What is Innovation? Part 2

In this two part blog series, I’m exploring the definition of “innovation” in an effort to bring clarity to a word that has been overused and genericized.

In Part 1, innovation was defined as increasing benefits and/or reducing costs.  The blog went on to explore in detail the top half of this innovation equation.  In this part, the exploration will move to the denominator:

What is cost?

To explore (what is cost), I came to the idiom: at all costs

What are all these costs?

  • Lives lost in war?  The effort to win the war?
  • Resources to achieve a goal?  The effort to reach that goal?
  • Money spent?  The effort to earn that money?


Indeed, (at all costs) can be translated to (regardless of effort).  It is logical that cost is relative to effort which itself can be defined as energy spent on work.

We work … to make money … to buy a product.  Logical.

But I’m hung up on this notion that if our goal is to reduce cost, it is suggesting we reduce effort?  Not logical.

Lessons learned from baseball include:
“Control what you can control: attitude and effort.”

I explored attitude and effort a few weeks ago in a blog post on caring and courage.  The idea of giving less effort just didn’t sit right with me when first meditating on this part of innovation.

But if attitude and effort are two things we can control…, what is control anyway?

If we give maximum effort all the time, is that really controlling effort?  Is the foot on the gas pedal all the way down controlling the car?  Or is that car out of control?  Interesting.

What is the control of attitude and effort?

Is this to mean we have choice of attitude and effort?  What are we asking the baseball player to do here?  Choose a “good” attitude.  Choose an effort.

Choose an effort?  What effort?  Full effort?

It feels right to consider that the choice in attitude is to choose a “good” or a “bad” attitude.  Choosing a good attitude is one that promotes conditions for health.  This was defined as “caring” in part 1 of this blog.

This is making sense, but now I’m back on benefits, quality, what is good, and health.

This is an exploration of cost… of effort.

What effort are we choosing?  Is there good and bad effort?

In the book, The Goal: A Process of Ongoing Improvement;  author Eliyahu M. Goldratt takes us to the floor of a manufacturing plant and explores many concepts, including a notion that “always working” is not the most efficient way to run a business.  The concept is resisted by the characters in the book, rightfully so, as it is not intuitive.

The Goal masterfully uses the scientific method and Socratic thinking to teach lean manufacturing.  Among the many lessons learned is that (always working) is not a solution to (improve plant efficiency).

If we have a choice in effort, is the effort we put forth an effort that is well thought out?  Scientifically?  Socratically?  Thoughtfully?

Aha.  This is the old debate of “working hard” versus “working smart.”

Cost.  Effort.  Work.

The relationships of these make sense.  However, even after reading The Goal, the notion of minimizing effort is still not sitting right.

I need to zoom back out to the big picture: innovation

There’s an example I’ve used in class for years about a swimmer at the beach.  The undertow is bad and they’ve drifted far off shore and suddenly realize they need to get back.  This can be a scary situation.

As the lesson goes, I ask the students, “what is smarter, putting your head down and swimming towards shore as vigorously as possible, only coming up for air when you need it?  OR, slowing down, thinking, and looking at the waves?”

Swim in with the waves.  Rest between waves.  Swim smart.

Work hard with the waves.  Take breaks.  Observe.  Be thoughtful about your return to shore…  your return to conditions favorable for health.


It’s not to minimize effort…, but to maximize effort.  Using ALL of your effort can be wasteful, if some of your effort is used without the waves.

Work Hard AND Work Smart (with the waves).

So, what is innovation?

Innovation is increasing benefits over reducing cost.  This is value based care.

Innovation is improving conditions favorable for health and maximizing effort.  It is working towards (what is good) through (hard AND smart work).

Innovation is to be caring and thoughtful.

Would love to hear your feedback on this exploration of innovation.

Health and Happiness for All


What is Innovation? Part 1

For the past twelve years, my academic scholarship has been primarily focused on teaching a process of innovation.  This is an area of great interest and philosophical debate.  As a process, innovation can be described in stages of product design starting with an initial investigation, then a definition phase, brainstorming phase, and so on, until a final execution phase.  In various courses, I’ve broken down these stages into 3, 4 or 5 steps, and used catchy terms like Stanford Biodesign’s “Identify, Invent, Implement” process.

From a process perspective, whether it’s (identify, invent, implement) or current favorite (discover, describe, develop, deliver): the basis of this “innovation” process is not a secret.

That being said, the term “innovation” itself has been overused and become so generic, its meaning has been lost.  I wish to find it.  The following two blog post series is an exploration of this word “innovation” in search for a useful definition, for clarity, and for enlightenment.

What is Innovation?

My favorite definition to date comes from Scott Burleson, friend and innovation expert at The AIM Institute.  Scott describes innovation as, “an improvement in value” and then further defines value as benefits over cost.

(innovation) = (value increase) = (benefits) / (costs)

To explore this topic further, I’m going to dive deep into the definitions of each of these words proposed by Scott.  In part 1, the focus is on “benefits.”

What is benefits?

The root of the word benefit comes from the Latin bene facere  which translates to ‘do good (to).’

The book Zen and the Art of Motorcycle Maintenance by Robert M. Pirsig explores the concept of “good” in great detail by examining the word “quality.”  In this fantastic journey of quality, Pirsig makes a case that it is intrinsic, existing in both the romantic and classical thought processes.  Indeed, the book explores quality as The Buddha, as Tao, and as what is good.

Quality as what is good feels like common sense to a professor who has to assign grades by (quality of work) or (what is good work).  And the notion proposed by Pirsig that it exists in both romantic and classical thought processes is key to the topic of assigning grades to students in the arts as well as the sciences.  This can further be extended to commercial innovation in the sense of both psychology and economics; often considered two unique domains.  Tying together emotional and rational purchase decisions can be explored further in its own right.

Benefits. Quality. What is Good.

What is good?

What is good work in an engineering class versus what is good work in a poetry class may seem subjective.  What is good flavor to one person might not be good flavor to another person.  The notion that “good” is subjective is a complicated road to go down, because it suggests that good is whatever you like it to be.  If that were the case, how then can grades be assigned by any other means than a subjective measure of good???

What if we define “good” another way?

I’m biased towards the areas of “Health Innovation, Education, and Art” as called out in the description of DiMeo (dot) info.

So, I’m going to propose a definition of “good” as:
conditions favorable for health

What are conditions favorable for health?

For this, I’ll draw from Maslow’s hierarchy of needs and consider our most basic needs such as air, water, food, and shelter.

It is a natural instinct to seek conditions favorable for health for all living things.  From bacteria, which “like” conditions such as warmth and moisture, to a stray cat that might like to be under a parked car with a warm engine and safe from the falling rain.  These would be “good” conditions for bacteria or a cat (not that I’m comparing the two).

So far I’m building a hypothesis that:

(benefits) = (what is good) = (conditions favorable for health)

Looking back to Scott’s original definition of innovation as benefits over costs, then a new proposed definition might look like this:

(innovation) = (value increase) = (conditions favorable for health) / (costs)

Indeed, this is the thought process at the root of our nation’s focus on value-based care as defined by CMS.  This topic is explored in detail by organizations such as Deloitte and Optum.

If this formula is correct, then it is not enough just to have conditions favorable for health, but rather, to promote such conditions.  After all, if innovation is indeed a process; a process is active, not static.

Innovation is a process of improving health and reducing costs.

What is a process of improving health?

Caring.  To Care.

But this is just the top half of the equation.

Today the focus was on benefits and related that to quality, what is good, conditions for health, and ultimately the act of caring.

In part 2, I’ll begin to explore the bottom half of the equation: costs.

Your thoughts on the topic are encouraged in the discussion below.

Health & Happiness for All


Where do you go in Downtown Raleigh?

I guess it started when I moved from the burbs to Cameron Village in 2014.  What seemed like a confusing journey to find parking turned into a walk or bicycle ride, enjoying all that Raleigh had to offer from live music to breweries, from restaurants to art.

For me, this was like coming home.  I grew up in Rutherford, NJ with a view of NYC, a short bus ride away…, and walking to the butcher, baker, and (not the candle stick maker), post office.  As a kid, I rode my bicycle all over town, walked to the train station to go to High School at Saint Peter’s Prep in Jersey City, and took the Path Train from Hoboken into the city, making my way up to Flushing Meadows to go see the Mets at Shea Stadium.

A few years ago, I moved with soon to be wife and Gus to the South Park neighborhood in Raleigh.  Whether it is friends or family coming from out of town for a party or a visit, colleagues coming to the convention center for a conference, or meeting strangers (more like friends I don’t know), like Kelly & Dale over beers at Trophy Maywood…, I’m hearing a lot of this:

“Where do you go in Downtown Raleigh?”

It just happened again on Wednesday evening at Lynwood Brewing Concern where I met up with a couple of old business partners to shoot the breeze, or, as we’re calling it, “Beer Summit.”

What are your favorite restaurants in Downtown Raleigh?  Where do you like to catch some live music, drink a beer, or buy a loaf of bread?  Where do you go for comedy acts, art displays, and late night cocktails?

If you want to see some of my favorites, check out the map and page dedicated to this topic here.

But I want to hear from you.  Why?  Well, for one, Kelly and Dale asked if they could leave comments…, and so, I promised them I’d write this post.

Health & Happiness for All

Can Caring Build Courage?

A few years ago I was going through a particularly stressful time.  It must have showed, because during class, one of my students rose her hand and asked a question: “Dr. DiMeo, do you know how stress can save your life?”

Minutes later; the whole class was watching a TED Talk she shared with me, as an answer to her own (rhetorical) question:
How to make stress your friend by Kelly McGonigal

If you have 15 minutes, take it to watch Kelly get down to the science of how attitude towards stress is a life or death decision.  This attitude can capitalize on a natural biological response that encourages us to be more caring and to face challenges with courage.

Spring training is underway…  and with baseball on the mind, I’m recalling this morning a couple of coaching mantras:

  • Control what you can control
  • There’s two things you can control: Attitude and Effort
  • Look forward…, it’s about the next play

Maybe you hit a home run, extended your lead, relaxed and took the foot off the pedal…, only to find yourself falling behind later in the game.

Maybe you struck out, got frustrated, and made an error the next inning in the field.

These mantras in baseball are about not letting the past, whether good or bad experiences, impact the future.  We can’t control the past.  We also can’t control the future.  But what we can control is our attitude and effort, which could impact our next play…, impact the future.

Attitude Impacts Outcome

What might be intuitive to the mental game of baseball is what led to this morning’s aha moment.

I saw Kelly’s talk years ago…, and I believe it.  Our attitude towards stress has health, caring and courageous implications.

The aha moment  is the part where “Attitude” is one of those things we CAN control.  That, combined with the other thing we can control, “Effort” – gives us tools to choose, proactively, making our world a healthier and happier place for all.

Control what you can: Attitude and Effort

A student in a class choosing an attitude that stress is a healthy human response, took the effort to help another person.  She certainly changed my life forever.

Choosing an attitude that is positive…
Making efforts that are helpful…
…have a physiological effect on our body that is healthy, makes us more empathetic, more caring, and more courageous to meet life’s daily challenges, whether in baseball or in business; in school or social settings; and with family, friends, neighbors, and strangers.

Health & Happiness for All

Medical Innovation: Collaboration is Key

Today I gave a talk at the NC State Engineers’ Council Lecture Series.  With that, I’m going to take a break from the “Case Studies of Why” posts and, instead, blog the presentation (including the slides).

Medical Innovation: Collaboration is Key

Have you noticed these cell towers that are wrapped with what looks like an artificial Christmas tree?  For me, these towers symbolize a symptom of our society for Product Development in Silos.  Marketing defines the specifications and budget.  Engineers develop the tower.   After that, Designers add the branches (aka racing stripes).  Maybe after this, we start to study the environmental impact.

Why aren’t we all working together from the beginning to make an environmentally friendly, inherently beautiful, functional, and affordable cell tower???

What I can say is this.  In telecommunications, it might not be pretty, but it works.  In the Medical Device industry, adding the racing stripes after the fact may be the reason why your amazing technology never made it to the patients that need it.

Medical innovators simply cannot afford to work in silos if our intention is to improve health outcomes.

I’m an engineering professor speaking to engineering students…, so, let’s get to the basics.

I like to think of Engineering Education as an Oreo Cookie with Milk.

The bottom cookie is Science…, the foundation of the cookie.  The filling is Engineering.  I personally like double stuffed.  For all of the engineers, you know that in the last year of school, we all take a capstone class called, “Senior Design.”  So, the top cookie is Design.

Science as the foundation for Engineering and capped off with Design.

There’s this other thing we do in school though.  It’s these general education requirements.  I like to call them, the liberal arts.  This, to me, is the Milk.  The Oreo Cookie is so much better when paired with milk, as is the Science, Engineering, and Design when paired with the liberal arts.

Please note that I’m using this term “liberally” and putting everything from business to social sciences to education to economics in the liberal arts bucket.  They are fields of study of their own…, as is Science and Design…, and are the filling of those majors.

So what is this Engineering Education all about anyway?  I’m going to say to get the depth you need in engineering (that’s why I like the double stuffed Oreo) and an appreciation and working knowledge of Science, Design, and the liberal arts.

  • But are we getting this working knowledge?
  • Are we getting the appreciation?
  • Are we poised to collaborate when we graduate?

To stress this point, I’m going to ask you some questions:

  • What are the differences of Science, Engineering, and Design?
  • Where might they overlap?
  • How do you define Science?
  • How do you define Engineering?
  • How do you define Design?

If you’re reading this blog right now, I’d ask that you maybe take a minute before reading on, and think about these topics and explore the concepts on your own for a few minutes.


The law of conservation of matter

Sure, this was a law…, and why the word, “law”?

What is it about laws?
They set order.  They are geographically specific.  They are defined by humans.  They change over time.

And then a fella by the name of Einstein comes along, and writes a new law.

The law of conservation of matter and energy

The scientific method is a thought process to search for ways to describe nature…  But the laws we humans write to describe nature, are not universal truths.  They are laws that change in time and space.


I’m going to define this as the practical application of what we’ve learned from science.

Let’s talk about Gravitational Potential Energy.

We have one formula that works great for dropping my coffee mug off the counter.

This formula might not work so great for getting a satellite launched into space.

The formulas are location specific (just like laws)…

And when we get to some places, like black holes, our understanding of gravity may break down.

My favorite question for students is, “What is light?”

They’ll respond:

  • “It’s energy”
  • “It’s a particle”
  • “It’s a wave”

I’ll respond by saying…, I think the answer is:

  • “I don’t know”

I don’t know what light is.  Scientists have discovered that it can be described as a particle.  They call that Particle Theory.  It can be described as a wave… Wave Theory.

These behaviors of light have practical applications, that the engineering mindset can then use… to read at night and put slides on a screen.

What this may look like in industry for an engineer developing medical devices is the MD&M Expo where they go and collaborate with executives, manufacturing and operations personnel looking for suppliers, new technologies and inspiration.

So what about Design?

Design is not adding racing stripes to a car or wrapping a cell tower in fake tree branches…

In fact, it’s a buzz word these days…
“Design Thinking” … “Human Centered Design”

What is it?

My definition:  It’s about putting humans at the center of an experience.

Let’s just say that the experience is: “Drinking Coffee on the Go”

What is the ultimate experience for drinking coffee on the go?

Well…, we need to go talk to people who drink coffee on the go and ask them.

Let’s just say that after interviewing 30 people who drink coffee on the go, we determine that they would like:

  • The first sip of coffee after pouring it into a mug, to be the exact perfect drinking temperature… not scalding hot.
  • To start drinking it right away and not wait for it to cool off.
  • To hold it in any orientation, throw it in their courier bag, and it won’t spill.
  • Enough coffee to last 4 hours.
  • The last sip of coffee, 4 hours later, to be the exact perfect drinking temperature… not too cold.

Sure, the way the coffee mug looks and feels is important, and a well known aspect of Design…, but, the human centered research to understand the needs of the product are critical to the development process.  Oh, and side note, thanks to the science behind phase change materials, engineering, design, and business, a coffee mug like this was developed from the work of researchers at the University of Missouri.

This type of mindset is what gives startup companies like Axonics the ability to raise $20Million and compete head to head for a market dominated by Medtronic.

Why Medical Innovation? 

The health care economy is the fastest growing sector in the united states with employment expected to grow 21% by 2024.

Collaboration is Key

In January of 2018, the National Academy of Engineering (NAE) announced Paul Yock, MD, professor of medicine and biology at Stanford would receive the 2018 Gordon Prize for Innovation in Engineering and Technology Education.

This is a big deal for the NAE to give such a prestigious award to a medical doctor…, and a well deserved award that should have all of us sit back and take note.

In the press release for the announcement, Paul Yock said, “To create meaningful new health technologies, innovators need to understand everything from biology and medical care delivery to engineering and health care economics. No one individual can cover that waterfront; you need a team to be effective.

That waterfront that Yock refers to is massive and includes professional areas that are key to medical device product development including regulatory pathways to approval and reimbursement.

Current trends in the field take this collaborative approach from the smart thing to mission critical.  Most notably, the affordable care act has shifted the highest hurdle to commercialization from the regulatory burden to reimbursement.  This is due to the focus on improved health outcomes, reduced cost of care, and a visible change to the clinical experience.

click to see full size image

This is a shift from a fee for service model to quality of care.  The health economic impacts affect the entire product development process.

Indeed, just yesterday, a guest speaker from industry said to my students that his engineers will be surprised and say, “I don’t understand how reimbursement just killed my project.

The Takeaway

In today’s medical innovation ecosystem, we need to be thinking collaboration up front.  Industrial Designers, Engineers, and Business minds need to be working together at the front lines of patient care, working directly with the stakeholders including patients, payers, and providers.

Adding racing stripes and wrapping your medical device with artificial branches simply won’t make the cut.

As always, these blogs are meant to spark conversation and debate for all of us to learn from each other.  I hope to learn from you in the comments below and the discussions that follow.

Health & Happiness for All


Why? A Federal Funding for Research Case

Been exploring “What Matters” and “Starting with Why” over the last few weeks on this blog and thought it would be interesting to do some case studies on topics that are of particular interest to innovators.  Things like:

  • Why Federal Funding for Research?
  • Why Patent Law?
  • Why Quality Systems and Regulations?

Federal Funding.  Why?

As an academic and entrepreneur, it’s my opinion that federal funding for research is looked at as a zero-sum game.  There’s this finite pot of money, shrinking, that has a growing number of researchers competing for dollars.  Maybe that’s more like a negative-sum game.

What if we could raise all ships?  What if we could grow the pot of money?

Here’s another question:
Why research for the sake of research?

There’s no question that basic science research, especially that happening in academia, should not be biased by external commercial pressures.

But why does federal funding for research exist at all?
Is it for promotion and tenure?  Is it for keeping our technology company doors open with an SBIR grant?

Why would any government, anywhere in the world, take it’s tax payers dollars and grant them to support basic science research?

My opinion…, why, is for the return on investment.

And what is that return?
I’m thinking: the health and wellbeing of our citizens and to improve the economy of our nation.

Interestingly enough, the NSF and the NIH both have programs to promote innovation:

The NSF I-Corps program prepares scientists and engineers to extend their focus beyond the university laboratory, and accelerates the economic and societal benefits of NSF-funded, basic-research projects that are ready to move toward commercialization.

The NIH C3i Program is designed to provide medical device innovators with the specialized business frameworks and essential tools for successful translation of biomedical technologies from the lab to the market.

Why do they have these programs?

Imagine an NIH Program Officer making a case to our federal government to keep the program funded.  What is the case they are making?

The Mission and Goals of the NIH include:

  • enhance health, lengthen life, and reduce illness
  • enhance the Nation’s economic well-being
  • ensure a continued high return on the public investment in research

So…, is the case they are making to point to examples that show the investment made in a grant returned enhanced health and improved economy for our nation?  I’m thinking so.

How hard do they have to look to find these examples?

While research for the sake of research protects scientists from biasing their work based on commercial pressures…  Don’t those same scientists have an obligation to use those federal funds considering the potential for commercialization?  (in other words… an obligation to the mission of the funds)

I think the NSF I-Corps program and the The NIH C3i Program both were implemented to increase the success rate of basic research that results in commercial products to improve our economy and health.

Imagine if every researcher that wrote NIH and NSF grants did it with this higher purpose, this higher “why“, in mind.

Would the results of that research lead to more commercialization?

Would that increased commercialization lead to a stronger case for that Program Officer to keep the program funded?

Can you imagine a world where the politicians allocating federal funding simply can’t ignore the return on investment from the NIH and NSF?  Where the improvement to our economy and our health is easy to trace back to that federal funding?  Where the pot of money available to basic research is growing?

I can.

I’d love to hear your feedback on this topic.

Health & Happiness for All

The Axis of Abstraction

When writing What Matters a few weeks ago, I didn’t expect it to turn into a multipart series, but, here we are in part three of (?).

Last week, we moved from What, to starting with Why.

Today, I’d like to take a journey on the axis of abstraction in the What That Matters solar system.  It’s the axis with “Abstract” at the top and “Concrete” at the bottom.

Harvard Business School professor Theodore Levitt said, “People don’t want to buy a quarter-inch drill, they want a quarter-inch hole.”

But do people really want a quarter-inch hole?
Or do they want safety and security?

That’s the “Axis of Abstraction”

I first heard this notion when good friend Scott Burleson guest lectured in a class back in 2012.  He reminded me just this week that he’d used the phrase “levels of abstraction” hundreds of times with little notice, but, he said, “it seemed to stick with you.”  It most certainly did stick.

For fun, and for hypothetical sake, imagine starting a company competing with CPI Security, ADT, and Ring, as a few examples.

What if old Theodore was buying that quarter-inch drill to put a quarter inch hole into his front door at home.

Why? Maybe he was installing a lock.
Why? To be safe at home and keep his belongings secure when away.
Why?  For peace of mind.

Scott would say the highest level of abstraction is “Happiness and Bliss.”  In summary, for this example, from the top down on the axis of abstraction we go:

  • Happiness & Bliss
  • Peace of Mind
  • Safety & Security
  • Lock
  • Hole
  • Drill

What happens on the way down when we start to ask “how“?

If we start with Happiness & Bliss and start to ask why, the answers can be peace of mind, health,, food, music, art, the universe and everything.

Let’s try starting at the level of Safety & Security for our company.
How are all the ways we can stay safe and keep our belongings secure at home?

  • A door that locks
  • A home security system
  • A doorbell that’s a camera
  • A light that comes on when it detects movement outside
  • Get a dog
  • Set up a neighborhood watch

Going down the axis of abstraction, (asking how? along the way), is like the roots of a tree digging into the earth.  We diverge on the way down, to an infinite number of solutions that are concrete.

Going up the axis of abstraction (asking why?), we may eventually converge to Happiness & Bliss (or some core value).

The Axis of Abstraction can be used as a tool for building a personal or corporate Vision and Mission.  It can be for business unit missions, and project missions.  It can be used for brainstorming solutions.

Our hypothetical company might have a high level vision of “Peace of Mind” and a corporate mission dedicated to “Safety and Security.”  We can have business units that are focused on Alarm Systems, Automated Devices, and Web/Mobile Apps.  Our products can be locks, lights, cameras, and the associated user interfaces.

I’d love to hear your thoughts on this topic and where else you might like to explore the “What that Matters” solar system in future posts.

Health & Happiness for All

Start with Why

After writing the “What Matters” post last week, I’ve received great feedback from friends and strangers through emails and posts. Some of my favorite topics included:

  • How do we rank and choose different “whats” ?
  • Can this be an objective/quantitative process?
  • How can we improve as teachers and coaches of this thought process?
  • Exploring ALL stakeholders is great, but lumping them together is not great.
  • Fully vetting the archetype of each stakeholder is critical in the process.
  • There’s a distinct difference, especially in medical device product development, between verification of design inputs, versus validation of a user need.

Of all the feedback, the one that jumped off the screen was when asked if I’d read Start with Why by: Simon Sinek.  I hadn’t read the book, yet, but had previously watched and enjoyed his TED talk, How great leaders inspire action.

In the book, Simon uses the Apple, “1000 songs in your pocket”  slogan as an example, when he gets to his point and states, “Only later, once we decided we had to have an iPod, did the WHAT matter.


It goes back to the first bullet above…  How do we rank and choose different “whats” ?  How do we know they matter?

Start with Why.

WTM – You Are Here tool

I have this process for use in class with students called, “The What that Matters – You Are Here tool” that starts with “why” and then spirals you through all the questions, including when, where, who, and even how.  But yes, start with why.


If you click on the WTM – You Are Here tool and explore it like a solar system, you’ll see that it looks into the past, the present, and the future.  The spiral represents increasing quality of the exploration, or investigation.  But for this post, let’s just look up, at “Why.”  It gets to motivation and mission.

Let me steal again from Simon Sinek and use the “100 songs in your pocket” as an example.

In the 1980s, the Sony Walkman ultimate “why” or motivation may have been to take your music with you.  What you could do only in your home or car could now be done on the subway during your commute to the city.  By the early 2000s, that motivation went from one album to getting your entire music library in your pocket.

But does this matter any more?

If I’m playing in this space today…, why? What matters today? In the future?

Today, with the cloud, we can carry the entire planet’s music library in our pocket.  So getting more storage in a smaller space just doesn’t matter.

What matters, maybe, is to be able to listen to songs I’ve never heard before, but be likely to like them.  I mean, I just don’t have time to listen to the entire planet’s music library.

So, whether it is using automated intelligence to learn what I like in products such as Pandora…, or if it’s real human beings curating music, like on Radio Paradise, the motivation is about new (and old) music gems I’ll love.  That’s why…, and that’s what matters.

If you have other inspirational thoughts, reads, or other resources in the process of why we do what we do and developing innovative solutions, please comment.

Health & Happiness for All

What Matters

In 2001 I landed a job as a design engineer at Alaris Medical Systems (now part f BD). It was there I learned design controls and the Waterfall Design Process that calls out User Needs. It was my good friend, co-founder of Gilero, and then colleague at Alaris, Ted Mosler, who gave me a first lesson in User Needs. My takeaways were this:

1. User Needs and Voice of Customer (VOC)
Who exactly are “users” and “customers” of any product, especially medical devices? Are they Doctors? Nurses? Therapists? Patients? What other needs should be considered? Hospital Administrators?  There are many stakeholders to consult. I started substituting “Stakeholder” for “User” and “Customer” … they are the Stakeholder Needs and Voice of Stakeholders.

2. Solution Independence
Ted would say that the user needs should be clear, concise, verifiable, and free of solutions. More on that to come…

In 2006, I started teaching Biomedical Engineering Design at NC State.  Taking these two lessons, I implemented a process where students interviewed and shadowed stakeholders and developed a single statement. At the time, I called it The Problem Definition.  This was a single sentence (to be clear and concise), needed to include a metric for success (to be verifiable), and was to be free of solutions.

None of this was a secret, but rather well known industry best practices being implemented in a classroom.  And I wasn’t alone.  In fact, Stanford had recently started a fellowship called Biodesign that was built on a foundation of having diverse teams immersed in clinical settings to identify stakeholder needs and develop innovative solutions.  The Stanford Biodesign lexicon became the standard in Biomedical Engineering Education when they published their book by the same name in 2010.

Biodesign highlights a process they coined, Need Statement Development, to compose a single statement that is solution independent.  This is the cornerstone of the Biodesign process, and the mantra they’ve coined is, “A well-charactarized need is the DNA of a great invention.

So from 2006 to 2010 I called this solution free statement, The Problem Definition… and from 2011 to 2016… the Need Statement.

While the results of this methodology are undoubtedly successful, it is not straightforward as an educator to teach what this solution free need statement is.

Over the years I got more specific with the instructions for how to craft a well written need statement. They should be:

  • Free of solution
  • Free of bias
  • Concise
  • No assumptions, inferences, or judgement
  • Incorporates a metric of success or indicator of change
  • Be pleasant to the ear and clearly understood

In 2017 while serving as a coach for the NIH C3i Program, there was this combination of coaching a nurse from Arizona while being married to a nurse in North Carolina.

My wife and I were sitting at a bar in downtown Raleigh at Trophy Tap & Table where I was describing the challenge I was having teaching Need Statement Development to the Nurse in Arizona.

Abby said, “Can you give me an example?” and when I did…, she followed that up by saying, “Isn’t that an outcome?”


This sparked an email chain to two gurus in the area that are the best in the world at Need Statement Development: Ty Hagler of Trig Innovation and Scott Burleson of The AIM Institute.

It was meeting with Ty and Scott that triggered what matters.

What Stanford Biodesign calls Need Statement Development is, in my opinion, what Clayton Christensen calls Jobs to be Done…, and what Tony Ulwick calls Outcome-Driven Innovation.  Indeed, it was the word “outcome” from Abby that triggered this…  Indeed, it was early 20th century economist and Harvard Business School professor, Theodore Levitt, that said, “People don’t want to buy a quarter-inch drill, they want a quarter-inch hole.”

Whether it’s a need statement, job to be done, or outcome… it’s the “WHAT” that matters… not how it’s done.  And not only is it the “what” that matters, the “what” has to matter.  After all, if the need, job, or outcome has no value, it doesn’t matter, and therefore, it’s not worth doing.

So what I used to call The Problem Definition, and then the Need Statement, is today referred to as the What that Matters (WTM).

More thoughts on what matters in future blog posts…  in the meantime, would love to hear your thoughts.

Health & Happiness for All