Posted by Greg Warman on Feb 16, 2010 11:11:00 AM

Design Thinking in Action: Embrace Global

In conjunction with the launch of our new game ExperienceInnovation, we will post several real world examples of design thinking in action. Today’s post highlights the work of Embrace Global and one of its co-founders, Linus Liang.

20 million premature and low-birth-weight (LBW) babies are born every year. Of these, four million will die within the first month of life. Those that survive face severe long-term health problems like diabetes and respiratory disease.

99% of neonatal deaths occur in low to middle income countries. Why? The proven treatment – the infant incubator – is cost prohibitive. At $25,000 for a single unit, this life saving device is out of reach for the world’s poorest.

The solution seems obvious – design an affordable incubator.  In 2007, Linus Liang and his team at the Stanford d.School were tasked with the ambitious objective of creating an incubator for 1% of the standard cost – a mere $250.

I recently shared this story with a friend who is an accomplished engineer and his immediate reaction was one of excitement. “It actually might not be that difficult,” he claimed, “incandescent bulbs, analog, combined with appropriate insulation would be a starting point.” A talented, visual thinker, my friend appeared to be working up the schematics in his head.

And perhaps he’s right – it might not be that hard. However as Linus and his team soon discovered, hard to design or not, an affordable incubator would have little impact because it solves the wrong problem.

Lesson One: Solve a real problem

Linus comes from a programming background – he was a Product Manager at Microsoft, built and flipped a technology start-up here in Silicon Valley, and received his Masters from Stanford’s prestigious Department of Computer Science. Since co-founding Embrace, the company that formed around his team’s project, life has changed dramatically. Now based in Bangalore, India, Linus’s focus is on the complex operational issues associated with the design, manufacture, and distribution of a product in the developing world. I reached Linus in Bangalore to discuss Embrace and the meaningful work the company has planned.

Their story begins in “Design for Extreme Affordability”, the’s project-based course focused on innovating for social good. Of the assignments available, Linus and his team gravitated to the incubator challenge, a project sponsored by a Nepalese NGO (Note: Nepal has the highest percentage of neonatal deaths per babies born in the world). As good design thinkers, the team’s first step was to observe users, specifically the healthcare workers in Nepal responsible for treating premature and LBW babies.

Linus journeyed to Katmandu and immediately started touring hospitals, speaking with doctors and nurses about the issue of premature births. As he walked around, Linus noticed something surprising – there were already a number of incubators, primarily older units that had been donated. Even more surprising, most of the incubators sat empty.

When Linus asked why this was the case, a doctor shared that most problematic premature and LBW births occur in rural villages, up to a day of travel away. Sadly, because babies cannot regulate their body temperature, they often die en route to the hospital. It was a powerful insight and Linus immediately recognized his team had the wrong design challenge. To evolve it successfully, he would need a completely different data set.

He cancelled his remaining hospital tours and arranged to visit surrounding villages, the areas where the true need existed. He spoke with local doctors and with mothers who had lost their babies as a consequence of premature or LBW births. He discovered that geographic proximity to urban hospitals was only part of the problem; in many cases families simply couldn’t afford the travel let alone the cost of hospital care. He also unearthed several realities that would inform the design of his team’s solution: no reliable source of electricity, rudimentary local healthcare, extreme cost constraints (It became clear that $250 would be far too expensive for local adoption).

With these factors in mind, Linus’s team reframed their task. Rather than focusing on affordable incubators, they endeavoured to “design an ultra low cost, portable way of maintaining babies’ temperatures without the use of electricity.” By shifting and narrowing the challenge, the team increased the likelihood their final solution would indeed have impact.

Lesson Two: Solve that problem well

Once back in the USA, Linus’s team engaged in a flurry of activity. First, they gathered as much information as they could on incubator technology and its methods for regulating babies’ temperatures. They were fortunate to be at Stanford where access to expertise in medicine, engineering, and materials science was readily available. Their research revealed, among other valuable facts, that a significant portion of the expense associated with standard incubators had little to do with temperature regulation.

Second, focused on their revised design challenge, the team brainstormed possible solutions. Using the brainstorming principles advocated at the (including deferring judgment, building on the ideas of others, and allowing for wild ideas), they generated a large volume of potential ideas, a subset of which would ultimately influence their final solution.

Third, after synthesizing and voting on their brainstorming output, the team evolved their ideas by engaging in rapid prototyping. Using a variety of sundry items available at the, the team threw together various solutions, pushing their thinking in unique directions. In just a few weeks, the team built and broke over 100 prototypes.

The path was tortuous but necessary; the resulting solution was extraordinarily elegant. Resembling a miniature sleeping bag, the product insulated a child against the cold. A side pouch accommodated the real magic – a unique, removable heating pad. After a few minutes in boiling water, the pad releases just enough heat to maintain the perfect temperature inside the sleeping bag for over four hours. As importantly, the solution had no moving parts and could be built for under $25 (that’s correct, 1/1000th the cost of a traditional incubator).

In typical business scenarios, a prototype this polished would enter into clinical testing, production planning, and finally manufacturing and distribution. Linus’s team however was determined to make sure their final product would optimally suit the intended market. So with prototype in hand, the team returned overseas seeking evaluative feedback.

The learning was fast and furious. Because there was now a tangible prototype, users had little difficulty reacting with suggested improvements.

For example, the team learned that local doctors often accompany new mothers and their premature babies to urban hospitals. When in transit, a key consideration is observing chest movement to monitor respiration. To facilitate such observation (without requiring the opening of the sleeping bag and the consequent loss of valuable heat), Linus’s team designed a rugged plastic window for the front of the unit.

Another modification fit a cultural norm. The team discovered that it is fairly common for patients to use intuition when taking medication, regardless of a doctor’s instructions. Local doctors worried that the LCD temperature strip on the exterior of the sleeping bag, which showed temperature in degrees Celsius, would invite interpretation and result in bad decisions. Using paper mock-ups, Linus’s team quickly tested a temperature gauge that had two states – a happy face to indicate the temperature inside the sleeping bag was warm enough, and a sad face to signal the need for a new heating pad. This level of abstraction was well received and has been incorporated into the design.

The “Embrace Infant Warmer” is nearly ready for market. Interest in the product has already exceeded expectations. Indeed, healthcare systems around the world have been inquiring about the unit’s availability. By solving a real problem and solving it well, Embrace is poised to do more than introduce a popular product; they will be saving lives.


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