Introductory Case Study

While trying to develop a low-cost syringe for the developing world context, you (the designer) hit a crossroads. Constructing the syringe to auto-disable after a single use, an important safety feature, significantly adds to the cost of the design – making it potentially unaffordable for some hospitals and clinics. However, if you don’t add the safety feature, you are enabling the potential for the spread of disease. How do you as a designer proceed?

• Step 1: Determine the facts in the situation
  • • The auto-injection feature is an important safety feature
      • Adds cost to the design
      • Product can’t be used for intended community with high cost
    • Without the safety feature of the needle, it could increase the spread of disease
    • Balance question to consider: Is the spread of disease more augmented by decreased cost by not including the feature for more financial access or including it to reduce the risk of spreading?
    • The product must be manufactured properly so the auto-injector always works and it reduces or eliminates the risk of death
• Step 2: Define the Stakeholders
  • • Primary: hospitals & clinics, patients, regulatory body,  manufacturers
    • Secondary: Distributors,  insurance company
• Step 3: Assess the motivations of the Stakeholders
  • • Hospitals & Clinics: patient safety, drug administration time, easy disposal
    • Patients: easy to use, low cost, and accessible
    • Regulatory Body: No violations in safety or ethics
    • Manufacturers: to make a profit, innovation, company reputation
    • Distributors: to make a profit
    • Insurance Companies: to make a profit
• Step 4: Formulate (at least three) alternative solutions
• • • Assess if oral administration is a viable option
      • Ethical principal
        • Nonmaleficence
      • Pros:
        • Easily administrable
      • Cons:
        • Not really solving the problem of needle
    • Have both auto-disable and not disabled
      • Ethical principal
        • Autonomy, beneficence
      • Pros:
        •  Having both options available for the consumer to use
      • Cons:
        • May be difficult to use for the consumer
    • Create a reusable device with replaceable syringes and needles
      • Ethical principal
        • Autonomy
      • Pros:
        •  Environmentally friendly
      • Cons:
        • This can be an issue in terms of disease
        • Difficult to enhance clean protocol by replacing the needles each time

• Step 5: Seek additional assistance, as appropriate
  • Organizations that can contacted; Formulate a proposition that includes the organization(s)’ mission and ties it to more effective health care and/or preventing the spread of disease
  • Seeking grants from different foundations, NGOs, and INGOs.
  • Seeking governmental help
  • Seeking advice or literature from similar ventures in similar settings
• Step 6: Select the best course of action
  • Find the cheapest, safest, and most durable materials to construct a prototype
  • Create a new design for the auto-injector to replace the auto-disable and the medicine inside
    • Adjust size, shape, and needle disposal technique
  • First, auto-disabled needles come with UV light to sterilize the needle
  • Priority is finding funding to make the auto-retracting syringes financially accessible
• Step 7: (If applicable) What are the implications of your solution on the venture
  • If orally taken, might not be a one-time pill. Instead, taking it for a series of days could be a solution. That would cause a non-adherence to taking the pills on time. Can also cause problems with the stomach and digestion
  • Investors/funders could have mandatory manufacturers or designers to go through as requirements for partnership/sponsorship

1. Identify the 10 toughest questions from the 14-page list, and answer them in advance of your presentations.
   1. How prevalent/significant is this issue? Can you provide specific and relevant statistics?
      1. This issue is very prevalent, we can see that the HC distribution is not even in urban or rural areas whatsoever. There is a 2:10,000 provider-to-population ratio, only 185 doctors in the entire country with 8.5 million people living in Sierra Leone.
   2. Is this issue relevant outside of the specific geography you are working in?
      1. Yes, because even in rural areas of the US for example, there is an inadequate amount of healthcare workers in relation to the population. A lot of HC workers want to work in urban areas, leaving the rural areas empty.
   3. How do these numbers compare against the US?
      1. In the US it is 295 physicians per 100,000 population.
   4. What SPECIFIC issue are you trying to tackle?
      1. Education in HCW in SL, also the overall efficiency of a PHU in SL. Doesn’t have to be specific to SL, can also be broadly as a healthcare work environment.
   5. How exactly are you tackling this issue? Can you show me how it works step by step?
      1. We are developing Alexa skills in the developer console and going to demo it in the country. We are developing use cases, some examples of which include a question-and-answer format or a flowchart conversion. Here is a demo of one of the skills.
   6. If I am a <primary stakeholder>, how will I experience your solution?
      1. You will use Alexa in a healthcare setting, asking her to possibly schedule patients’ appointments, send reminders to patients, log patients’ info, and ask something about insurance – all depending on what role you have in the healthcare force.
   7. What is your core innovation? What sets you apart? What is fundamentally novel about your approach/solution?
      1. Nobody else is really doing anything like this, especially in an LMIC. There is some research surrounding Alexa in high-income countries, but not in low-middle-income countries. This is still a new and emerging field so we are still setting the stage for what’s to come.
   8. Who are your primary stakeholders?
      1. HCW, patients, SL government, non-profits, local hospitals
   9. Is there a novelty factor with your product/service? What will make the customers keep coming back?
      1. The efficiency of Alexa itself is something we hope that will make customers keep coming back to our product.
   10. How accessible is your product?
       1. This is something we are working on with connectivity in the country. We discovered mifi devices that we will test during Mountaintop and plan to use in the country as well.
2. Write 3 elevator speeches about your project:
   1. For a professor/advisor
      1. We’re using Amazon’s Alexa for healthcare in Sierra Leone. The current PHUs in SL are inefficient with flowcharts scattered around the rooms. Alexa will help with this and store all of this information so that it can help the HCW in the PHU.
   2. For an interviewer for a summer internship
      1. It’s a group research project that focuses on using Amazon’s Alexa in a healthcare setting in Sierra Leone. We are researching different use cases that would be helpful for an HCW in SL, and later we are going to demo this during fieldwork.
   3. For a roommate asking about your project
      1. Think of it like using Alexa but for healthcare, so in an office, you would be able to say, “Hey set up patients x’s follow-up appointment”. Or a patient could also use it and help them with reminders for medicine and things like that. The only difference is we are trying to implement this in Sierra Leone for the healthcare workers there since a lot of how the peripheral health units are run is inefficient and can be made easier with the help of Alexa.

1. Refine the income statement for your venture
   1. https://docs.google.com/spreadsheets/d/1CQKaeNLd6JmXY_YQxo1gLHRVsTL6Nbyb82a9VzAMry8/edit?usp=sharing
2. Refine the capital expenditure budget
   1. same spreadsheet as above.
3. Identify two SPECIFIC funding sources for the design phase of your project and two SPECIFIC funding sources for the dissemination (implementation / distribution / commercialization) phase of your project. For each funding source, explain why this is a good fit for your project, and what SPECIFIC aspect of your project might the funding source support.
   1. Design phase and why (2)
      1. National Science Foundation (NSF) – The NSF funds research and development in a wide range of scientific and engineering fields, including healthcare technology. The Alexa project could fall under their Smart Health and Wellbeing program, which supports the development of intelligent systems that can improve health and wellness outcomes. The NSF could support the design and development of the Alexa healthcare application by providing funding for research, hardware and software development, and testing.
      2. National Institutes of Health (NIH) – The NIH provides funding for research and development in a variety of healthcare-related fields. The Alexa healthcare application could be funded by the National Institute of Biomedical Imaging and Bioengineering (NIBIB) or the National Library of Medicine (NLM). NIBIB funds the development of biomedical imaging and bioengineering technologies that improve human health, while NLM supports the development of information services that can improve healthcare delivery. The NIH could provide funding for the design and development of the Alexa healthcare application, as well as testing and validation of the system.
   2. Dissemination and why (2)
      1. National Institute of Standards and Technology (NIST) – The NIST is a federal agency that develops and promotes standards, measurement, and technology to enhance economic security and quality of life in the United States. The Alexa healthcare application could be funded by the NIST to support the development and implementation of standards and guidelines for the use of voice assistants in healthcare settings. The NIST could provide funding for research on the security and privacy implications of the technology, as well as for the development of guidelines for data management and interoperability with other healthcare technologies
      2. VentureWell (maybe: Ascend Medtech Accelerator, powered by VentureWell and LEAP) – “The Ascend Medtech Accelerator, powered by VentureWell and LEAP, is a 12-week intensive program that prepares startups for the partnerships and investment necessary to launch their venture. Entrepreneurs-in-residence work closely with startups to prepare their business models for due diligence.” This program is mainly run online (aside from three days in the very beginning and the last day) during the summer. The program scheduling fits well with Mountaintop. (https://venturewell.org/ascend-leap/)
      3. NSF Program on Fairness in Artificial Intelligence in Collaboration with Amazon (https://new.nsf.gov/funding/opportunities/nsf-program-fairness-artificial-intelligence):

1. Identify five specific partnerships that you need to forge to advance your project forward with the ultimate goal of positively impacting at least one million people. Describe exactly how that partnership might help you achieve scale and why that entity might be willing to work with you.
   1. Sierra Leone Government
      1. The government of Sierra Leone could be a valuable partner for an Amazon Alexa project as they could help provide support, resources, and funding for the initiative. The government’s involvement can also help increase the project’s visibility, build trust with the local communities, and provide access to critical data and insights.
   2. Amazon
      1. Could provide access to resources such as software development kits, marketing and promotion, and support services for scaling the Alexa healthcare application. Amazon may be willing to work with a project team to advance the use of Alexa in healthcare settings as it aligns with their mission to improve people’s lives through technology.
   3. Lehigh Valley Health Network
      1. Help us understand the physician or healthcare worker perspective of technology coming into this space. Access to patients and credibility and trust will help us gain more knowledge when developing different use cases.
   4. Red Cross (or other non-profits)
      1. Could help the project team connect with patients and caregivers who are most in need of the Alexa healthcare application. Nonprofit organizations may be willing to partner with a project team if the Alexa healthcare application aligns with their mission to improve the health and wellbeing of their constituents.
   5. St. Luke’s
      1. Partnering with healthcare providers such as hospitals, clinics, and physician groups could provide access to a large patient population and help the project team understand the needs and preferences of healthcare providers and patients. Healthcare providers may be willing to partner with a project team if the Alexa healthcare application can help improve patient outcomes and reduce healthcare costs.

https://docs.google.com/spreadsheets/d/1CQKaeNLd6JmXY_YQxo1gLHRVsTL6Nbyb82a9VzAMry8/edit?usp=sharing

https://docs.google.com/presentation/d/1bO3N4Jp3Pl8bqybxRqtIjpnaJRdqCpTTii1TmSUvnnI/edit?usp=sharing

1. From the social enterprises we reviewed today, or others you have studied, identify ten extremely specific strategies that you can leverage for your project. The strategies can be about the technology, the business model, access to capital, customer education, messaging, thought leadership, etc.

1. Educating HCW about the devices
2. Using WhatsApp to communicate with people in SL
3. Apply for grants or proposals to supply our project
4. Go through Khanjan for specific resources and interviews
5. More research about Sierra Leone HC
6. More research about Alexa devices in HC
7. Start planning field work goals before the summer
8. Creating a manual for Alexa devices for our targeted audience
9. Conduct interviews to gain a more personal perspective of Sierra Leone HC
10. Already done use cases that we can model after (either conceptually or literally with the algorithm itself)

2. Create a first draft of your business model using the business model canvas. Please be as specific as possible and explain why you picked those specific approaches for each of the building blocks.

• Key partners
  • Local nurses/doctors
  • World Hope Organization
• Key activities
  • What are we doing?
  • Provide standard treatment protocols
  • Answers to questions
  • Active feedback to nurses/CHW
• Key resources
  • Interviews
  • Flowchart of Diseases
• Key propositions
  • Reduce patients waiting times
  • Reduce human error
  • Reduce workload
  • Increases their confidence
  • Reduces likelihood of misdiagnosis
• Customer relationships
  • Feedback form a few times a year
    • Customer service
• Channels
  • Word of mouth
  • Maybe the government?
• Customer segments
  • Local community health workers
  • Nurses
  • doctors
• Cost structure
  • Converters
  • Internet!
  • Alexas themselves
• Revenue streams
  • Grants as main source of funding
  • Maybe sierra leone gov but likely not
  • Publish skill on Alexa skill store and make profit off of it

3. Create a set of 2-4 slides to articulate your business model in a presentation. Come prepared to describe your business model in the next class.

https://docs.google.com/presentation/d/1i2E1w3rmRACY46O3oIugfuxS8xwUq1BXtNrIUFvniSo/edit?usp=sharing

https://docs.google.com/presentation/d/100Fb8Z72tNdBR5cVJs6lB4ndam_JA-GL/edit?usp=share_link&ouid=117882849317142044351&rtpof=true&sd=true

1. What are the common personal goals within the members of your team, and how can you leverage those goals to build collaboration?
   • Some common personal goals within members of my team include gaining more research experience for future career choices and seeing how interdisciplinary work can be done. These goals will help build collaboration as having the common goal of wanting more research experience will allow us to collaborate with this similar interest. Future potential career paths may be discussed and can be further explored as a topic in relation to the project. This will again hopefully lead to building more collaboration. Interdisciplinary work is inherently collaborative since you have to combine a lot of different fields to create the niche topic that you are studying. Due to this, our team will have to build upon our collaboration as many of our members have strengths in different fields, and sharing this knowledge is very important for interdisciplinary work.
2. What are the common project goals within the members of your team, and how can you leverage those goals to make progress?
   • As stated above, common goals include gaining more research experience for future career choices and seeing how interdisciplinary work can be done. These goals can be leveraged to make progress within our project as gaining research experience can only be done by doing the research itself. Therefore, in order to make this progress the research has to be ongoing by team members. Interdisciplinary work cannot happen with just one person. Since it involves more than one field, and hence, more than one person, creating progress with this goal looks like sharing strengths from each person’s knowledge of that field and seeing where specific progress within our project can be made.
3. What are some biases that might become a barrier to your project goals?
   • The false consensus effect and bangwaggon effect can both be biases that might become a barrier in our project goals. The bandwaggon effect, which is when one wants to “fit in” with the group, may happen but can be overcome by becoming more comfortable with the group in order to create open and honest communication. This is similar to the false consensus effect, as one can assume that others may have a similar idea to them, when they do not. Again, with trust and communication we may try to overcome this potential barrier in our project goals. Functional fixedness is a bias that could be a barrier in our project goals. Function fixedness is ” the tendency to see something or someone as possessing a very particular, fixed role”. This may happen when we split people into specific sub groups of tech and non-tech, which may force team members to view themselves as only within that specific role.
4. What type of decision-making system will you use and why?
   • When it comes to decision-making systems, we have different strategies for different areas. For instance, when it comes to deciding on a time to meet, it is almost always likely that at least one person’s availability does not match everyone else’s in such a large group. However, we do a majority rules decision-making style on this, as the one person can read over the meeting notes, and everyone else can still make it to the meeting. When it comes to decisions involving the project specifically, such as developing different uses of Alexa in the healthcare sphere, we typically use a unanimous decision-making system as everybody should be on board with what we are planning to do in terms of progress for the project.

1. Identify FIVE specific things in your slides that you could have done differently.
   • More Research about where AI has been used elsewhere. Where has it worked before?
   • Added a separate challenges slide as opposed to incorporating it in the progressive challenge.
   • Finding more specific statistics regarding urban vs rural distribution.
   • Adding a slide about use cases and the progress we have made.
   • Maybe add a potential slide about future possibilities for AISHA.
2. Identify FIVE specific ways in which you could have delivered your presentation better.
   
   • Speak slower
   • Project voice more
   • Be more conversational
   • Condense answers; Only need to talk about the main points
   • Speak with passion!
3. Identify FIVE specific ways you could have built your credibility further.
   
   • Be more confident
   • Engaging the audience
   • A stronger opening that set the stage for a strong presentation
   • Drawing deeper conclusions from the statistics
   • Showing specific challenges or use cases to show progress
4. Identify FIVE specific questions that you could have answered better. What was the question, how did you respond, and how should you have responded?
   • Question on whether AISHA is static. This was answered by saying how as of right now it might be static and that we’re looking into making it more dynamic. However, it could have been answered by saying that AISHA is a dynamic tool that will be used for learning by the collaboration with the Maternal Health team that gave us a list of questions that are asked by patients. This can be used as a learning tool for the patients
   • Question on the distribution of healthcare workers in urban vs rural. Responded by saying that rural distribution is clearly worse. This should not have even been a question, to begin with since it should have been clearly answered in the slides. We will work better to do this next time. Maybe work on getting clearer statistics on the actual number in rural vs urban.
   • Question on who we are working with. Responding with world hope international and how they will serve to connect us to the local community. The answer was okay but could have answered a little more precisely.
   • Question on what issues besides malaria is seen regularly. Answer about how the system works to becoming a doctor, and how a PHU works with helping sickness. The answer was a bit long, and we should try to be more concise and ready to produce kinds of diseases and corresponding treatments.
   • Question about connectivity and internet. The answer was about radio networks, solar batteries, and more. The answer was good but could have been kept a bit more concise by saying that we will look into this further. Also, this did not even need to be a question as it could have been easily added in a slide.

1. Identify three different primary stakeholders on your project, and come up with a list of 10 distinct questions you would ask each of them. Remember the aspirational / emotional /functional categories of needs and desires and try to find a balance of questions that might give you information in each of those areas.

• Community health workers
  • What current issues in healthcare are you facing right now?
  • What would your solution be?
  • What are some things in the current healthcare system that you think work nicely?
  • How do you feel when you are working (emotionally/mindset)?
  • How does it feel when a patient comes in?
  • Are there times when you feel as if one person is not enough to handle the demand for healthcare? If so, can you explain?
  • Can you explain what a typical day looks like in this health unit?
  • Why did you choose to work in this field?
  • Are you happy working in this field?
  • If you could change anything about how this field runs/works what would it be?
• SL government
  • What resources are you allocating toward healthcare right now?
  • Do you think that what is being done right now is enough?
  • What sorts of improvements should be made to the healthcare system?
  • What suggestions would you give for better healthcare quality?
  • How does it feel to have the ability to make such an impact on people’s lives in this way?
  • Are you happy working in this field?
  • If you could change anything about how this field runs/works what would it be?
  • Are you open to new technologies?
  • Can you explain ways that you collaborate with other sectors?
  • Can you explain ways that you measure long-term effects?
• Patients
  • What does it look like when you seek healthcare?
  • Do you have concerns about the quality of care you receive?
  • Do you think the current system is reliable?
  • How do you feel when obtaining healthcare in this system?
  • Are you getting personalized care?
  • Where do you think there is room for improvement in this healthcare system?
  • How do you feel about introducing new technologies to this space?
  • Do you think what is available now is good enough, or is there room to improve?
  •  How do you feel when going to seek healthcare (emotions/feelings)?
  • Does the current healthcare system cause extra stress or strain on your everyday life?

2. Identify all of the key customers for your product/service/creation/solution. List specific ways that you will ensure that your product will meet their aspirational, emotional, and functional needs and desires.

Our key customers for this product will be community health workers in Makeni, Sierra Leone. Additionally, a customer can also be a patient since they will technically be on the receiving end of this product. Functional needs will be fulfilled by helping in following the standard protocol when diagnosing a disease. Aspirational needs may be fulfilled when Alexa helps a worker, the worker may feel more empowered to make a change in this field. Lastly, emotional needs can be fulfilled when this product helps a worker and can alleviate the stress and burden being put on them.

3. Articulate your value propositions for each of your customer segments (using the format presented in class).

Our value proposition for our customer segments cannot be fully fleshed out using the format presented in class as there is no business model and with it things such as cost structure or revenue streams. However, our value proposition which is the Alexa device with the specific use cases to help in a healthcare setting will build a customer relationship with community health workers. Our key activities are researching and developing these skills. Our key partners are still in progress, but potentials for this include Amazon itself and the Sierra Leonean government.