Peter Chamberlain from the 2015 MIT-RISD PDD student team
- James Wall, MD
- Lou Halamek, MD, Lucile Packard Children’s Hospital
- Janene Fuerch, MD, Lucile Packard Children’s Hospital
Some of the key insights from research include:
- Otter is for the prevention, not the treatment, of hypothermia
- The lack of prenatal care means that it will be difficult to accurately assess a newborn’s gestational age, so we need an alternative criteria to identify newborns that are appropriate patients for conductive warming.
- The ability to visually monitor at-risk newborns is as important to survival as warmth, so Otter must not obstruct a caregiver’s line of sight.
See the article on the product point of view for how these insights inform the product hypothesis.
One tool we used in these interviews is called a “sacrificial concept”. The idea is to exaggerate different product features as a way better understand the intuitive responses we get from users and domain experts. In this case, we were aiming to prioritize qualities of a medical product by presenting polarized feature options and asking doctors to choose between them. The first set is exploring forms of comfort. The second compares the trade-offs and implications of side wall height, and the last set looks into the importance of perceived infant safety versus the need for access to the newborn.
This week we welcomed Kristen Moulton as a Clinical Fellow to the summer design team. Kristen is a second-year medical student at Philadelphia College of Osteopathic Medicine. She recently completed the Summer Medical Institute, where she volunteered to provide healthcare screenings to an underserved community in North Philadelphia. Prior to starting medical school, she held a 2-year research coordinator position at the National Institutes of Health. She investigated biomarkers and potential therapeutics for Fragile X Syndrome (FXS), the most common inherited form of autism. Two of her research projects were published in peer-reviewed journals, one in Human Mutation and another in Behavioural Brain Research. Kristen graduated from Amherst College in 2013 with a Bachelor of Arts in Neuroscience with honors. She was selected as a Howard Hughes Fellow, inducted into the Sigma Xi Scientific Research Society, and was named a NESCAC All-Academic Honoree for both cross country and track. Kristen is excited to begin medical research and improve health with the DtM team.
It takes a village to launch a summer design sprint!
We’re thrilled to be recognized as part of Lenovo’s #ThinkRevolution campaign, an amazing collection of social impact organizations. Lenovo donated a raft of superfast computers for the summer design team, including Thinkpad P40 and P50 laptops for sketching and CAD on the go, and two screaming fast Thinkstation P910 PCs that whip through even the most complex renderings. Check out the DtM page on ThinkRevolutions for updates on our programs and the DtM-Lenovo collaboration.
The Autodesk Foundation has a mandate to invest in people and organizations that use design for impact. They have supported DtM’s work with funding, software licenses and training since 2014. This summer, the Autodesk Foundation supported DtM in recruiting a design team from the Autodesk Student Expert Network, an international program for university students in architecture, design and engineering.
Over the last ten years, DtM has recruited over 1,200 students and professional volunteers through university courses and pro bono employer programs. This summer’s student expert team is our first experiment with an internal design sprint and it’s something we probably wouldn’t have tried without the Autodesk Foundation’s encouragement. It’s turned out to be an amazing idea! Where design teams recruited through university courses have access to invaluable resources and mentorship, an internal design team has the ability to dive deep into user research and hard questions about product positioning. This summer’s program has already been a huge success and a model for future time-bound volunteer design sprints.
Thanks to Autodesk, this summer we also have the opportunity to augment DtM’s rapid prototyping studio with the space-age fabrication resources at the Autodesk BUILD Space, which just opened in Boston’s Marine Industrial Park. Residency in the BUILD Space means DtM now inhabits a group of workbenches in the second-floor collaborative workspace, and we have access to the extraordinary fabrication machines throughout the facility. These include a five-axis CNC mill the size of a garage and a waterjet cutter with a bed the size of a basketball court’s freethrow lane (but a kerf of just four thousandths of an inch). The BUILD Space even has a vacuum former that they claim (but we’re sure they’re joking) that they ordered just for us.
One of the biggest challenges in prototype development is what we call the “nuisance distance.” It can take several iterations of a physical prototype before the best ideas emerge. If each iteration involves expensive and time-consuming negotiations with a contractor, there’s a strong temptation to self-edit and call the current design “good enough.” Products that are capable of threading the needle in developing countries between the demands of user needs, context and resource limitations requires excellence, and unfortunately “good enough” usually isn’t. The BUILD Space resources will allow us to quickly and efficiently test loads of ideas.
DtM hosted our second annual Field Day at Chelsea Piers in New York City earlier this month. Forty families and 75 kids spent a sunny afternoon launching rockets, building a giant geodesic dome, and learning about Design that Matters. Thank you to all who attended! Special thanks to co-hosts Suzanne and Michael Graves, Elizabeth Wyatt and Craig Peckham, and Lisa Levy and Jon Goldberg.
If you’d like to learn how to build your own geodesic dome from laser-cut cardboard, check out these step-by-step instructions on Instructables!
As of June 2016, Firefly has treated over 50,000 newborns in 20 countries! DtM distribution partner Thrive Networks and Vietnamese manufacturing partner MTTS have installed Firefly units across Southeast Asia, sub-Saharan Africa, and the Caribbean. DtM and our partners are on track to distribute at least 1,000 Firefly devices, reaching over 500,000 newborns.
(click for larger view)
Dollars per DALY and Health Systems Strengthening
In global health, the key metric for assessing program cost-effectiveness is dollars per DALY (death- or disability-adjusted life-year). For the Firefly devices manufactured and currently treating newborns, we project that the Firefly program costs $8 per DALY. For comparison, the World Bank estimates that the EPI vaccine, which is considered a cost-effective health intervention, is $7/DALY. Furthermore, Firefly pays for itself in health care system savings within the first two years of use, by reducing treatment times and in some cases averting the need for expensive and risky exchange blood transfusions.
Firefly is designed for 5 years of night and day performance: Firefly's LEDs are rated to last up to 44,000 hours before requiring replacement. The design eliminates all moving parts, including fans and adjustable components, that can easily be broken. In order to prevent insects, dust, and other foreign bodies from entering and damaging the device or dimming the lights, the outer casings have tight seams and no holes.
Clinical results show that, compared to overhead LED phototherapy, Firefly significantly reduces phototherapy treatment times, reduces the incidence of nosocomial or hospital-acquired infection and in some cases averts the need for expensive and risky exchange blood transfusions. In collaboration with Thrive Networks, MTTS and Steven Ringer, MD/PhD, Section Chief of Neonatology at Dartmouth-Hitchcock. Design that Matters developed a rigorous model for Firefly's cost of ownership and return on investment. Our financial makes the following assumptions:
- the Firefly device is operating at capacity (treating two patients per week)
- the healthcare system incurs a cost of US$20/day for inpatient care and $200 for an exchange transfusion
- Firefly is operating in a region with a high incidence of severe jaundice
- the total cost of Firefly production, delivery and installation is US$1,700, and the device has an effective operating lifespan of five years.
Given our clinical results and the assumptions in the financial model, we find that, compared to overhead LED phototherapy in terms of health-care system savings due to reduced treatment time, reduced incidence of newborn cross-infection and averting exchange blood transfusions, Firefly reaches break-even in less than one year and offers a lifetime ROI of $10K or seven times the initial cost of production, delivery and installation.
Firefly Theory of Change
These clinical results align with the goals of the Firefly program as articulated in the program’s broader theory of change:
we designed a phototherapy device that was a match to the resources of a rural hospital,
- Rural clinics would treat newborns rather than referring them to crowded secondary or tertiary facilities
- Treating babies quickly at the point of diagnosis would reduce morbidity and mortality due to severe jaundice
- Reduction in referrals to other hospitals would make more efficient use of national health resources
- Demonstrating the effectiveness of a WELL DESIGNED global health technology would create government demand and drive multinational device companies to emulate DtM's design philosophy.
Full list of countries where Firefly devices are treating newborns
Cambodia, East Timor, Laos, Malaysia, Mongolia, Myanmar, Nepal, Philippines, Singapore, Thailand, Vietnam, Benin, Burundi, Ghana, Nigeria, Somaliland, Tanzania, Uganda, Zimbabwe, and Haiti
Design that Matters is excited to welcome the summer design team. Together, Karan, Kristine and Malory will be making a concentrated push toward getting Otter, newborn warmer, off the ground over the next two months.
Karan Chaitanya Mudgal is DtM’s new Industrial Design Fellow. He joins from NASA’s Johnson Space Center and recently completed his graduate studies in Interaction Design at the Copenhagen Institute of Interaction Design (CIID) . Prior to this Karan received his BFA in Industrial Design from the Rhode Island School of Design in 2013.
Karan aims to design products that elevate human ability. Over the past four years he has primarily focused on the design and implementation of digital products, specifically in healthcare while working at Philips Design Healthcare and also in two startups, both in the medtech space.
At the beginning of September Karan will move to India for one year to continue his thesis work from CIID on low cost upper limb prosthetics for children. The fellowship at DtM comes at an opportune time, providing mentorship while allowing the team to innovate on a compelling healthcare product while learning about the methodology regarding the design and dissemination of products in resource poor settings. Please visit the project site [here] to learn more about Kind Prosthetics.
Kristine Chen is DtM’s new Mechanical Engineering Design Fellow. She is a recent graduate of Stanford University, where she majored in Mechanical Engineering. Her educational background includes coursework in mechatronics and hands-on manufacturing experience. She has worked on a variety of projects in medical technology, ranging from prosthetic accessories to vaccine carriers.
Kristine is especially interested in the intersection of engineering, design, and entrepreneurship. At Stanford she served as a principal coordinator of the university’s largest student-run startup competition, the BASES $100K Challenge, and a facilitator for a design thinking and business skills training intensive for Tibetan social entrepreneurs. She is planning to pursue a Fulbright research grant in the Netherlands focused on medical exoskeletons for rehabilitation in patients with impaired motor control in the fall.
Design that Matters stood out to her for its thoughtfulness and rigor in the implementation of the design process. “For me, it’s DtM’s commitment to meticulous research and monitoring of results and impact that sets it apart from the crowd,” she says.
Malory is DtM's Industrial Design Fellow. She is a multidisciplinary designer who specializes in design research, product development and graphic communication. Previously, she has worked for clients like Airstream, AmericanHort and Procter & Gamble. Malory graduated in 2015 from the Columbus College of Art and Design with a BFA in Industrial design. There she worked in the Tad Jeffery FabLab for 2 years pushing the limits of the latest rapid prototyping machinery. Malory earned the IDSA Student Merit award for her class and two collaborative Spark Design Awards. In her free time, she enjoys being an artist, seamstress and woodworker.
Malory has been working at Design that Matters since 2015, and is looking forward to continuing the program work with the team.
Classy Awards: Winner - Firefly
DtM was selected from a record 1,300 applications to be recognized as one of the 6th Annual Classy Award Winners.
“The Classy Awards team spends a year extensively researching social innovations from around the world, and this year’s pool of nominees was one of the strongest we’ve ever seen,” said Pat Walsh, Co-Founder and CIO of Classy.org. “We’re so pleased to have named Design that Matters’ Firefly Newborn Phototherapy program as one of this year’s winners, and to play a role in recognizing their efforts to improve how rural hospitals operate. We were really impressed by how user- friendly yet impactful the Firefly unit is, and are proud to have been able to honor Design that Matter’s work here at the Classy Awards.”
ISHOW: Finalist - Otter
DtM's Otter Newborn Warmer was a finalist for the American Society of Mechanical Engineers (ASME) iSHOW competition in Washington DC. The ASME Innovation Showcase (ISHOW) is a global competition for hardware-led ventures. ISHOW focuses on the design and engineering journey of taking physical products to market.
Core77 Design Awards: Notable - Firefly
DtM's Firefly Newborn Phototherapy was recognized as a Notable Design by the Core77 Design Awards 2016. We love the Core77 Jury commentary from Maria Guidice, Autodesk VP of Experience Design and John Bielenberg, Partner at Future Partners:
Maria (to John): You had a good way to encapsulate this particular project. What did you say about it?
John: Yeah, so the brief is "blue light on babies," and then design the sh*t out of it.
Maria: That's exactly. This solution, they designed the sh*t out of it. That's why we liked it. It was just well-crafted. It was something that already exists in hospitals, but they kind of upped it to 11. You know, the Spinal Tap reference.
John: This gets the Spinal Tap award.
Maria: Yeah, they took this solution to an 11.
National Endowment for the Arts Grant
The National Endowment for the Arts will provide funding support to Design that Matters for the development of Otter, a durable, portable, cost-effective newborn warmer. The NEA’s flagship grant category, Art Works funds projects designed to achieve one of four outcomes; creation of art, public engagement with art, lifelong learning in the arts, and the strengthening of communities through the arts.
“The arts are all around us, enhancing our lives in ways both subtle and obvious, expected and unexpected,” said NEA Chairman Jane Chu. “Supporting projects like the one from Design that Matters offers more opportunities to engage in the arts every day.”
“DtM is honored to be a grantee of the National Endowment for the Arts,” said DtM CEO Tim Prestero. “Design--the translation of user needs into context-appropriate products--is our core competency, and we are applying this expertise to create a newborn conductive warmer designed specifically to allow rural hospitals with limited resources and inexperienced staff to successfully treat premature newborns who are especially vulnerable to hypothermia. It’s fantastic to have the NEA as a partner in this project.”
We love David Mindell’s Digital Apollo: Human and Machine in Spaceflight. Mindell’s book tells the story of “human pilots, of automated systems, and of the two working together to achieve the ultimate in flight.” From our perspective, the book explains the link between what rocket scientists in the 1950s called “systems engineering” and what the cool kids in skinny jeans now call “design thinking.”
Whether we’re designing the first spacecraft to land on the moon, or the first phototherapy device intended for use in a low-resource hospital, the key is to start with a very clear idea of success. In the case of a rocket, the system is only successful if it brings the astronauts all the way home. In the case of a medical device, the system on works if people are willing to use it and able to successfully treat patients with it. There is no partial credit!
Another similarity is the role that we as designers imagine for the users. In the Apollo program, the two primary metaphors for the astronauts were “cowboys or cargo.” Would astronauts serve as the pilots of “dumb rockets” or as passengers in an autonomous vehicle?
As pilots, the early astronauts expected to have lots of instrument data and full control of the vehicle. Rocket engineers, on the other hand, were more comfortable developing fully autonomous systems. They realized that rockets could develop problems too quickly for the human response time.
Initially, [software engineer Alex] Kosmala pictured the spacecraft with one button: "The astronaut goes in, turns the computer on and says ‘Go to moon’ and then sits back and watches while we did everything." Another version has the computer running two programs—"P00" to go to the moon, and "P01" to return home. [David Mindell, Digital Apollo, p. 161]
MIT Instrumentation Laboratory cartoon showing the extremes of automation. Too much automation leaves the astronauts bored, awaiting an abort, while too little overwhelms them with work. (Draper Laboratories/MIT Museum)
The Apollo system was ultimately a synthesis that combined autonomous systems with human inputs. It serves as an excellent metaphor for healthcare. Do we imagine caregivers in low-resource hospitals as “cowboys” who need lots of options and the ability to override medical device settings, or do we imagine them as “cargo,” overloaded with too many patients and not enough training and grateful for machines that can reduce their workload?
As designer thinkers, we see two options for guaranteeing our desired social impact outcomes with a given medical device: provide lots of training and incentives for appropriate behavior, or create product features that make a device intuitive and easy to use.
DtM’s overall philosophy of making medical devices “hard to use wrong” is really a statement about our expectations for users. In the same way Apollo rocket scientists realized that too little automation would place unrealistic demands on the astronauts, we see how medical systems that expect significant amounts of prior training and user expertise are poorly suited to the needs of rural hospitals in developing countries.
Mindell’s book includes loads of other ideas that have applications in social impact design. One is Apollo’s approach of “all-up testing”: only investing in tests of complete systems, rather than individually testing subsystems that might not work as well together. Another is what the Apollo team called “configuration discipline”: the rigorous documentation of system changes.
Fantastic book, check it out! And if you buy the book through the links in this email, Amazon will send part of the proceeds to DtM! [Digital Apollo]
The Design that Matters team first visited the town of Bac Giang in October 2009, as part of our second phototherapy field research trip to Vietnam. Our goal on that trip was to better understand newborn jaundice and phototherapy, and the gap between existing overhead phototherapy devices and the needs of low-resource hospitals in Southeast Asia.
We learned a ton at the Bac Giang District Hospital, one of the busiest facilities we visited on that trip. After slogging through the smoggy morning traffic in Hanoi, past the enormous Canon and Foxconn factories outside the city limits, and then miles and miles of flat and dusty green fields, we arrived in Bac Giang just after lunchtime. The street outside the hospital was crowded with stalls selling baby clothes and snacks. The entrance was buzzing with mopeds. The ward was hot, crowded and very busy. Fathers and grandparents stood waiting in the white tile hallway outside the neonatal intensive care unit (NICU). Exhausted-looking new mothers paced the hallway in their pajamas, or squatted on plastic stool in the NICU feeding their newborns. The NICU walls were lined with bassinets and all of the beeping monitors and buzzing alarms made it sound like a Vegas casino.
The experienced and hardworking NICU team at Bac Giang had already received early versions of the MTTS newborn health suite, including their CPAP, overhead phototherapy device and the Bilibed, MTTS’s predecessor to the Firefly newborn phototherapy device (see photo). The NICU team explained that they loved how the Bilibed fit just a single newborn, but they were worried that the lights weren’t bright enough to be clinically effective, and they were frustrated with how hard the device was to keep clean. They also stressed that a great medical device should look modern and reliable. These were all critical design inputs for Firefly.
Having learned so much from Bac Giang, we’re thrilled to report that MTTS and Thrive Health have returned to the hospital to install a Firefly phototherapy device! It’s a funny story of connections. As a child, Thrive Health’s Breath of Life program director Luciano Moccia belonged to Boy Scout Troop 1 in Trent, Italy. His brother is now scoutmaster of that troop, and as a volunteer activity the scouts raised the money necessary to donate the Firefly to Bac Giang.
Bac Giang serves both the 120,000 people who live in the city, and all of the rural communities in the district. On any given day, the NICU might host more than a dozen newborns. Firefly will allow the hospital to treat jaundiced newborns, including those with severe jaundice that the hospital might otherwise have had to refer to the main pediatric hospital in Hanoi for a dangerous exchange transfusion.
We want to say a quick thank you to our two fantastic spring semester student teams! The first team was part of MIT Sloan Professor Steven Eppinger’s course “Product Design and Development” taught with MIT Mechanical Engineering Professor Maria Yang and instructor Jerome Arul from the Rhode Island School of Design (RISD). The multidisciplinary team included MIT MBA students Adam Chao, Leslie Martin, Andrea Schneider and Christopher Sommerfeld, Master’s Fellow Deepa Fernandes Prabhu from MIT Systems Design & Management (SDM) and industrial design students Maria Yang and Young Hun Chung from RISD.
In the last Pelican project, the student team focused on a pulse-oximeter device specifically for newborns. Since then, our field research has identified the device user--rather than the patient--as the diagnostic bottleneck. This year's design challenge focused on low-skilled community health workers (CHWs), the first line of diagnosis for newborns with pneumonia in rural communities. CHWs cannot afford a newborn-specific device, and many lack the clinical expertise to make sense of all of the health statistics provided by a traditional pulse oximeter.
The second team was part of Harvard computer science Professor Krzysztof Gajos’s course CS179, “Design of Useful and Usable Interactive Systems.” The team included undergraduates Wilder Wohns, Amy Huang and Maria McLaughlin and graduate student Ariana Siegel. The students tackled the user interface for Project Echo, DtM’s tool for the remote monitoring of medical device donations. At the highest level, this year’s CS179 project was about determining which device data, and what formats of data-presentation, were the most likely to lead to our desired social impact outcomes: hospitals with high rates of device use receiving more equipment, those with low use rates receiving more training, and those with broken devices receiving service calls.
The Harvard students also considered the hospital’s point of view, and the tough question: “What’s in it for me?” In other words, we understand why international donors and programs that implement medical device donations might want to track the use and status of hospital equipment, but what obvious incentives do the hospitals have for agreeing to be remotely monitored?
Stay tuned for each team’s research findings, and details on their design concepts and prototypes!
A position paper from the 2015 Don Ostrow Trieste Yellow Retreat (Greco et al., Neonatology, 2016) finds that tools for the cost-effective diagnosis and treatment of jaundiced newborns are not always readily available in low- and middle-income countries (LMICs). As a consequence, the incidence of severe jaundice is difficult to estimate but likely to be underreported by a significant margin. Jaundice is a symptom of severe neonatal hyperbilirubinemia, and is associated with the risk of permanent neurologic damage and death.
The Greco paper includes statistics on neonatal jaundice in several African and Asian countries, many of which have no national records in the medical literature. For example, in 1999, a preliminary report of the National Perinatal Health Conference stated that about 25–30% of babies admitted to selected hospitals in Malaysia were severely jaundiced. As part of an ongoing “Saving Lives at Birth (SLAB)” project, a collaborative study of severe neonatal jaundice and acute bilirubin encephalopathy (ABE) prevalence was performed at 9 hospitals in 6 regions of Nigeria in 2014–2015. The prevalence of severe hyperbilirubinemia was high: 26.9% of admissions for jaundice.
These research findings represent another important validation of the value proposition for DtM’s Firefly Phototherapy Device. At the time of diagnosis in developing countries, jaundice presents almost as a different and more severe disease. Given the limited resources in these countries (everything from unreliable power supplies to lower staff-to-patient ratios), it’s unlikely that a phototherapy device designed for US or EU conditions will be appropriate for long-term use in low-resource settings. It’s hard to imagine how there could be a single “one size fits all” or “world class” standard for even a relatively simple medical technology like phototherapy.
Firefly provides high-intensity phototherapy from above and below the newborn, covering a significantly larger skin surface area than single-sided devices designed to the international standard. Fixing the position of the lights with respect to the bassinet also eliminates opportunity to user error that might occur in settings with limited user training and a much greater number of patients per caregiver. These features allow Firefly to treat neonates who might otherwise require an exchange blood transfusion.
Earlier this month, DtM joined the Consortium for Affordable Medical Technologies (CAMTech) and Global Disaster Response at Mass General Global Health to host a Zika Innovation Hackathon at Massachusetts General Hospital. We packed our Makerbots and some hacking gear to help teams with rapid prototyping, and we mentored teams on product design and strategy. The event kickoff featured experts from USAID, the US National Security Counsel, the Panamanian CDC and a maternal hospital in Brazil. Here’s what we learned.
The Zika virus has become a public health emergency of international concern. During the 48-hour hackathon, teams of clinicians, engineers, entrepreneurs and end-users created solutions to pressing clinical challenges in three critical areas:
- personal protection, particularly for pregnant women
- vector control, in particular eliminating mosquitoes in and around homes
- public information, including early case-reporting and fighting the spread of misinformation
Zika may feel like the crisis of the moment, but climate change means we will only see an increase in the incidence and spread of vector-borne illness. Any solution that addresses Zika would likely also apply to other flaviviruses, including dengue, West Nile and yellow fever and other diseases carried by the aedes aegypti mosquito, including chikungunya. Dengue cases have increased 200% in the last year, and the disease has much more severe burden of morbidity and mortality. Meanwhile, the crashing pregnancy rates in countries like Colombia and Brazil from prospective parents anxious about birth defects means that the region will see lots of empty kindergarten classrooms in five years.
Disease-bearing species of mosquito are “as different as hummingbirds and eagles.” While the anopheles mosquito that transmits malaria prefers pristine forest and attacks at night, the daytime-biting aedes aegypti mosquito has co-evolved with people, such that it thrives in urban settings. One terrifying statistic: the aedes mosquito can breed in just a teaspoon of water. In fact, it can breed in the drip pan underneath your refrigerator. Brr! Zika-bearing mosquitoes follow the plume of CO2 over a range of hundreds of meters, an individual’s infrared signal and hormonal signature from a range of meters. Unfortunately, the higher heat signature and hormonal profile of pregnant women make them particularly attractive to mosquitoes.
For more background on the Zika virus, we’re big fans of this comprehensive infographic developed by Juhan Sonin and the team at Involution Studios--another hackathon mentor.