---

Listen Now

---

A great deal of the actual “work” delivered in the social sector comes in the form of services. Of these services, the lowest hanging fruit is skill building, often known as capacity building. But there are, of course, many other flavors of services – everything from helping to draft policies and plans, to the know-how behind running a power grid, to mapping service centers for at risk youth. My point here is that delivering services is a tried and tangible means for getting your hands dirty helping others. While not new by any account, one of the more exciting areas of the social sectors is the delivery of products. I think product delivery is especially interesting for a number of reasons. The design and delivery of products offers the opportunity for true leapfrog moments, and the measurement of success of a product is extremely tangible. Finally, in most cases the evolution of a product, as it iterates and is improved over time, is again extremely tangible. But, as we already know, designing, delivering and properly servicing products is a challenging prospect, even in the best of circumstances. When you also add the challenges associated with emerging economies and context, those challenges are multiplied. This is why I’m excited to have Krista Donaldson as my guest for the 156th Terms of Reference Podcast. Krista is the CEO of D-Rev, an organization that designs and delivers medical technologies that close the quality healthcare gap for under-served populations. As you’ve come to expect from our guests, Krista has been driving innovation in product design, engineering, and international development for more than 15 years. And, her work has won her acclaim as one of Fast Company’s Co.Design 50 Designers Shaping the Future, a TED speaker, and a World Economic Forum Technology Pioneer. You’re going to love this conversation about D-Rev’s origins, the choices made to focus their product lines and the challenges around finding high quality suppliers and servicing. We also talk about my favorite aspect of their work – the never ending march towards making products that people are obsessed about. You can connect with Krista here: https://www.linkedin.com/in/kristadonaldson/ Tweets by kmd_drev

---

IN TOR 156 YOU’LL LEARN ABOUT

• D-Rev, and Krista Donaldson’s design philosophy of relentlessly listening to the end user
• What is it like to design low-cost medical products in a way that makes sure the right people are using it and benefiting from it in the right way
• The importance of organizational focus to foster and brandish a line of expertise
• How developing a product involves a lot of repetition, and defying the public’s ideas about failure
• The perils and challenges of finding financing for 3-year long product pipelines
• An overview of D-Rev products “Brilliance” and “ReMotion”, and on “sexiness” in humanitarian product development

---

OUR CONVERSATION FEATURES THE FOLLOWING

Names:

• D-Rev
• Paul Polak, Out of Poverty (book)
• Facebook
• NPR
• BBC
• Partners in Health Rwanda (PiHR)
• PiHR’s University of Global Health Equity
• Apollo System

Topics:

• Design
• Product development
• Supply chain
• Low-cost design
• Medical devices
• Prosthetics
• Health care, Amputation
• Jaundice

Places:

• Chennai, India
• California
• Silicon Valley
• Rwanda

---

EPISODE CRIB NOTES

Download an automated transcript.. 03:57 D-Rev, short for Design Revolution Started by Out of Poverty‘s Paul Polak and Silicon Valley’s Kurt Coleman (??) Initially focused on project development for people making under USD 2 a day The initial quest was about launching products And scalable power plants Now, the focus in on closing health and equity gaps Medical devices   05:34 Among a wealth of economic problems, along came Krista The D-Rev board was looking for a leader for years Technological innovation was paving ways for solutions, but its “waves” were not thoroughly understood Products weren’t getting to users Then Krista came in When Krista took over, she closed several programs to give D-Rev a focus: Health Get a better understanding, “build expertise around health” This uncovers a lot more problems Physicians on the ground weren’t thrilled: “Great, another Westerner with ideas” They were expecting the latest toy from D-Rev, the “nonprofit medical device company” Krista made D-Rev prioritize products who were actually used in practice Not those “pushed” by donors or sponsors “Brilliance” is moved forward, among other projects http://d-rev.org/projects/newborn-health/   08:15 Is the “bottom of the pyramid” debunked? Data is perhaps the biggest problem for low-cost product design Marketing companies are not interested in the bottom of the pyramid In 2009 an anthropologists suggested Krista to conduct customer research on Facebook “I nearly fell out of my chair” Product developers are supposed to go out there and talk to people “It’s not that hard” Always comparing available data from large agencies with on-the-ground experiences for a sturdier landscape   12:51 Lots of sensible business model decisions Relentlessly user-centered Focused. D-Rev outsourced distribution “We’re not experts in the places we operate” But they reach out constantly to the actual users, with lots of questions about fine details Chennai, India, partner for delivery “We see ourselves as an orchestra” Partners that are well-aligned, serve customers   15:42 Tell us about that all relatable time when you were fine-tuning your supply chain and then Working for years for a product People think “design” ends with cool proof of concepts “It’s a lot of repetition” A partner in the Philippines set high prices “We should have predicted that, but we didn’t” Follow your products. Find out what happens to them Now, D-Rev interacts more deeply with delivery partners Like with any partner, the key is communication They agree not to raise prices “too much”, offer to share data D-Rev algorithms take confirmed dates of delivery into account   19:30 Funding 3-year development pipelines Philanthropic money Some money from sale, “not very much” People suggest to raise prices all the time Truth is there’s a lot of price sensitivity Raising might affect impact Funding for R&D is hard to come by Stephen: But large agencies are trying out new things. Krista agrees. The challenge is about articulating the many potential threads to innovation They are told “you are too small,” “innovation comes from universities” Universities are not great are getting products into market, dealing with contracts, partners, commercial capacity It’s just not their cup of tea For problems to get solved, “you have to have alignment” from basic research through design, through delivery Cool concepts need commercialization. Products must be meant to be sold Great ideas without impact abound India’s Apollo System It’s a multi-step process that takes aligning multitude of views, intentions   24:11 Take a look at the fast evolution of ReMotion, a high-performance knee joint, at http://d-rev.org/projects/mobility/ Sexiness “is a big thing” They were showing early prototypes to physicians, explaining every detail They were digging it, but they were really hoping it “works well” with patients It has to feel comfortable, for people who may have never even had a doctor’s appointment Lots of feedback and redesign later, doctors went from trusting to confident, to proud Before this product, solutions for low-income people were stripped down versions Patients are often young, car or workplace accident victims They are more interested in “blending in” As opposed to patients with congenital diseases, who tend to prefer utility The ReMotion knee is “slick” A Silicon Valley partner seeded doubt about ReMotion’s “sexiness” They tend to look for silver bullets   29:04 Solve for India, answer for California? It depends on the regulatory class of the products D-Rev focuses on referral facilities, with doctors keen to improve quality of care There are some basic infrastructure needs (not too stringent) Some of the products are available in the US and Canada D-Rev does not explicitly exclude markets, but getting approvals can be prohibitively expensive Added to the fact that demand is not large enough, there is not a real attention to the US into the strategy   30:55 Dis-Ruptions “I love competition. I feel comfortable saying that” I’m all about physicians and government official have a wealth of sources Irruption by D-Rev seems to have induced lower prices by the competition in some cases “We’re always learning” The market is becoming more sophisticated Customers know what they want with more detail D-Rev has sold to over 45 countries ReMotion has been met with acclaim New product development, line of product in the coming 2-3 years Leverage the private sector for delivery   33:52 Krista’s focus “It’s a mix” Being a CEO is fun. “You get to work with a lot of people” Negotiations with distributors Work with partners and donors Talking to doctors, understanding the needs After years of listening, patterns and trends emerge Better understanding about people   35:09 Is there a path to standard? I would love to be a path for every quality, affordable product for every hospital in the world “Morally, I struggle with the idea of maximizing profits with medical devices if that means children are dying and have brain damage” It would be wonderful that the market delivered such great things and not D-Rev   35:54 Why is impact important? Asking for a friend Buyers focus on quality, durability, not impact explicitly Impact is D-Rev’s job. “If our product has no impact, there is no point” If the product does not solve the problem sustainably, did it solve it? The importance of predicting impact And tracking what happens to the product Which counties in Kenya Does it attend the local priorities? Learning is a priority, for future products There are special challenges, blockages. It’s important to understand their causes to see how they can be sped up   37:57 Bottleneck There might be a need and D-Rev might have the product, but placing it in the right delivery facilities is not a trivial task This happens with the most unexpected medical devices Bio-medical engineers are scarce Conditions are not ideal Babies are supposed to have unique care units to avoid cross-contamination   39:02 Krista answers to the board The D-Rev board is very engaged Focused on capacity building Their advice has been critical Coming up: more formal advisory relationships This will allow a better way to analyze data Also, more formal partners on the ground Jaipur foot, India D-Rev’s small size is misleading, as it enjoy a large network of supporters   41:26 Krista’s Crystall Ball NPR, BBC, Radio “Our users” Rwanda’s Partners in Health’s University of Global Health Equity

---

 

Please share and participate

If you have any questions you’d like to ask me or Krista directly, head on over to the Ask Stephen section. Don’t be shy! Every question is important and I answer every single one. And, if you truly enjoyed this episode and want to make sure others know about it, please share it now: Also, ratings and reviews on iTunes are very helpful. Please take a moment to leave an honest review for The TOR Podcast!

Love this show? Tell us about why (or why not) below: