Wednesday, July 12, 2017

There is Design Thinking. Then, there is such a thing as Single-Use Thinking! And so is Device Thinking.

By now, I hope you have heard about Design Thinking, a term, though surprisingly old, has now become popular among Designers, and those who would like to apply this way of thinking about problems and solutions to problems in all walks of life. Lacking one core owner (thankfully), the term has come to enjoy diverse interpretations. The basic idea remains the same. As a designer, you are asked to understand the problem you are trying to solve very well, however, the impetus is on spending more time thinking in solutions, or, grammatically, of solutions, to your problem.

The idea is to understand the problem, and instead of being stuck on the analytical side, you then try to prototype solutions, learn from your failures fast and move towards a better solution. There is of course, much depth and diversity associated with this concept, but I am just throwing this out here to explain how I have usurped the title of the concept to describe the way in which we ought to think about medical devices, especially the disposable ones.

The Strategy behind Single-Use Disposable Devices

Once upon a time, devices were rarely designed for single use. One of my late aunts, a Doctor herself, had a clinic in a semi-rural town in South India. I remember visiting her clinic as a child, and being fascinated by the steam autoclave in which she had one of her aides sterilize all her instruments. That was typical of that era in a developing nation, and much of it is still probably practiced where money is tough to come by. Of course, we have always had your bandages, the gauze pads and more that became disposable much early on, due in part, to the wars people were fighting, were there was need for speed and reusability was neither a priority nor an option.

Doing this type of thing, companies such as J&J, Colgate and others started seeing huge profits, from disposable products, especially in healthcare and related areas, such as personal hygiene. Thus burgeoned an industry, the medical devices industry, which, according to an NY Times Article I read today, is worth something like $148bn USD!

Single-Use Devices can lead to significantly more profits than repeatable use devices. Of course, some of you will question the ethics of this, and rightfully so. However, there are also significant advantages Single-Use Devices have over devices that require reprocessing, including:

1. Ease-of-Design,

2. The ability to be rendered in various sizes and forms to treat patients of varying age, gender, body dimensions and other factors, and,

3. Primarily, the prevention of infections and their spread.

Unless, there are serious failures of biocompatibility or failures of the sterility barrier, single-use devices are safe to use. Anyone who has heard of the debacle with the poorly reprocessed Olympus Medical Endoscopes can relate to the advantages of using a single-use system where possible.

While it is only one factor, once you find out about infections as a factor, most of you will become fans, at least in part, of single-use as well! However, do not discount reusable devices, or even the reprocessing of single-use devices performed by third parties, for repeated use, especially in developing nations where most patients cannot afford new devices. Even Implantable Cardioverter Defibrillators (ICDs) are reprocessed and implanted!

On to the thinking

So, leave alone business and revenue strategy, for the sake of patients, you'd still want to think of the various situations where you specifically design, or turn reusable devices into single-use ones. As a device engineer and/or an entrepreneur, this sort of design thinking, or solution thinking or industry-specific/strategy-specific thinking is important, regardless of what you want to call it! And with this premise laid out, let me go on to my example.

Cats, Tongue Depressors and Popsicle Sticks!

I love to adopt old cats, and they love being adopted because they are often overlooked by people at shelters. However, with that, comes illness and hospice care. I am vacillating between those two stages with one of my beloved felines, appropriately named Gi-Ve, who has picked up multiple sufferings as she ages, but is still loving exploration, play and companionship. Her illness is causing her to be unable to hold food down well, even though she chows down enthusiastically. Previously, another one of my cats Bob had a similar problem for a while. So, vets recommend you force feed cats using a high-energy gel, that comes in tubes (disposable, like the erstwhile toothpaste tube), which I have become accustomed to.

Now, because of the tube, I guess I have thus far been motivated to force feed (actually with Gi-Ve, who is a living angel, the force required is very low) the cats with toothbrushes. However, the gel never completely gets into their mouths, so I am constantly having to "sterilize" the toothbrushes with hot water, followed by vigorous rubbing, rewashing, visual inspection and so on. It is painstaking and time consuming as any cleaning process typically is. I wanted to get away from it, and last night, what I call Single-Use Thinking came to the fore. Necessity, as many have said, and as Clayton Christensen has improved upon, which I have mentioned before in this blog, remains the mother of invention.

The Mighty/Humble Tongue Depressor/Popsicle Stick

I didn't want to be a burden on the environment, and I still wanted an easy way to get the gel to the cats and not have the darned toothbrush "reprocessing" routine. Lo! I thought of the mighty, yet humble Tongue Depressor/Popsicle Sticks. These things are just genius. There are hundreds of uses for them, not the least of which is to give Doctors and Nurses the ability to look down the throats of patients, the ability of enterprising vendors to freeze flavored ice creams for (yup, disposable) consumption and so on!

In my own garden, with enough plants to approach the Law of Large Numbers, I have semi-successfully used colored popsicle sticks to differentiate and classify my plants as gymnosperms/angiosperms, succulents, vegetable garden plants, etc. So, I always keep a stash of popsicle sticks in my home lab, and I have now started the attempt of feeding the cat her gel with this. Only time and a good sample size can tell me if this is the ultimate solution for my problem.

However, it has all the promising elements - it is cheap, multiply available, ease to pre-rinse, and compostable (the wood ones are)! Once I hit upon this, I had that sigh of relief and then realized, I am doing exactly what Design Thinking wants you to do:

1. I understand the problem. The cats, especially older ones will need to be force-fed from time to time.

2. Using toothbrushes means reprocessing, or a fairly expensive disposable. Spoons are usually too large for the quick 2-5 seconds in which a cat will tolerate your efforts to pry his or her mouth open without getting homicidal (they are carnivores, with the ability to bite and kill prey!).

3. I wanted to try something quick, and there handily are my swords - the popsicle sticks!

4. The next step is to prototype, learn and see what happens and I am already underway.

Device Thinking

However, I also think this is one of the ways in which we Device Design Professionals should consider problems. Don't forget, we have other factors to consider - safety, the prevention of infections, biocompatibility, repeatable effectiveness and so on. Taken together, I would like to call this "Device Thinking".

Of course, I think Single-Use Thinking is also real, and is a branch of Device Thinking. This is a topic on which I hope to expand further on this blog. Let me know your thoughts.

A quick note - "Home Lab"

With life interests (they are not mere hobbies with the amount of energy, money and time I have invested), ranging from photography and travel to gardening and cooking, I have a wide variety of tools and equipment I need. Therefore, like many of you out there, my house is full of "junk" that gets used laterally, so to speak. Years ago, when I visited IDEO, one of the world's most famous and premier design firms, I learned of how they collect interesting tools, materials and other items to help their designers prototype solutions to very challenging design problems. So, I have always been on the right path - buying and picking up stuff I think I can somehow use for a project. Of course, they are much more organized, but I am looking to get there. I also will be posting about some of the really cool things I have collected over the years in my Home Lab, in a few posts here.

A second quick note - cats!

Just a reminder, it takes guts, leadership and motivational ability to get a cat to repeatedly open his or her mouth and be fed forcefully. And, skills as well as talent. Let no one tell you otherwise. I have sometimes thought I should put this on my resume! Giving cats a bath or two, of course, is the true sign of heroism (been there as well)!! :D

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