State Department in Iraq, and a lecturer at Stanford University. Dawson is a Xerox PARC veteran who helped lead startups such as CASE Technology and Zentek. They’ve been devoting much of their energy over the last year to a product called Brilliance, which uses blue LEDs to deliver phototherapy to babies with severe jaundice. It’s a perfect case study in D-Rev’s methods, which are heavy on customer engagement, rapid prototyping, field testing, and data collection—all standard procedures in the for-profit product development world.
Jaundice is an excess of bilirubin, a breakdown product of red blood cells, in the bloodstream. It’s a common condition in newborns, especially pre-term babies, and usually goes away without treatment. But persistently high levels of bilirubin can cause brain damage, so doctors treat extreme cases with blue light, which breaks down the bilirubin so that it can be excreted.
Commercial “bili lights” aren’t particularly sophisticated, but they’re costly ($3,000 or more), and in places like India, they use blue compact-fluorescent bulbs, which burn out quickly and are difficult and expensive to replace. “We’ve been told that there are no phototherapy units in the whole country of Liberia,” Donaldson says. “Even in India, a fairly wealthy state, 90 percent of clinics will not have effective therapy, because the bulbs are burning out and not being replaced, or they’re being replaced with white bulbs,” which have minimal effect on bilirubin.
After learning about the need, traveling through developing countries and interviewing doctors about their needs was the first step in the creation of the Brilliance system. “There is a long history of not really listening to the customer,” Donaldson says. “You see it even now with these sexy, silver-bullet products. A phototherapy device is not a sexy product, honestly, but it is what the doctors who make purchasing decisions told us they want. They said, ‘We want to have it not break, and we want to be able to afford it.'”
Back in their Palo Alto lab, Donaldson and other D-Rev engineers ran quickly through a series of prototypes—Donaldson calls them “embodiments.” The team gravitated immediately to blue LEDs, which are more efficient than fluorescent bulbs and last far longer. One embodiment was a flexible rubber blanket with strips of LEDs embedded inside. Another was a long tube with LEDs inside, made the same size and shape as a fluorescent bulb so that it could be popped into an existing phototherapy rig.
“One of the things we do very well, which is typical of Silicon Valley, is this very rapid prototyping,” says Donaldson. “We’re not just sketching, we’re building things. We’re not worried about it being ugly. On one trip we were cutting up Air Emirates socks on the way to India to use in a prototype eye covering, because the material was so stretchy. We might walk in with four or five ideas and talk to 60 people and ask the same questions four different ways. You have to be careful about asking what people think, because often they won’t tell a nice foreigner that they don’t like something. But they will say ‘Oh, this one is better than that one.’ That’s how we learn about products.”
D-Rev settled on a simple design for Brilliance: a rectangular array of LEDs in replaceable strips of three, with lenses that diffuse the light into a baby-shaped pattern. Donaldson showed me heat maps D-Rev produced using optical modeling software; she called the precise irradiance pattern, plus the low-cost parts, the “secret sauce” of the design. The whole LED assembly is mounted on an adjustable-height stand that can be rolled across a nursery and placed over a bed or bassinet. Even the design of the casters required special attention, says Donaldson: “We learned from talking to users that the casters are often the first things that break, not the lights. In a lot of these environments, a typical cleaning method is to slosh water on the floor, and you don’t want the casters to get clogged up with caked dust.” Now that the basic design is finalized, D-Rev is working with Phoenix Medical Systems, a Chennai, India-based medical equipment maker, to optimize the Brilliance device so that it’s easy and cheap to manufacture.
“Krista has tons of experience with these exact problems,” Dawson says. “Once [a product] gets to a customer, there is still a loop; the feedback you get is really important. We could deliver the thing to some Chinese manufacturer who would
