The Real Problem with Healthcare Innovation! (And The Solution)
CONFUSING THE SOLUTION FOR THE PROBLEM!
This happens all too often in healthcare. It is not that we are necessarily “in-love” with the solution, but we are so wedded to it, that we continue to apply it even in the face of failure.
The story of the Embrace Infant Warmer is a great example of just that. In 2007, a group of five students gathered at Stanford University’s d.school for of course in Design for Extreme Affordability. They were not designers. Nor were they healthcare professionals. Despite that, they were challenged to solve the problem of premature infant mortality.
Background: Each year roughly 20,000,000 infants are born prematurely. By some estimates, one million die within the first 24 hours, and 4 million within the first four weeks. (These are of course estimates as it’s hard to get accurate counts in these situations where we can’t even get basic care.) The biggest problem facing these infants is hypothermia. Infants that young are not able to keep themselves at the proper body temperature. Our current “first-world” solution to that, an incubator, comes at a whopping $20,000 price tag, which seems ridiculously expensive considering that most of these deaths were occurring in Third World countries. They set out to solve the obvious problem.
How to make much cheaper incubators?
It just so happened that one member of the team, Linus, took a trip to Nepal during the course. While there, he noticed that there were a number incubators sitting around the hospitals, unused. He brought that incongruence to one of the physicians, who remarked that the babies weren’t dying in hospitals, they were dying in the villages — where they neither had access to clinicians, nor reliable electricity. Both of which are important ingredients to run an incubator successfully!
The light bulb went off for the team!
The user they were designing for wasn’t the physician in the hospital, rather it was the young mother in the village. One, they found, often didn’t trust Western medicine.
They realized they had been confusing the solution for the problem! The real problem was that premature infants couldn’t maintain their body heat! The incubator was just one of many possible solutions to help keep the babies warm.
They set about crafting a different solution.
What they came up with was essentially a sleeping bag for the baby. The bag held a beautifully simple, low-tech heating element — a paraffin wax sleeve that would take advantage of the tremendous energy absorbed and released during phase change. This sleeve could easily be heated to the perfect temperature in a pot of boiling water. This could maintain the baby at the right temperature for up to five hours. Better still, it was 200 times cheaper to produce then an incubator.
(They won a ton of awards for their truly innovative idea — see the diagram below.)
But the gains don’t stop just at the financial.
Follow me on a simple thought exercise: where would that baby ideally be at this point in it’s life? When I ask this during a workshop, I usually hear responses like “in a hospital,” or “in the NICU!”
The answer is even simpler: Still in the mother’s womb. The plastic box and harsh lights of our “first world” solution couldn’t be more different than the warm, immediately responsive, amniotic environment. Their elegantly simple solution is much closer to that than any plastic cube in a hospital. By allowing the mother to hold her baby, and care for it with love and affection well beyond any hospital attendant’s ability — she can bond with it. We know how important the oxytocin released during the mother-baby bonding is for the health of the baby, not to mention in cementing a primary relationship that will carry that infant through much of its life. Pioneering work by Harry Harlow on primates, and John Bowlby and Rene Spitz, who observed children orphaned in World War II, have shown us how devastating the lack of that human touch and connection can be on a newborn. How much worse is it for the most fragile of newborns.
A recent study even revealed that pre-mature infants (in incubators) who received 15 minutes of massage 3 times a day reached their developmental milestones much more quickly than those who didn’t. Imagine now the baby that is nestled in the Embrace is constantly being stimulated by touch and inadvertently massaged throughout the day. How much more quickly will it reach its milestones?
It is critical to note that the Embrace team members were by no means the only ones to confuse the solution for the problem. Countless well-meaning governments and companies who have over the years donated and transported incubator after incubator to third world countries have thrown millions of dollars after the same mistaken solution.
Few, if any, of us are immune to this error. It can happen in a variety of ways.
For example, when an exciting new technology is introduced to the market, a flood of early adopters will see how they can plug it in to every hole they see in the system, like fingers in a proverbial dyke. (We see this a lot in digital health!)
Another strain is common to inventors who get so attached to their idea, that they fail to see how it doesn’t adequately address underlying problem. Having advised several inventors and startups, I have seen this first hand quite frequently.
UNDERSTAND THE REAL PROBLEM!
So what is the cure to this dilemma?
Solution: To truly understanding the problem. The Embrace team initially fell victim to not understanding the problem as well, thinking that the issue was that “incubators were too expensive.” As long as we think that the problem lies in the cost of the incubators, we will continue to only explore ways to bring down the cost of the incubator! (Although this is admirable and important, it wouldn’t have addressed the real issue.)
Understanding the real problem allows us to explore a whole array of solutions that we may not have previously seen before, and unleash our creative problem solving power on it.
Process: There are many methods to do get to the heart of the problem. Design Thinking in one such process to not only get to the core issues, but start exploring solutions.
So while the task may at times seem Sisyphean (or at best Herculean) the reward (transforming healthcare) will be worth the effort. This continues to be my passion, and I welcome your ideas and energy behind this effort as well!