At the beginning of each new project, Design that Matters creates a point of view statement to focus the project on the need, users, and contexts will be included AND excluded from our design. During Project Firefly, we focused on treating otherwise healthy newborns with jaundice using a phototherapy device that rural district hospital staff with little training could use in the mother's room. Our evolving point of view statement was an invaluable tool to guide the design and invention process and create agreement between partners.
The need - To achieve positive social impact, always start with a need (not just a desire).
The users - Who are the end users? What other stakeholders must be satisfied?
The context - Where and when will your design be used? What else must it interface with?
You may be familiar with the saying "Design for everyone is design for no one." At the beginning of each new project, Design that Matters creates a point of view statement to focus the project on the specific need, users, and contexts we will and will NOT design for. During the design of Firefly Newborn Phototherapy, the point of view was an invaluable tool helping us build agreement about project purpose with our implementation partner, East Meets West Foundation (an affiliate of Thrive Networks), and our Vietnamese manufacturing partner,Medical Technology Transfer and Services. We focused on treating otherwise healthy newborns with jaundice using a phototherapy device that rural district hospital staff with little training could use in the mother's room. As such, we were pleasantly surprised when the device also found a home in Neonatal Intensive Care Units at National-Level hospitals to treat the most severe cases of jaundice.
Left: Two infants share an incubator while receiving phototherapy from an overhead lamp. Right: A nurse places a newborn into Firefly.
What is the need?
Beginning at the Firefly kick-off meeting, we talked with our manufacturing and implementation partners about whether they envisioned our phototherapy device would treat all jaundiced newborns, or a subset. Approximately 10% of all newborns require phototherapy for jaundice. Some jaundiced newborns have other health conditions in addition like respiratory distress, infection, or complications due to prematurity. Because of this, we would have to marry a lot of constraints in attempting to provide phototherapy to newborns with the widest array of conditions. For example, we would need to ensure the design could fit inside or around an incubator, a device created to keep the sickest babies warm.
East Meets West Foundation found that around one third of babies in overcrowded national-level Neonatal Intensive Care Units were otherwise healthy newborns with jaundice. These babies were sharing beds and overhead phototherapy lamps with a rotating cast of other newborns, some with infections. The babies were often blocking the light or rolling out of the effective area of the light. Most overhead phototherapy lamps were designed to cast a light on a bed big enough for only one newborn.
Result: In the end, we were all happy that we had focused on otherwise healthy newborns. Departing from designing around an incubator enabled us to create a device that holds only one newborn directly under the lights, increasing effectiveness and possibly decreasing spread of infection.
Left: One of nine rooms with 150 newborns at the Neonatal Intensive Care Unit in National OBGYN Hospital, Vietnam. Right: A midwife shows all the equipment she possesses at Tonlebaty, a rural clinic in Cambodia.
Who are the users?
When we began designing Firefly together, East Meets West Foundation had already provided training and equipment to the over 100 national and provincial level hospitals in Vietnam. They hoped a new, simpler phototherapy device could enable them to expand their Breath of Life newborn health program into rural district hospitals, the lowest level of hospital providing overnight care. They planned to provide training and equipment, but were worried about how best to instill confidence in staff members at these hospitals who may be accustomed to sending all newborns in need of treatment to higher level hospitals. As Luciano Moccia, director of the East Meets West Breath of Life program noted, "Phototherapy will only work in hospitals with the confidence to treat babies." How could the newly-designed phototherapy device help doctors and nurses with little experience treating jaundice feel good about providing treatment after the trainers had left?
We noticed some interesting behaviors during observations. First, when given a phototherapy device with multiple settings, healthcare providers in the same hospital had different approaches to choosing power levels for newborns. Second, we would sometimes see newborns lying under phototherapy lamps with a blanket covering them for warmth, blocking the light from reaching their skin. Third, doctors and nurses reported flipping the babies like burgers on a grill to ensure both sides were sufficiently exposed to the light. Ideal phototherapy shines as much blue wavelength light over as much skin as possible. The light passes through the skin to alter a chemical in the blood called Bilirubin so that it can pass through the baby via the urine and stool. Given that blood circulates, it is not necessary to flip the baby to expose different parts of the skin.
Result: Because of these observations, we simplified the device to go beyond just user-friendly - we made it hard to use wrong. There is only one button and only one power setting to turn the lights on and off. We provide effective light intensity from above and below in case someone covers one side of the baby with a blanket. The final design was not intended to please super-users, but surprisingly this unique device has also found a home in national-level facilities treating the most severely jaundiced babies because the the double-sided lighting also reduces treatment time. Designing for a user with little training yielded a device that is better for other healthcare providers as well, enabling them to devote more of their energy to more complicated conditions.
Left: Mothers who have recently received c-sections wait outside the Neonatal Intensive Care Unit to breastfeed their babies at Philippines General Hospital. Right: A mother who has recently given birth stands to comfort her baby who receiving overhead phototherapy in Vietnam.
What is the context?
Throughout the field research process, we couldn't help but notice how jaundice treatment separated moms and babies during the earliest days of life. In one of the smallest rural hospitals we visited, the nurse confided that she sometimes was the only nurse for the entire hospital during the night. If a baby was receiving phototherapy in the Neonatal Intensive Care Unit, she may not have time to bring the newborn to mom to breastfeed all night. Newborns need to eat every 2-3 hours and effective jaundice therapy requires both phototherapy and hydration to produce urine and stool to flush the bilirubin from the body. We saw a tremendous opportunity for technology to facilitate a new treatment context for otherwise-healthy newborns with jaundice in mom's room.
We considered many other possible contexts in conversations with our manufacturing and implementation partners. What about using it in a vehicle to transport jaundiced newborns? Or using in a high-level hospital Neonatal Intensive Care Unit? We explained that planning for these disparate environments would so totally change the design that it could end up not fitting well in any context. We ultimately maintained our focus on mom's room and we are happy with the result!
Result: We created a smaller, more portable device compared to traditional overhead phototherapy that can fit in the room with mom, uniting mother and baby for better bonding, breastfeeding, and monitoring. As a happy surprise, the smaller device also fits in a crowded Neonatal Intensive Care Unit even better than typical overhead phototherapy because its small size enables it to fit in a common infant cot.
Left: The first mother to experience phototherapy in her own bed. Right: The highest level hospitals save Firefly to treat their most severely jaundiced babies.
Design that Matters used our point of view process to build ongoing agreement with our manufacturing and implementation partners around a focused project. Though it was heart-wrenching to narrow focus to serve the needs of otherwise-healthy newborns instead of all jaundiced newborns, in doing so we created a better design that was even more well-received than we anticipated.
This "Design Experience that Matters" series is provided courtesy of Timothy Prestero and the team at Design that Matters (DtM). As a nonprofit, DtM collaborates with leading social entrepreneurs and hundreds of volunteers to design new medical technologies for the poor in developing countries. DtM's Firefly infant phototherapy device is treating thousands of newborns in 21 counties from Afghanistan to Zimbabwe. In 2012, DtM was named the winner of the National Design Award.
Elizabeth Johansen is Senior Advisor to Design that Matters (DtM), Principal of Spark Health Design Consultancy, and Adjunct Faculty at Olin College of Engineering's Affordable Design & Entrepreneurship Program. Elizabeth uses human-centered design to develop world-class technologies that lead to better health outcomes. She is also a sought after speaker and facilitator who has taught design for social impact to hundreds of organizations, from the smallest social enterprise to the largest bank in the world. Notable product launches include Eli Lilly's Kwikpen insulin injector (during former days at IDEO); Jana Care's improved Aina A1c rapid diagnostic test app for diabetics at home; and DtM's Firefly phototherapy device currently treating newborns with jaundice in over twenty developing countries. Firefly has earned ten design awards including the Edison Gold, IDSA IDEA Silver, and Green Good Design.