The core issue with your post is that one cannot simply state the cost of ownership then use that to calculate the cost-effectiveness, and be taken seriously. To be convincing, you need to actually factor in all the costs of your intervention:
1. The cost of getting each hospital to sign up 2. The cost of delivering the equipment 3. The cost of training people in how to use it 4. Your salaries 5. All your other costs
To do so seems intellectually dishonest, or at least that you’re missing out much of the information we need to properly evaluate your intervention. I don’t think you are doing this on purpose. It looks like you’re doing great work:
It isn’t easy to get founder’s pledge to give you money, and their charity evaluations are taken pretty seriously.
It seems like you’re saving a lot of lives that otherwise would not have been saved
It seems at first inspection like your intervention could be cost-competitive with other top EA charities, which would be an incredible accomplishment. It’d put you in the top >0.1% of charities.
I’d suggest that your presentation of your work is the biggest barrier to getting it taken seriously right now.
1. The post is pretty long and most of the paragraphs are verbose. 2. It took me a while to actually understand what you do. Most readers have probably clicked off before actually knowing what your intervention consists of. I believe the relevant information is in paragraph ~7? It needs to be in paragraph 1 or 2! 3. Your call-to-action (requesting feedback) as at the top. It needs to be at the very bottom
It might be worth getting some external advice on how to present your work better to donors and EA audiences.
I’ve up-voted your post because I want more people to engage with your work. I’ve screenshot this to show you that I’m not just criticising you for fun. I want you to succeed.
Thanks a lot for your candid feedback. This is exactly what I hoped to get from this forum.
Honestly speaking it has been quite a struggle to think what could be the right tone and what information should be included and what not. What we do is not that simple and the context in which we operate isn’t either. I guess you have captured my failure to strike the right balance well with your feedback.
What might help to better understand what we do is our product video. I didn’t include it before because I don’t want people to feel like I am here to promote my work. Curious if you feel it should be included.
Regarding the costs remark, actually everything is included in the costs that we presented here. You can find a detailed breakdown with rationale at the bottom of this document from which I took the screenshot below. If we can achieve sufficient scale (>5000 devices) we can deliver and sustain it at the costs presented below and likely for sifnificantly less if we achieve a bigger scale.
Unfortunately I do not have time to rewrite and organize everything right now, but hopefully I can make some improvements over the weekend. If you are open to it, I would gladly receive your feedback before updating the post.
To John’s point (which I agree with), these cost estimates just include the cost of purchasing and maintaining the equipment. But there are other costs! As John notes, at the very least there are people costs — the cost of your time, and hospital staff time — and probably if studied carefully we would discover that there are even still other costs.
Actually we think these are all costs. To clarify a bit: we are operating as a social enterprise. The prices mentioned here would be what the hospital/NGO/government pays. Implementation is done with local staff which is quite affordable, after implementation everything is done by hospital staff. There is only limited need for support and maintenance which is all done by local teams which keeps costs low. Because (assuming we will reach sufficient volume) there are margins on the product and services this will ultimately pay for all international staff including mine.
Hospital staff time/costs goes down after the intervention, because the system automates repetitive tasks. Moreover we see a 10% shorter admission time, which will also have a positive impact on workload.
Soon we will publish more results showing that both costs for the health system and the patient will go down after the intervention. Based on what we see so far it is even very likely that our intervention is net cost saving over time.
We didn’t include that in this analysis because we did not yet have the results and it again complicates it further.
There are different philosophies here of course, but from my perspectives hospital staff time required to set everything up (including training etc), and international staff time, should be treated as costs, while hospital workload improvements and improved hospital or patient costs should be treated as benefits. Among other things, that is because the benefits are somewhat speculative while the costs are more certain.
Sorry for a delayed response. But indeed you are right abou this. However, the costs at the hospital staff for availing staff is actually very low. Typically it is 20-30 people for 1 day, the costs are negligible in relation to the 10 year total costs. Moreover in-service training is part and parcel of every nurses job and part of the hospitals responsibilities. That is why we have not counted it so far.
In the coming months we expect to have a proper assessment of the impact on workload and costs and can more clearly describe it as a benefit. Initial results from one hospital indicate that IMPALA is leading to a significant cost-reduction. Will keep you posted about developments.
The core issue with your post is that one cannot simply state the cost of ownership then use that to calculate the cost-effectiveness, and be taken seriously. To be convincing, you need to actually factor in all the costs of your intervention:
1. The cost of getting each hospital to sign up
2. The cost of delivering the equipment
3. The cost of training people in how to use it
4. Your salaries
5. All your other costs
To do so seems intellectually dishonest, or at least that you’re missing out much of the information we need to properly evaluate your intervention. I don’t think you are doing this on purpose. It looks like you’re doing great work:
It isn’t easy to get founder’s pledge to give you money, and their charity evaluations are taken pretty seriously.
It seems like you’re saving a lot of lives that otherwise would not have been saved
It seems at first inspection like your intervention could be cost-competitive with other top EA charities, which would be an incredible accomplishment. It’d put you in the top >0.1% of charities.
I’d suggest that your presentation of your work is the biggest barrier to getting it taken seriously right now.
1. The post is pretty long and most of the paragraphs are verbose.
2. It took me a while to actually understand what you do. Most readers have probably clicked off before actually knowing what your intervention consists of. I believe the relevant information is in paragraph ~7? It needs to be in paragraph 1 or 2!
3. Your call-to-action (requesting feedback) as at the top. It needs to be at the very bottom
It might be worth getting some external advice on how to present your work better to donors and EA audiences.
I’ve up-voted your post because I want more people to engage with your work. I’ve screenshot this to show you that I’m not just criticising you for fun. I want you to succeed.
Dear John,
Thanks a lot for your candid feedback. This is exactly what I hoped to get from this forum.
Honestly speaking it has been quite a struggle to think what could be the right tone and what information should be included and what not. What we do is not that simple and the context in which we operate isn’t either. I guess you have captured my failure to strike the right balance well with your feedback.
What might help to better understand what we do is our product video. I didn’t include it before because I don’t want people to feel like I am here to promote my work. Curious if you feel it should be included.
Regarding the costs remark, actually everything is included in the costs that we presented here. You can find a detailed breakdown with rationale at the bottom of this document from which I took the screenshot below. If we can achieve sufficient scale (>5000 devices) we can deliver and sustain it at the costs presented below and likely for sifnificantly less if we achieve a bigger scale.
Unfortunately I do not have time to rewrite and organize everything right now, but hopefully I can make some improvements over the weekend. If you are open to it, I would gladly receive your feedback before updating the post.
To John’s point (which I agree with), these cost estimates just include the cost of purchasing and maintaining the equipment. But there are other costs! As John notes, at the very least there are people costs — the cost of your time, and hospital staff time — and probably if studied carefully we would discover that there are even still other costs.
Hi Ian (and John),
Actually we think these are all costs. To clarify a bit: we are operating as a social enterprise. The prices mentioned here would be what the hospital/NGO/government pays. Implementation is done with local staff which is quite affordable, after implementation everything is done by hospital staff. There is only limited need for support and maintenance which is all done by local teams which keeps costs low. Because (assuming we will reach sufficient volume) there are margins on the product and services this will ultimately pay for all international staff including mine.
Hospital staff time/costs goes down after the intervention, because the system automates repetitive tasks. Moreover we see a 10% shorter admission time, which will also have a positive impact on workload.
Soon we will publish more results showing that both costs for the health system and the patient will go down after the intervention. Based on what we see so far it is even very likely that our intervention is net cost saving over time.
We didn’t include that in this analysis because we did not yet have the results and it again complicates it further.
There are different philosophies here of course, but from my perspectives hospital staff time required to set everything up (including training etc), and international staff time, should be treated as costs, while hospital workload improvements and improved hospital or patient costs should be treated as benefits. Among other things, that is because the benefits are somewhat speculative while the costs are more certain.
Hi Ian,
Sorry for a delayed response. But indeed you are right abou this. However, the costs at the hospital staff for availing staff is actually very low. Typically it is 20-30 people for 1 day, the costs are negligible in relation to the 10 year total costs. Moreover in-service training is part and parcel of every nurses job and part of the hospitals responsibilities. That is why we have not counted it so far.
In the coming months we expect to have a proper assessment of the impact on workload and costs and can more clearly describe it as a benefit. Initial results from one hospital indicate that IMPALA is leading to a significant cost-reduction. Will keep you posted about developments.