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Save the world wasn’t in Jane Chen’s five-year plan when she landed an enviable consultant position at Monitor Group right out of college. But three years in, she read a New York Times article that changed that.
The story was about a ghastly AIDS epidemic in China. “A switch went off in my head,” the Taiwanese-descended California native said. “I could just as easily have been born there.”
Chen realized, “I had won the genetic lottery.”
She quit the job and joined a nonprofit. She traveled and saw how the destitute half of the world lived. Eventually, she ended up at Stanford Business School studying “Design for Extreme Affordability,” or how to create products for people who live on less than a dollar a day.
That’s when she found out about the babies.
At the time, 20 million premature or low-weight infants entered the world every year. Most of them were born in developing countries. In the first world, a one-kilogram baby could be nursed to full health in an incubator in a hospital’s neonatal intensive care unit (NICU). However, in poor nations like India and Pakistan (the two accounted for more than a quarter of the world’s preterm births), most mothers had access to no such care. Millions of their babies didn’t make it through the first year of life.
Worst of all, the World Health Organization estimated that three-quarters of those deaths could be prevented with proper equipment.
Infant life-support tech had come a long way by the time Chen found out about the babies, in 2008. In the 1800s some physicians recommended incubating preterm infants in warm crates, but it wasn’t until after World War II that more sophisticated incubation equipment became a feature of many US hospitals. Inspired in part by chicken-egg incubators, hospitals began placing the fragile infants in clear, heated boxes, where they could be kept warm and sterile. By the 1970s most developed-world hospitals had NICUs with glass incubators. The survival rate of babies born weighing less than 1.5 kilograms shot from 40 to 80 percent. Incubators went from what looked like china cabinets to six-by-two-by-three-foot, space-age plastic pods with easy-access arm ports (for minimal heat loss when handling the infant) and built-in life support—ventilators and cardiorespiratory monitors and the like. Every iteration of the incubator was bigger and better than the last. After fifty years of improvements, NICU tech had gotten pricey. The typical incubator cost between $20,000 and $40,000. Not including electricity.
At Stanford, Chen and three colleagues, an engineer, a computer scientist, and a PhD candidate studying artificial intelligence, took up the challenge to lower that cost.
“We started making a cheaper glass box,” said Rahul Panicker, the AI guy, in an interview with the Times of India. With a little ingenuity, the team thought it could shave off some materials and electricity costs inherent to building and running a typical incubator. But components like the life-support monitors were not about to get less expensive anytime soon. Furthermore, the team realized that the typical NICU incubator required serious training to operate. The unfortunate mothers of premature babies were often illiterate. “What was needed was not just low cost but something that [the moms could use themselves],” Chen said.
“We realized something was wrong,” added Naganand Murty, the engineer, “and asked ourselves: do we need a cheaper glass box or something that will save babies’ lives?”
CHEN’S TEAM STEPPED BACK to reassess its approach. What features did the babies actually need to survive? they pondered.
The answer, they discovered, was primarily just warmth. NICUs kept premature babies nice and toasty. Sure, they kept the kids clean and sterile, too, and they kept track of heart rate and respiration and other things. But many—Chen says most—premature infant mortalities involved complications arising from simply being too cold. (Premature babies are born with too little fat, which they need to stay warm while their bodies develop outside of the mother’s womb.) The other features of the incubators made a difference in only a tiny percentage of cases, Chen says. To prevent the majority of preterm infant deaths, her team realized, they just needed to figure out how to keep a baby at a constant 98.6 degrees. And that was something you ought to be able to do for less than $20,000.
From that realization came Embrace, which Chen describes as, “a sleeping bag for babies.” It’s a tight, insulated pouch with two compartments: one for the baby and one for a hot pad that’s heated in a small box—something like a toaster.
It worked. The tight enclosure kept the baby’s own body heat from escaping. The bag’s insulation and hot pad regulated temperature at 98.6, and the pad lasted four to six hours on a 30-minute charge. The most uneducated mother in the world could figure it out, and it kept underweight babies alive and developing.
Perhaps most miraculous, however, was the cost at which they could produce each unit: $25. One thousand times less than the cost of a NICU incubator.
Chen and her colleagues moved to India. They field tested Embrace, improving it over dozens of iterations. They created a nonprofit organization to give the Embrace away for free to mothers who couldn’t afford it, and later added a for-profit arm to the company to sell the warmers inexpensively to hospitals that could.
In January 2013 Chen told me, “We’ve saved 3,000 babies so far.” By that September, Embrace reported that the number of preterm infants protected by the Embrace warmer had increased to 39,000. Embrace won design awards, grants, and venture investments. The team grew. Chen suddenly became a spokeswoman for developing-world health issues, and even first-world hospitals started calling about the warmer.
Thirty-nine thousand infants with a fighting chance of living a normal life is incredible. But Embrace’s story is just beginning. The last time I spoke with Chen, she said, “Our goal is to get these for every baby in the world.”
SOMETIMES BIGGER IS NOT better. Sometimes more of a good thing is too much. Sometimes the smartest next step is a step back.
In the case of neonatal incubators, incrementally bigger and more powerful improvements meant, at the very most, incrementally less expensive (though it was usually the opposite). The hacker’s approach to NICU design was to think smaller. In doing so, Chen’s team created something world class.
This teaches us something important about breakthrough success: simplification often makes the difference between good and amazing.
Let’s step back for a moment and talk about innovation. Over the last several years, we’ve bastardized the word. Today, we equate it with change or general improvement, a buzzword meaning “bigger” or a synonym for creative. But the word used to mean “upheaval” or “transformation.” It comes from the Latin innovare, in meaning “into” and novus meaning “new”; the word innovate in Middle English meant to “renew” or “refresh.” Innovation is about doing something differently, rather than creating something from nothing (invention) or doing the same thing better (improvement). Harvard management professor Clayton M. Christensen furthered this concept in the mid-’90s when he coined the term “disruptive innovation.” Disruptive innovation is when the introduction of a lower-cost product steals market share from existing players, like when e-mail usurped postal mail (how much would you spend a month if every e-mail cost the price of a postage stamp?) or when Craigslist replaced costly classified newspaper ads with free Internet listings.
The key feature of disruptively innovative products is cost savings (either time or money). But the key ingredient behind the scenes of every disruptive product is simplification. E-mail is not just cheaper, but simpler than postal mail. USB flash drives were not just less expensive than compact discs, but simpler to use. And cloud storage became even simpler than flash. Automobiles won out over horse-and-carriage because they made transportation simpler. The machines themselves were complicated, but Henry Ford kept the complexity under the Model T’s hood.
There are a lot of great inventors and improvers in the world. But those who hack world-class success tend to be the ones who can focus relentlessly on a tiny number of things. In other words, to soar, we need to simplify.
TECH WRITER BRIAN LAM, known to friends as Blam, was one of the first to give me a shot as a journalist. In his early career, he worked both smart and hard, parlaying from photocopying intern at Wired to editor in chief of Gizmodo, Gawker’s popular gadget blog. He took the blog from 13 million to 180 million page views per month during his five-year tenure. Blam pioneered a new style of tech blogging, consistently scooped mainstream media, and made Gawker CEO Nick Denton a lot of money.
But he also gained 30 pounds, and was, as he tells me, “an angry boss and boyfriend and pretty miserable.”
The next rung on Blam’s ladder was not a prestigious job at CNN or the New York Times, as one might expect. (He had plenty of such offers.) Instead, he moved to Hawaii to become a surf bum.
Well, not just a surf bum. He leveraged his Gizmodo cred (Frank Sinatra style!) to launch a small website called TheWirecutter, a gadget-review site that takes simplicity seriously.
If you want to know which type of wireless speakers to buy, a typical blog—or store—will show you scads of options. Brands. Versions. Specs. Upgrades. Pros and cons. Features! Benefits! STRESS!
Blam will simply tell you that Logitech’s UE Mini Boom speakers are the best.
And then he’ll go surfing. Rather than worrying about inventories and shipping and cost-of-goods-sold and all the other headaches of a typical electronics business, his website sends you to Amazon. When you buy those Mini Boom speakers there (as I recently did), TheWirecutter gets a small kickback.
With simplified costs and no full-time employees, Blam was soon working one day a week, living in paradise, and making more money than he ever did at Gizmodo.
Most important, he was a lot happier.
OFTEN, THE THING HOLDING us back from success is our inability to say no. Think back to the Olympic rings analogy. We can’t keep the momentum going if we don’t let go of the ring behind us as we swing forward. By breaking that weakness and simplifying, Blam became untethered, able to move on to better things.
In a wonderful scene in Sir Arthur Conan Doyle’s A Study in Scarlet, detective Sherlock Holmes chides his companion, Dr. Watson, for explaining to him that the earth revolves around the sun, which Holmes previously did not know.
“Now that I do know it I shall do my best to forget it,” Holmes declared to the astonished Watson, a lifelong man of science.
“But the Solar System!” protested Watson.
“What the deuce is it to me?” said Holmes. “You say that we go round the sun. If we went round the moon it would not make a pennyworth of difference to me or to my work.”
Holmes was a first-class noticer. The police leveraged him as the highest platform, if you will, in criminal profiling. His legendary powers of observation and deduction earned him the distinction of Britain’s finest criminal investigator. He got to be the best by focusing on what he needed to know, knowing how to figure out what he didn’t know, and forgetting about everything else.
Like Holmes, hackers strip the unnecessary from their lives. They zero in on what matters. Like great writers, innovators have the fortitude to cut the adverbs.
This is why Apple founder Steve Jobs’s closet was filled with dozens of identical black turtlenecks and Levi’s 501 jeans—to simplify his choices. US presidents do the same thing. “You’ll see I wear only gray or blue suits,” President Barack Obama told Michael Lewis for his October 2012 Vanity Fair cover story. “I don’t want to make decisions about what I’m eating or wearing. Because I have too many other decisions to make.”
I don’t want to make decisions about what I’m eating or wearing? How could that possibly make one better at governing? Or problem solving? And isn’t variety the very spice of life? What about creativity? Or not going crazy?
What he’s talking about has been proven in experiments led by Dr. Kathleen Vohs of the University of Minnesota, experiments that show that making lots of tiny choices depletes one’s subsequent self-control. Students who were forced to decide between products for long periods of time had significantly less willpower afterward than classmates who answered random questions instead. Vohs had batches of kids make choices, then do things they didn’t want to do, like practice homework or drink vinegar water or hold their arms in ice water. Those who hadn’t just spent time making decisions performed several times better than those who did. Apparently, patience and willpower, even creativity, are exhaustible resources. That’s why so many busy and powerful people practice mind-clearing meditation and stick to rigid daily routines: to minimize distractions and maximize good decision making.
Simplification is why Steve Jobs’s Magic Mouse doubled Apple’s mouse market share overnight. With zero buttons (the whole thing is a button, actually) and a touchscreen glass top, the mouse is both pretty and intuitive—a huge departure from the conventional “innovative” mouse arms race, which amounted to adding more bulk and more buttons. Similarly, Apple’s iPod won the MP3 player war with breakthrough simplicity, both in physical design and how the company explained it. While other companies touted “4 Gigabytes and a 0.5 Gigahertz processor!” Apple simply said, “1,000 songs in your pocket.”
Constraints like that in Jane Chen’s “Design for Extreme Affordability” challenge are often the forcing functions that lead to breakthrough innovation. No one had thought to create a radically simple incubator because no one had been tasked with making one for people who live on one dollar a day. Convention said incubators were large and cost thousands, so the expected “innovation” route would have been to find cheaper plastics or optimize the assembly to inch down costs. But constraints meant Chen’s team had to throw convention out. And they came up with something more creative than if they’d had an unlimited budget.
Here’s a fact: Creativity comes easier within constraints. For example, what if I asked you to do the following exercise:
Say something funny.
Most of us freeze at such a broad challenge. Sure, there’s a lot of “freedom” in it, but somehow it’s tough to come up with something on the spot. Now, say I put a constraint on the exercise:
Tell me a knock-knock joke.
For most of us, this one’s much easier. There’s a formula to follow. You can probably think of a few right away. And if you’re coming up with a joke from scratch, the knock-knock is going to be significantly easier.
Constraints make the haiku one of the world’s most moving poetic forms. They give us boundaries that direct our focus and allow us to be more creative. This is, coincidentally, why tiny startup companies frequently come up with breakthrough ideas. They start with so few resources that they’re forced to come up with simplifying solutions.
Constraints made New York City an architectural marvel. Manhattan Island’s narrow shape forced the city to build up, to rethink and renew; it impelled architects to reinvent stone buildings into steel skyscrapers.
Remember Tony Wagner and the Finland phenomenon from chapter 4? Finland’s education system built a higher platform—a better starting point—for its students by requiring all teachers to have master’s degrees and deep expertise in teaching how to learn. That was half of Wagner’s explanation for Finland’s rapid ascent to educational greatness. The second half had to do with what the Finns didn’t do. Over the decades, Finnish education, in fact, had gotten simpler. Instead of teaching kids a little about a lot of things—like most schools do—the Finns started teaching deeply in fewer subjects. Rather than emphasizing general knowledge students would promptly forget, they cut filler and taught vocational skills.
“Less is more” and “small is beautiful” are common aphorisms in Finland, and Finnish schools injected them into the curriculum. While every other country added more tests, more homework, and more athletics—with decreasing academic results—Finland scaled back on all of the above.
“Walk into the typical high school in America. What do you see? The first thing you see? A wall full of trophies. Are they academic trophies? Hell no. They are athletic trophies,” Wagner says. “We don’t celebrate academic achievements,” Wagner says. “We celebrate athleticism, and I think it’s sending all the wrong messages to kids.”
In Finland, on the other hand, there are no school sports teams. As sad as that may sound to those of us who grew up cheering on the football team, the lack of in-school athletics allowed Finland to focus minds and resources and sprint forward academically. Kids can play intramural sports on their own and on the weekends, but they go to school to learn.
Classes were small, yes. But more interestingly, students often had the same teachers for several years in a row, developing rapport and allowing teachers to focus heavily on individual students’ needs.
Students start learning vocations like engineering and business as soon as they hit high school. They skip many of the general education courses most of us forget. And they actually like school.
Research shows that kids who are tenaciously focused—psychologist Angela Duckworth calls them “gritty”—beat smarter kids in spelling bees. Their hard practice is targeted, simplified. This is the art of being a first-class focuser.
Geniuses and presidents strip meaningless choices from their day, so they can simplify their lives and think. Inventors and entrepreneurs ask, How could we make this product simpler? The answer transforms good to incredible.
Perhaps that’s why Steve Jobs referred to simplicity as “the ultimate sophistication.”
Holmes, on the other hand, would simply call it elementary.