Many founders feel a great sense of urgency to get up and running, and they are too hurried in launching and then give up too soon if the service or product doesn’t take off right away. Another key problem in this phase is that once they’ve created a business plan, they follow the plan too rigidly, mistaking what should be only a rough guide for a fully worked-out business model. A third common mistake is believing that they have to have all the answers and should be able to design their product or service on their own or with only minimal input from others.

The stories of successful social innovators, however, clearly demonstrate the value of taking a more user-focused and iterative approach to designing your product or service. Every one of the enterprises profiled encountered unexpected setbacks and had to scramble to make improvements to their concepts or products, often making a substantial pivot away from the original plan. It’s not important whether you follow the Lean Startup methodology or improvise your own particular development process, but what’s vital is that you approach the process with a good dose of humility, not believing you’ve got answers, but rather that you’re testing hypotheses, and that you move forward according to these three steps:

Listen

Build

Iterate

In this article, we’ll go on the journey of discovery of the founders of Embrace as they worked to develop their baby warmer, to see how user feedback and pivoting were vital to their successful development of the product and entry into the difficult market in India.

EMBRACING CHALLENGES

Jane Chen and her team at Stanford working on developing their low-cost incubator had a clear idea of what they thought were the requirements for their product. They needed to create an incubator that would work without electricity, and was mobile and simple enough for a new mother or a midwife to use. But even with such a clear concept, actually making such a device turned out to be a challenge full of pivots.

The first step was coming up with a basic design, and they thought through many possibilities, including a tent-style device. Then, with the deadline for the project fast approaching, they did what any good students would do; they put on a pot of coffee, stocked up on Red Bull, and pulled an all-nighter. Finally, as the sun was starting to rise, they landed on an idea they thought had real promise. The design would resemble a tiny sleeping bag. The core heating technology would be a phase-change material, a wax-like material contained in plastic packets that when heated in boiling water maintains a constant temperature for eight hours. The packets could be slipped into a pocket in the back of the sleeping bag, and they could be reheated over and over again. They decided to call the device the Embrace Warmer.

This solution met all of their design criteria; it required no electricity, it was easily portable, intuitive to use and it could be produced at a very low price point.

As a bonus, the design would also work well in a variety of cultures, as mothers all around the globe warm their babies by wrapping them in blankets and holding them close to their own warm bodies. Finally, the sleeping bag could be easily sanitized by boiling it, making it easy to ensure a bacteria- free environment, crucial for a vulnerable newborn.

By the time the semester ended, they had tweaked the design enough that they knew they had something that might be able to work. Others agreed. They won both the Echoing Green fellowship, given to a select few social entrepreneurs every year, as well as a Stanford business plan competition. The team incorporated as a nonprofit, calling the organization Embrace.

Even armed with their Stanford degrees and such expert support, they had a great deal to learn, and the humility they brought to the process allowed them to listen effectively and to make many alterations to their plan.

Knowing that it would be foolish to try to launch the warmer globally, they decided to focus on one market, and after doing some research, they found that one out of every three babies in India are born with low birth weight and that more than one million die every year. So, they chose India.

A number of trips to India revealed to them that in order to truly understand the customers, the manufacturing issues, and the ins and outs of the distribution system, they would need to move to India. A side advantage of the move was that it kept costs low at this critical early product development stage. They could be with their custom- ers and keep overhead low: win-win.

Once on the ground in India, they began meeting with anybody and everybody who could give them advice and feedback. In the first year they spoke with more than 150 stakeholders, from doctors, to mothers, to manufacturers, to hospital administrators.

One of their early discoveries was that boiling water wouldn’t be an adequate heat source for the Embrace. Most of the Indian health- care system is comprised not of large modern hospitals, but of one- room primary health clinics staffed by one doctor serving a whole village or rural region. More often than not, when a baby is born with low birth weight in these primary care health clinics, the doctor recommends a transfer to a hospital in the nearest town, and that journey is often long and dangerous due to road conditions. For these journeys, boiled water would not be viable.

So they decided they would produce two versions, one for the home, which would be heated by boiled water, and one for clinics and hospitals, which would be heated by electricity. Again their decision had an unexpected benefit. The electricity-powered model resolved safety concerns among doctors and clinicians about the use of boiled water, which smoothed the way to gaining their support. An added side-effect of this was the credibility the doctors’ approval earned them among the public, which has great respect for the doctors and the professional healthcare system. Yet another benefit of splitting the product line was that they could charge a higher price for the clinical model, earning extra profit with which to fund the continual product development of the home version. For all of these reasons, they decided to bring the clinical model to market first.

Simply by spending quality time on the ground and asking stakeholders about the product they wanted, the team was able to greatly improve their model.

USER TESTING HAS MANY BENEFITS

Designing a breakthrough product is fairly meaningless if it can’t be manufactured and distributed for the right price point, and the Embrace team still had lots of work to do to make the products viable. For one thing, they were up against the considerable skepticism any truly new product tends to face, let alone  one you are asking doctors and mothers to use with vulnerable babies. They knew they needed high-quality product testing. First they tested with mannequins, then they moved to testing with full-term healthy babies and finally, they moved to a small randomized, controlled trial on low birth-weight babies who were experiencing cold stress.

The results of all the testing were positive. The product kept babies at a constant temperature, and it was able to bring babies with cold stress back to a healthy body temperature. In fact, the Embrace Warmer actually outperformed the current standards of care in the hospitals. They seemed to have exceeded their goal. But plenty of discoveries lay ahead of them, requiring yet more pivots.

KNOWING WHAT TO OUTSOURCE

Like any startup, Embrace had limited resources and people, so they wanted to run lean—focusing on what they are good at and outsourcing the rest. Their core competencies were design and strategy, so they decided to outsource manufacturing and sales.

As they pursued their plan for manufacturing, they learned one of the fundamental lessons anyone who produces a new product confronts: manufacturing is a challenging process. For the uninitiated, it seems so simple; you just give the specs to a manufacturer and a perfectly made widget appears. If only that were the case. There are so many steps in the process that many different kinds of mistakes can be made, and manufacturing a brand new product is especially prone to errors. The Embrace team was also working with a language barrier, and it somehow had to get high-grade, clinical-quality production at an extremely low cost.

Jane quickly realized that simply outsourcing the process wouldn’t work. She recalls, 

“You have to micromanage the  hell of out of the process to make sure that you are getting the quality that you need. What we ultimately ended up finding was that for some components, it was better to do it in-house.”

Embrace brought the making of the more complicated components in-house, such as that the wax pouch, and though the work was difficult, they managed to come up with a way of producing the pouches that are higher quality than those of the original manufacturer, and they produce them for less cost. Embrace also takes charge of the final assembly and the quality control.

The unexpected side benefit of this pivot was that Embrace has developed valuable expertise in manufacturing. Thus, should they ever outsource some components of manufacturing in the future, the in-house team will know exactly how to direct the process.

FINDING EARLY ADOPTERS TAKES WORK

The Embrace team also had to learn to be very strategic about whom they targeted for their first sales. The Indian healthcare system is bifurcated, comprised of both public and private hospitals, and Embrace wanted to be in both. But the sales cycle in a public hospital is much longer due to the relationships that need to be built and the bureaucracy to be navigated. So, in order to get to market in a timely manner, they decided to focus first on private hospitals. The team’s solid understanding of the Indian healthcare landscape shaped the Embrace go-to-market strategy to optimize for efficient use of time and money as well as the greatest chance for early wins. Again, they were willing to make a significant pivot. Their whole project had begun with the intent to get the warmers to poor women in villages, but they recognized that instead they should target the parts of the market that they could make the most headway with the most readily.

They still needed a strategy for actually getting the warmers into the hands of the doctors, and the team decided to test numerous strategies simultaneously. One was to sell through the pharmaceutical reps already visiting the doctors on a regular basis. Another was to work with a nonprofit that focused on sales and distribution of medical devices. The nonprofit would create a dedicated sales force for the warmer, funded by Embrace. The third strategy was to work through the stores called stockists in India, which are the wholesalers for medical products. Finally, they would partner with GE Healthcare, which made an agreement with Embrace for a minimum purchase. In the deal, GE obtained global sales and distribution rights but would begin in India. This deal carried two great bonuses; it lent the credibility of working with a huge well-respected partner, and the guaranteed minimum order allowed Embrace to make some basic revenue projections.

They launched the product in the summer of 2011, and as well planned as their strategy was, the next year was still one of learning how incremental the process of building awareness and breaking into a market can be.

YOU MUST EDUCATE CUSTOMERS

Need for a product and demand for it are two different things. There was a clear need for the Embrace Warmer, but demand had to be created. This is particularly the case when you are bringing a new product to market that requires a behavior change. Generally, in order to move from need to demand, a company has to invest a significant amount of effort and resources in educating the potential consumers. Putting distribution in the hands of outside parties, as Embrace had, makes this more difficult. Embrace was to learn another valuable lesson here about outsourcing. The warmer simply wasn’t been pushed vigorously by any of their distributors. Even the GE deal wasn’t leading to the growth in sales Embrace needed. All of the distributors they chose had other products they were selling, all of which had a much higher profit margin, so the warmer just wasn’t a priority.

The team realized that, as Jane says, “You can’t have the same sales force selling the higher end and the lower end products. You need to separate sales forces.” So they decided to pivot yet again and build out their own sales force. At first they hired sales people fresh out of college, known as Freshers in India. This is a common practice in the country, and it seemed like a good idea; they’d be low cost and, since they are fresh out of school, very trainable. Freshers have proven a great success in many sectors. But it turned out that whereas, Freshers work well for pharmaceutical sales, because the doctors they are selling to already know about the drugs, for a new product a more sophisticated sales force is required. The salesperson must have the ability to persuasively educate the doctor about the product. This requires skill, confidence, experience, and maturity. So, Jane knew that they needed to pivot yet again. They hired a team of experienced salespeople who would focus on key influencers in specifically targeted hospitals. They began to get some traction

GOOD NEWS TRAVELS SLOW

The early response from the medical community was very positive, which was helped by another smart decision the team made. They wanted to ensure that the first products on the market were being used properly, so they scheduled multiple follow-up visits with the doctors and nurses using the device, and in this process they collected a whole book of testimonials to use in sales. Then they got a lucky break that accelerated adoption. As the saying goes,

“Sometimes it’s better to be lucky than good.” But it’s best if you can be both lucky and good.

The Embrace team was introduced to the Health Secretary of the state of Rajasthan, and it turned out that his daughter had recently had a premature baby. He had direct experience with the problem, and he understood the concept of the warmer and the need for it immediately. He decided to test the device in every hospital in one of his districts. The nurses reported they found the warmer incredibly easy to use.

This led Embrace to propose a series of smaller pilots with public hospitals in other areas. They hired a case study coordinator to collect data from these programs. The results showed that 77 percent of premature babies were hypothermic and confirmed that after placing those babies in the Embrace device they were able to maintain a normal body temperature.

As a result of the positive data coming out of both the private hospitals and the public pilot programs in the public hospitals, Embrace started to gain traction among the broader public health- care system in India. Twenty months after launch in the private hospital system, the company got its first big entry into the public hospital system. The state of Karnataka issued a directive to 258 government hospitals, providing them funding to purchase the device. By the end of 2013, Embrace was in every hospital in the state.

Now Embrace is seeing a domino effect, with additional state adoptions.

KEY TAKEAWAYS

1. Listen

Good design starts not with doing, but with listening. Listening assumes that the user knows better than the designer. The designer should be interacting with the target users in their environment to gain both qualitative and quantitative insights about what kind of product or service they really need and want, how those needs and wants are prioritized, and how the context impacts those needs and wants.

The goal in the listening phase is to get as close as possible to a holistic understanding of the end user’s pain points and desires. This cannot be done in the office or in a lab. This requires not only the research out in the field, but aggregating all of the data so that you move from a set of individual stories to higher-level insights. You must make sense of the data by identifying patterns.

Key Question: What do the users want?

2. Build

After collecting, aggregating, and weighting the insights gained from the intended users and developing clear specifications, you are ready to roll up your sleeves and start building.

You should test your assumptions early on with a minimum viable product that you share with actual targeted end users. It’s important that your product is well-enough conceived and constructed that it isn’t rejected simply because of the execution of your design and gives users a good taste of how they might benefit from the product. This way, they are more motivated to engage with your questions about the product and to help you make improvements.

Key Question: How can I quickly and cheaply build an MVP to get my product in the hands of users as quickly as possible?

3. Iterate

You should go into the testing process with the assumption that your product will fail in some way, and that it might even turn out to be the wrong product entirely. You must not only be willing to pivot, you’ve got to be constantly keeping your eye out for signs that a pivot is required. Becoming comfortable with the idea that you will fail, perhaps many times, before you succeed will be invaluable in persevering through all the variables.

There are multiple methodologies for assessing the responses to your MVP. After receiving user feedback you must sort through all the data in order to find actionable metrics. This often involves serious grappling with the question of whether to pivot away from your plan or to forge ahead, or perhaps make just very moderate changes. You should go into the process expecting to go through several cycles of iteration.

Key Question: How can user feedback improve the MVP?

This process shouldn’t end even after you’ve launched your product. You want to be continuously listening, building, and iterating in order to find more ways to serve your users. Great social innovators are always looking for new opportunities to have an impact. 

Discover more: Design With Humility