a generation of question-askers

I bought my mom an iPad recently. Last week, we went to dinner to celebrate her 50th birthday. We were sitting at Ecco in Midtown on a gorgeous night, and I was asking her how she was liking the new iPad. She remarked to me that she hasn’t sat down at her computer in at least 4 or 5 days, but she’s still afraid to take it with her anywhere because she “might break it.”


Great conversation, gorgeous night at Ecco in Midtown Atlanta.

My mom is sort of afraid of technology. I find it frustrating to teach her how to use new pieces of technology. She grew up in a time and a place that didn’t encourage learning by doing. I grew up in a culture that supported playing, exploring, and trying things out without asking permission. Our paradigms of how we approach something are totally different.

When you think about it, Generation Y is a bunch of question-askers. We aren’t afraid of asking questions, because we’ve always had the tools to find the answers. When it came to computers and the internet, we very rarely asked our parents how to do something, because they knew as much about the technology as we did. As a result, we were allowed to explore, to learn, to break things if that’s what it took. We had a much higher tolerance for questioning, answering, and failing in our early lives, because it didn’t take time to try again.

I wish I could get Shan to write a guest post about success, failure, and startups. Michael Fairbanks said last weekend that to understand what you really should be chasing, ”fail frequently, fail fast, fail originally” - Gen Y is in the perfect place to do that. To take risks. It’s sort of exciting, given our backgrounds and upbringings, to think about the next 30 years of innovation in technology. To think about the next 30 years of thinking in human-centered design.

The iPad is a great device for Mom. Once she overcomes that initial barrier, that fear, it encourages her to play, to touch, to try (something that my generation has been doing by default all our lives). What’s the worst that could happen, I asked her - that you break it and we have to get a new one? It’s a low investment to learn to ask good questions and seek good answers.

designing cradle-to-cradle

In honor of Earth Day, a question: for any of you in [product] design, who generate physical things as a result of your work, have you ever designed anything to be cradle-to-cradle?


Chicks dig recyclers (true story). World of Coca-Cola, Atlanta, Georgia.

As in, something that can be completely repurposed and completely diverted from the waste stream?

It’s a difficult proposition in medical devices, because of biohazards and body fluids, but I’d be curious to see some good examples of how, in this age of smarter consumption, designers are coming up with smarter creations as well.

On another note, I’ve posted three times in two days! That’s got to be some sort of record or something. I’ll take a cookie for that.

the lottery of birth

From getrichslowly:

As I’ve mentioned already, at times I felt guilty too. It’s hard not to feel guilty when you’re staying at a hotel where the average room runs $618 a night — and meanwhile, half a mile from this posh palace, men and women are scratching to make ends meet.


On the road outside of Dharavi, Asia’s largest slum.


Four miles from Dharavi, is the Intercontinental Grand Mumbai.

What is my moral obligation to these people? Do I have one? Should I feel guilty for spending money on tourism? Or, as our guides suggested, should I be comforted by the fact that I’m participating in a transfer of wealth from the rich to the poor? What productive ways can I help aside from just throwing money at the problem?

I don’t have answers to these questions. 

Ultimately, however, I’ve realized that guilt is not productive. Guilt doesn’t accomplish anything. I can’t change who I am or the circumstances I’ve been born into. I’ve made the most of what I have: I’ve been lucky, and I’ve worked hard to build upon that luck. I can’t change this, and I can’t regret it.Instead, I feel like it’s my responsibility to do something with this hand that I’ve been dealt. Do what? I don’t know — and I’m not sure I need to know right now. As I travel, I’m becoming more aware of the world around me, and I feel like maybe there’s something I can contribute to make it a better place. I’m not sure what that something is, but I’m willing to be patient until I discover it.

I could have been born to any family, anywhere in the world, under any set of circumstances. I could have been any Indian girl - one of 600 million others.

But I wasn’t. I was born to incredibly intelligent and educated parents. Who had families that supported them and career choices that made them successful, in today’s terms. Who left the country of their past in hope of a country that could change their futures.


A man sleeping on a makeshift cot placed on a pile of trash near Loni Road in Delhi.


The Bah’ai Lotus Temple is one of the biggest tourist attractions in Delhi.

In Warren Buffett’s words, I (like most of you) have won the lottery of birth. It’s an incredibly humbling thought. As he describes it, if just before your birth you were put in front of a barrel containing 6.8 billion balls, and you pick one ball - one ball that would determine your gender, your birthplace, your parents - that determined the circumstances of your life. If you had that chance, would you put your ball back in hopes of something better?

I know I wouldn’t. That’s the hand that I’ve been dealt. All I can do now is give something back for it.

we’re about to be surrounded by 7 billion of our closest friends and family

Check out this interesting map from good.is:

See the original here.
The top five in population as it stands today: China turns into Russia, India takes over Canada (which, the authors joke, would make a great arrangement for American companies who outsource technical expertise…), the US stays where it is as the third largest country in both population and land area, Indonesia moves to China, and Brazil stays where it is. Pakistan takes over Australia, and Japan displaces Sudan. Interesting stuff.

When I was born, world population was just under 5 billion. Today, it is almost 7 billion - with some estimates that nearly 99% of that growth takes place in the developing world.

How will we feed everyone? Care for everyone? Where are these people going to go? Already, Indian cities, as well as urban centers in Bangladesh, Pakistan, southeast Asia, sub-Saharan Africa, and Brazil are overcrowded. Around 50% (depends on which estimate you use) of India’s population lives below the international poverty line - $1.25 USD a day (even in India, with a relatively low cost of living, that’s a mere 55 rupees or less).

Mumbai is a good reminder of what 1.1 billion people really looks like. July 2008.
And bigger questions: how can we foster a world with more people and more perspective? How can longer lives mean more meaningful lives? Can we balance urban development with sustainable outcomes?

what do you give that doesn’t cost a thing?

Last month, just after visiting IDEO in Palo Alto, I asked, what is your relationship with money? More important though, is IDEO’s question on their facebook group Big Conversations & Small Talk: “What do you give that doesn’t cost a thing?”

It makes for good reflection just after the holidays. We give a lot of gifts. We give time. We give experiences & memories. We give hope. We give dreams.

Honesty.

Courage.

Momentum.

Things that don’t cost anything.

what is your relationship with money?

Not sure if any of you are Bank of America customers, but I dropped by IDEO Palo Alto on Friday afternoon to have a conversation with Altay Sendil about the emotional and human aspects of the goods and services we use.


(photo courtesy of… )

The Keep The Change program (I’m not a BofA client) is one of my favorite examples of good design strategy. When BofA was looking at creating an easy savings account, the questions started (predictably) about how we use savings accounts - about interest rates, linked accounts, online tracking, and other functionality that we classify as “account features”. But the interesting question is not how we save, but why we save. What is our savings paradigm? Fundamentally, how do we interact with money? What are our deep-seated attitudes, our internal scripting about spending and savings?

Understanding the why was important to making the how work. The Keep The Change program is very well-received in the consumer banking arena.

Microfinance in developing countries caters to similar attitudes. Repayment rates for microlending in Bangladesh are unbelievably high - not because people are more capable than in other countries to repay the loans, but because the lending structure - the women-centric, group-accountability, installment-structured system of lending - works for the villagers who take the money. The process fits with their relationship to money and the way they view capital and investments.

I have a Way2Save account with Wachovia (Wells). As I build my own financial paradigms and explore my attitudes toward wealth and savings, it’s been interesting to take a deeper look at how I interact with money, and to talk to others (including my parents) about how they deal with their own finances. About saving and spending. About the things that I value and what I’m willing to pay for them. About creation and consumption.

So how do you interact with your savings? When you were growing up, what did you learn about saving and spending? Ultimately, what is your relationship with money?

the difference between health and public health

For the second time in two months (and despite getting a flu shot), I’m sick. This is strange for two reasons; the first being that I grew up in a developing country and have an immune system bolstered by 1+ billion people living in an area smaller than half the United States; the second, because I’m a relatively healthy individual who exercises regularly, doesn’t (didn’t used to) get sick often, and maintains a fairly healthy diet (sleep schedule notwithstanding).


(photo courtesy of… )

If I had to guess, I picked something up at work. Because workplaces, like elementary schools, are incubators for illnesses. It’s all fine and well to be a healthy individual with a strong immune system, but throw that healthy individual into a building for 9+ hours a day with others of varying immune capabilities, and it makes no difference how healthy they were to begin with. Essentially, I need my coworkers to stay healthy if I plan on staying healthy, and I derive a very real benefit (in economic terms, an externality) from my team not being sick.

That’s the difference between health, and public health. Healthcare, like education, provides benefits not only to the individual that purchases the good, but also externalities to others in society such as increased productivity, lowered disease transmission, and reduced microbial resistance to medication.

Here’s the real kicker (and especially in the context of healthcare reform): if all of society derives these benefits from me not being sick, who in society deserves to pay for my health? We’ve managed to answer that question in education - society pays to educate its children because society benefits from an educated population. Should society be paying for healthcare when that society derives benefit from a healthy population?

And let’s take it one step further. In the developing world, individuals cannot afford to pay for the most basic of health services. In these places, though, because of the prevalence of infectious disease, keeping individuals healthy delivers huge impact to others in the population. Globally, preventing an outbreak of infectious disease in Niger means a smaller chance of a compromised population in Atlanta.

So, today’s good question: who should pay to keep people healthy?

a few statistics in global health

Last Friday Massachusetts General Hospital’s Center for Global Health had its first annual symposium. It was an incredible turnout - at least 300 or so were in attendance. Lots of good thoughts as I try and wrap up my research paper, but one in particular:


(photo courtesy of MedShare - if you live in Atlanta and don’t know about MedShare, you need to volunteer)

I posed a question to Kris Olson, who is a pediatrician and doctor of internal medicine at Mass Gen, and also the Director of the Global Health Initiative for CIMIT, about public-private partnerships and how we make innovation for the developing world a sustainable venture for the developed world. He didn’t have an answer (no one does, and even now, only a few people are trying to figure that out), but he did bring up some interesting statistics and the need for healthcare innovation:

~ 40% of needles used to vaccinate children in developing countries have been used in another child before
95% of medical equipment (what we call “durable medical equipment”, or DME) in resource-limited areas is donated equipment
90% of those devices fail in the first five years

Dr. Larson, while acknowledging the need for innovation in the space, made a great point: “A need does not necessarily equal a market.” Not sure if we can find a way around that, or create a market, or develop a nontraditional market, but answering that question and monetizing that market goes a long way to improving global health in all regions of the world.

how can we design to inspire self-efficacy?

I went to a talk yesterday by Josh Chuzi for Atlanta Design Week called Healing Environments: How Art & Design Can Improve Health. Although the context of the conversation came from his background in art history, he posed a very interesting question: how can we design to inspire self-efficacy?

The World Health Organization defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Chuzi talked about healing as a multifaceted term as well, highlighting not only physical healing, but psychological, spiritual, social, cultural, and sexual healing as well. The common theme in healing, though, is to build (and I don’t love this term) self-efficacy.


(thanks, Wikipedia)

The prevailing attitude in the healthcare environment today is to treat the physical body. According to Maslow’s hierarchy of needs, we must address the physical, corporal needs first. I think, though, sometimes in the current state of healthcare in the world today, we take that need out of proportion with the others. As a medical device designer, I see that we certainly think first and foremost (and sometimes solely) about how medically efficacious a device or therapy is. While that has to be our primary concern, it often becomes our only concern.

We lose sight of the human element of healing. The need to feel nurtured, stimulated, and protected - emotional self-efficacy. The need for our family and friends in times of medical emergency - social self-efficacy. So how do we inspire patients and clinicians to strive for that?

And even more importantly, how do we inspire patients and clinicians in the developing world to achieve that goal as well? In places where empowerment is in short supply, how do we create products and processes to drive people to total self-efficaciousness?

Clever design takes these things into account. That’s why music videos in India work wonders on rural literacy rates. That’s why Paul Farmer’s DOT program was such a success in Haiti. And why Greg Mortensen is able to effectively counter the Taliban’s madrassas in northern Pakistan and Afghanistan by building schools.

No, clever design can’t do this on its own. Empowerment and self-efficaciousness are a partnership of people, product, and process. I suspect that in the next 20 years in this country, we’re going to see a dramatic shift in how doctors see patients. As costs continue to rise, we’re going to have to. The process by which we pay for healthcare will change. And the products that we use will have to adapt to keep up. Health is about a whole person. While the medical profession is segmenting and specializing further, the processes and products that we use have to be able to synthesize those specialities into a whole person again.

question your assumptions

During my sophomore year of college I took a class in engineering thermodynamics. It was the kind of class that makes young engineers change majors, where the professor told us on the first day that 60% of us would fail the first test (we did). 
About that time in my life, I received a card in the mail from a mentor of mine. I’m a big fan of Quotable Cards (I’m a big fan of good quotes), and this particular card is still sitting on my nightstand.

Part of becoming an engineer is learning to make good assumptions. But part of being a great engineer is learning to question those assumptions.

It’s this part that’s lost in lots of designers.

In order to start the design process, you have to make assumptions. To solve a complex system, you have to engineer with information you don’t have yet. The design process dictates that you generate design inputs - that is, physical specifications, dimensions, materials… what the product will look like - before you can even create a prototype. And professional engineers do a great job of checking to see that their product meets those design inputs. That’s design validation.

But what about verification? What about verifying that my product does not what I wanted it to do, but what my doctor wanted it to do? what my patient wanted it to do? That’s design verification. And that’s where it becomes important to question your assumptions.

In the past two years I’ve learned a lot about myself as a designer. I’ve brought three products to market, taken a course in SolidWorks, and spent significant time in the hospital with clinicians and patients. I’ve been to a manufacturing plant in Mexico and created a new process for adhesive coating in New Hampshire. I’ve found that in my career what I’m best at is asking questions, and questioning assumptions. I spend my time in the top half of that graph - on asking why we’re doing what we’re doing, and how a product behaves with a patient.

I think we can all benefit from questioning our assumptions. Making an assumption is answering the question of how to do something. Questioning assumptions is about asking why we’re doing it in the first place. It’s about being mindful of decisions, of interactions, of relationships. So go ahead and jump into a problem headfirst. Make some assumptions. Move forward. And then come back and ask yourself why. Look at the assumptions you made, and question whether or not they were the correct ones. Give someone else a chance to surprise you. Give yourself a chance to surprise you.

welcome, new friends!

There’s been a recent upswing in visitors to the blog, and although it’s still modest traffic, there’s a good number of you coming in from overseas - welcome!


(photo courtesy of… )

When I first started blogging, I stressed an emphasis on creating good content, so that anyone reading was consuming interesting and thought-provoking posts. I don’t always hit that mark, but I’m always, always open to suggestion and comments!

If there’s something that you’d like to talk about, please don’t hesitate to ask.

If there’s a design or development issue that you’d like to write about, talk to me about a guest post.

And finally, if you’re subscribing on Google Buzz or Reader (and therefore I can’t track you as a visitor… if you know a way around that, can you let me know… Shan… ?), thanks for the emails with your thoughts - they are sincerely appreciated. A lot of you have some really sharp insights - don’t be afraid to share them publicly with other readers.

how information moves to create empowerment

Late last year I met with some folks in Boston who are working on some neat emerging technologies for diagnostics in the developing world. Since then, we’ve all been trying to brainstorm ways to engage others who are interested in this topic into the conversation. Recently, Aaron posed a really interesting series of questions to me in thinking about the world after their diagnostic technology becomes widespread:


(photo courtesy of… )

“How does the data move; what is done with the data when it gets there? How does it influence caregivers, governments, funding sources, etc? Can we predict what we might learn?”

I have an endless curiosity for questions like these (as Thomas Friedman calls it, this is my “inner fire truck”). Although my design skills are still in their infancy, and I hopefully have a long road in global health and technology ahead of me, these are the best kinds of questions to ask to move further down that path. Essentially, development is about empowerment, and empowerment comes from information. When you design for the developing world, and with the developing world, the primary concern is access to information. What information do these people need to make appropriate decisions (and how does that differ from the information that we provide for traditional devices in domestic hospital settings)? How can we deliver that information in a usable and readily accessible format? What will happen to that information once we obtain it? What other things can we couple it with to make the most of it?

Of course, you have to optimize your physical design for the environment that it will be used in, but these are questions of design intent, and they’re far more interesting than questions of form or function.

depth, breadth, and the “real world”

There are two things on Earth that grate on my nerves to no end. One is bananas; the other is when people refer to a certain milestone or experience in their lives as a mark of “the real world.” Graduating from college, returning from a trip abroad, or finishing a substantial service endeavor are all good examples of activities that seem to fall outside the realm of the “real world.”


I don’t know, it looks pretty real to me… (photo courtesy of… and read the headline for good measure)

This phrase always makes me wonder, what fake world were you in before that?

In adult life I think people value professional depth. For most people, school is about creating depth in one subject area to pursue after graduation. Work is about becoming a subject matter expert in one field. Graduate degrees are about depth of understanding in one very specific topic. But although our society encourages to specialize professionally and develop a depth of understanding in a particular topic, it personally idealizes those who do the opposite - who have a breadth of interests and engagements in addition to their (to use another buzzword) core competence. The phrase “the real world” is about experiences that create professional depth. But what you do outside that “real world” is what makes you a great designer.

To be a good designer is to possess depth. It’s very, very important to understand fully what tasks are needed to achieve a given outcome. It’s important to understand the realities of the use case. It’s crucial to be able to translate what a user is saying into design inputs, and ultimately, into a workable, physical form. That’s depth. To design products for mitral valve repair, I have to have a complete and thorough grasp on the anatomical details of the heart and the physiology of its components. But to understand the user is a different scenario - what are the pain points in the surgeon’s particular technique? How many patients does a nurse see in one day? What are the most challenges tasks on the agenda in the operating room? Being able to address depth issues, or task-specific challenges, is to meet your design criteria. But being able to address breadth issues, things that a user can’t necessarily articulate for themselves, things that are tangential to the task at hand but functionally related to the use of a device - addressing those issues is what creates products that defy expectation.

It’s one reason that I’m such an advocate of engineers having ethnographic experience in user sites. Understanding the technical details of what you’re designing to is one thing; but understanding physical environments, workflows, structures, and attitudes are priceless. Processing these connections in one setting can help us translate dissimilar experiences into useful inputs, can help us come up with good questions to ask when we’re designing something new. Even just being able to touch something, rather than hear about it, gives us a whole new dimension on what it is we’re designing. Watching a patient being transported into the ICU on an Army base in India has helped me translate the mechanical requirements to keep Foley catheters in place for patients in Belgium. Even if that observation didn’t take place in the “real world.”

live the questions now

“I beg you, to have patience, with everything unresolved in your heart and try to love the questions themselves as if they were locked rooms or books written in a very foreign language. Don’t search for the answers, which could not be given to you now, because you would not be able to live them. And the point is, to live everything. Live the questions now. Perhaps then, someday far in the future, you will gradually, without even realizing it, live your way into the answer.”  - Rainer Maria Rilke
Twelve stressful (but fun!) weeks later, life has demanded that today I ask the right questions and try and live my way into the right answer. It’s the hardest design challenge I’ve been faced with yet.

have a come-to-jesus talk with yourself

I’ve written a lot of posts about self-awareness lately. Every blog with advice on blogging says you have to have a focus when blogging. I’m going to be honest with myself – when I started blogging, I thought I would be writing about design, user interaction, and the developing world. And I’ve done that only halfheartedly. But the reason I write is to create conversations with people. And the conversations in my head lately are about self-awareness.


(image courtesy of… )

Blogging is about honesty. Design is about honesty.

I write about how people interact with objects, situations, each other, and themselves. Being able to view those interactions objectively – watching the gap between the encounter and the action of its response – is what makes a great designer great. Those honest truths that you uncover will lead you to great designs. The hardest interactions to understand, though, are the ones that you have with yourself. 

It’s hard to be honest. It’s hardest to be honest with yourself.

We see this all the time in product design. Donald Norman says that people only buy things for two reasons. Either something is useful, or it is beautiful. In marketing land, what sells a product is features. But people don’t want features. They want usability and beauty. They just don’t want to admit to themselves that usability and beauty are not found in the latest and greatest features. People are notorious for not being able to do that. Henry Ford once said, “If I had asked my customers what they wanted, I would have ended up with a faster horse.” Designers have to ask the right questions and be honest about the answers they get to be able to come up with something remarkable.
Right now, I don’t know what’s useful in my life, or what’s beautiful. In some ways, I’m at a personal and professional crossroads. It’s a good place to be, for the opportunities that it provides, but it’s a scary, uncomfortable, and brutally honest place to be, too. But that’s ok. I’m not sure what’s ahead of me, but I’m sure that it will be both beautiful and useful in my life.  To get there, I’m going to have to ask the right questions, and I’ll have to be prepared for the answers.

We’re all like that. We see beauty. We value usefulness. And yet we want the features – we want the 13 extra buttons that we’ll never use when we would have just been happy with the volume and channel controls. So ask yourself if the things you have are things that you find beautiful or useful. And if they’re not, ask yourself what they’re doing in your life. Do this with your things, your interactions, your circumstances. And do this with yourself and your personality.

Be honest with the answers you get.

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