Details are the worst.
We’re enamored by The Big Idea but bored by The How. We love the well-designed device but loath the discussion of a distribution strategy. We rave about the Sexy Silver Bullet that will solve [enter your pet social concern here] but gloss over the plan to do so.
As Adrianna McIntyre, wunderkind health policy wonk and writer, put it to me recently on Twitter, “Implementation just isn’t good fodder for the thinkpieces.”
@MikeMiesen Implementation just isn’t good fodder for the thinkpieces.
— Adrianna McIntyre (@onceuponA) January 27, 2015
She’s absolutely right. It isn’t. The details are, to put it mildly, unnervingly boring for all but the most wonky of us. The pessimistic take is that journalists write what will be read, and there isn’t demand (or, if it’s in print, space) for the messy discussion of how it will actually work. Implementation, therefore, necessarily takes a backseat to the quick description of a “live-saving” or “world-changing” technology, and society is worse off for it.
Adrianna was referring to policy, but the sentiment rings true for other sectors, too – particularly, I’d argue, the large umbrella of “technology for development.”
Take this recent article about D-Rev’s redesigned phototherapy unit, BrilliancePro; it’s an exemplar of this type of article. The general formula is simple: focus on a social problem through the lens of a technology-reliant solution; make a bold claim about the solution’s impact on the world; qualify the claim with a “to be sure” paragraph; end on an optimistic note.
BrilliancePro is used to treat neonatal jaundice, an extremely common condition – according to UCSF Children’s Hospital, 50-60% of newborns are jaundiced in the first week of life – with an extremely simple treatment: shining blue light on jaundiced babies for a few days. Brilliance and BrilliancePro exist because traditional phototherapy units aren’t designed for low-resource environments, a topic about which I’ve written previously and won’t revisit here; suffice it to say that widgets should be designed for the environments in which they’ll be used in.
And Brilliance Pro is well designed for the environment it will be used in. The article highlights all of the improvements and innovations that make BrilliancePro a great product, of which there are many: it’s sleek and includes a light meter, for example, which low-resource hospitals value but typically can’t afford.
But buried at the end of the article is this: “Getting Brilliance into hospitals is a challenge unto itself, and D-Rev’s success in that regard has been more measured.”
Frustratingly, the article gives a situation and hints at the conflict, but fails to provide any resolution; the ‘so what’ is left out.
This article was put up on Wired’s Design vertical, so you could argue that the business side of the business was purposefully – even appropriately – neglected. But this seems odd; an award-winning product without an end user is just a failed, award-winning product. The design of a business is just as important as the design of a product, and a product that wins plaudits for its design without actually getting to the end user is just as much a failure as one that doesn’t win awards and fails. Design is about more than design.
This shouldn’t be read in any way as a criticism of D-Rev. I wholeheartedly support its process and its products, and think it is probably the best at what it does. I’ve met Krista Donaldson, the organization’s CEO, and other members of its team in the past, and found all of them to be smart, pragmatic, and passionate. Above all, the team is incredibly thoughtful about how it designs products – “user-obsessed” isn’t just marketing spin – and it spends nearly as much time working on how to get its well-designed products to these users (who really like the product, based on my interactions with a few of them).
And anyway, D-Rev has actually been pretty successful. According to the Health Impact Dashboard D-Rev has on its website, it currently has 779 Brilliance units in nine countries*, and a lot of lives have been affected.
But it’s fair to say that D-Rev has set its sights a lot higher than this. The Wired article can’t answer the questions it never asks: How does D-Rev plan to get these brilliantly-designed products into hospitals? Why hasn’t it seen the type of success it should expect?
Yes, these are difficult questions to answer; it’s simpler to state that the “payoff from the incremental changes could end up being far more profound” than to investigate whether that is actually likely to happen. By not asking or answering these difficult questions, the journalist commits the Underpants Gnomes Fallacy:
I’d argue that D-Rev’s to-market issues have less to do with its design or business model than with a variety of exogenous factors it can’t control (and will do so in an upcoming piece). This only underscores the point: in low-resource markets, distribution is hard. Even a smart organization like D-Rev still has trouble getting its product into the hands of end users.
In other cases, though, an appropriately skeptical look at an overhyped design could have actually made a difference.
Here the PlayPump is instructive**. Invented in 1989, the device – which uses a merry-go-round to pump water into a tank, which can then be drawn from a nearby spigot – came to international acclaim in the early 2000s, winning an award from the World Bank and $16.4 million from USAID, PEPFAR, and the Case Foundation.
Amy Costello, then a PBS Frontline reporter, produced a positively glowing feature on PlayPump in 2005. But she went back to Mozambique in 2009 and found PlayPumps broken and unused, their promise unfulfilled. Costello then filed a much more critical report, and PlayPump’s grand schemes and overblown rhetoric never came to fruition.
To its credit, one of PlayPump International’s backers, the Case Foundation, admitted that it made mistakes in rolling out the device and committed to changing course. This is a great, laudable, and difficult thing to do. But I suspect that a bit of well-placed skepticism at the outset would have led all involved in this directly much earlier.
Skepticism is good for designers and potential designers, too. It forces them to question their assumptions and to think deeply about more than just the physical design of a product. It forces them to up their games.
To a person, journalists are hungry to tell difficult, engaging stories. But, especially when it comes to design, telling the whole story requires a deeper examination of how the design will lead to the impact they claim it will. Readers deserve it.
*The Wired article had much different figures – 1,100 units in 23 countries. Not sure where the discrepancy comes from, but here I’m using D-Rev’s figures.
**There are plenty of others – the Soccket immediately comes to mind – but the PlayPump is more or less the platonic ideal of an over-hyped design that little-to-no skepticism