Health Innovation Innovation

Graduation Day

Today, students from the UNC and NC State Biomedical Engineering class of 2018 will cross the stage and receive their diplomas after 4 (or 5 or more) years of very hard work.

Over the past 12 years, I’ve had the distinct pleasure of welcoming these bright minds into a lab and taking a journey with them through a process of innovation.

In 2007, the class decided to celebrate the year of hard work with a symposium.  Since that time, pioneers of the program (the students) have transformed the symposium from a small crowd at MCNC to standing room only at the NC Biotech Center, to it’s current format, renting out the Durham Convention Center.  These students have transformed the class from academic projects to startup companies.

Last week, at the 12th annual symposium, I was honored to give the closing remarks.  Fittingly, it started with failure: (pro tip … never use the term “pro tip”)

The talk was a play on Star Wars: Lifelong Learners that choose to study Biomedical Engineering have the most innovative minds in the galaxy

It was graciously recorded by one of the students and I’m humbled to present it here today on this graduation day.  Congratulations to the class of 2018!!!

Health & Happiness for All


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


Health Innovation Innovation

Trig Newsletter Guest Post

Took a break this week from my personal blog and humbly accepted the opportunity to write a guest post in Trig’s Newsletter: The Killer Experiment.

Health & Happiness for All
Andrew DiMeo

Health Innovation Innovation

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



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