The Biggest Competitor to Your Product Might Be Paper | Daniel Burka, Mahima Chandak & Elyce Cole, Hard Problems

Unmissables with Ariba Jahan

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The Biggest Competitor to Your Product Might Be Paper | Daniel Burka, Mahima Chandak & Elyce Cole, Hard Problems

On what eight years in rural clinics taught the co-founders of Hard Problems about building technology people actually trust and use.

Ariba Jahan

Mar 05, 2026

What if the hardest part of building technology isn’t the interface, it’s earning a place in systems that already work?

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Daniel Burka left Google Ventures to spend eight years in rural clinics across India, Bangladesh, Ethiopia, and Sri Lanka. Mahima Chandak came up through design school and went straight into building health tech for frontline workers who had no patience for tools that made their days harder. Elyce Cole is the organizational psychologist in the room asking the question that usually gets skipped: how do power structures, not just good intentions, determine whether anything actually reaches the people it’s meant to serve?

Together they’re the co-founders of Hard Problems. And the platform they built called Simple is a hypertension management system now used a million times a month across some of the most constrained clinical environments on the planet. Building for public health shaped how they think about collaboration, trust, data, and what technology actually has to demonstrate, before anyone will use it.

In this conversation we get into the specifics. What a nurse in rural Punjab told them that changed how they built. What it actually takes to get clinical data entry down to 13 seconds during a clinic visit that’s only 3 minutes long. Why they deliberately designed the system to hide individual productivity from managers and systems. What co-design looks like when one of your stakeholders is Ministry of Health official and government. And what it means to measure your impact not by what you shipped, but by whether the work survives after you leave.

None of them treat technology as the hero. They treat it as something that has to earn its place in people’s lives, in systems, in processes.

“Nurses didn’t come to use your app. They came to treat a patient. We tend to think that our app is the central hero of the story. But it’s really not.” — Mahima Chandak

What we explore in this episode

Why paper was their actual competition, and what made it so reliable that digital tools had to earn their way in
The design decisions behind Simple’s 13-second clinical visit: what had to be stripped away, and why that number matters more than any engagement metric
How they intentionally built the system to hide individual worker productivity from managers, and the reasoning behind that call
What co-design looks like at two scales: sitting with nurses to map their workflow, then prototyping overnight to bring something back to a Ministry of Health official the next morning
The surveillance question underneath every enterprise tool: whose data, shared with whom, and what happens when the government you’re building alongside goes through a coup mid-deployment
Why the beachhead analogy shapes how Mahima thinks about her work, measuring impact not as outcomes but as infrastructure for whoever comes next
What designer disillusionment is actually pointing toward, and where the energy is going

Some takeaways

When a nurse has three minutes per patient, the question of how much data is enough becomes a design decision that impacts everyone. Daniel’s team stripped everything down to what a healthcare worker actually needed to record in order for the system to work. The result was a clinical visit that takes 13 seconds. The constraint came from the context. The discipline came from watching someone actually do the job.

Technology earns trust by buying back time. This team sat in clinics and watched how care actually happens. A three-minute patient visit looks completely different from a desk in Delhi than it does standing in the room where it’s happening, and the product they built reflects that difference.

Your digital system is not a holistic measurement of work. The team deliberately designed Simple to only expose teamwork to managers, never individual productivity. A nurse who spent the morning assigned to the pharmacy wasn’t visible in the system, but that doesn’t mean she wasn’t busy. Not everything that can be measured should be measured and the decision about what to leave out is as important as what you include.

Co-design still requires being in the room. Most teams have replaced direct observation with data proxies, synthetic personas, and AI-generated feedback loops. This team sat in clinics and watched. A three-minute patient visit looks completely different from a desk in Delhi than it does standing in the room where it’s happening, and the product they built reflects that difference.

Impact in hard systems is measured in decades. Daniel’s reference point is Dana Chisnell: 21 years on voting systems. If the most important problems have a minimum-decade time horizon, that changes how you measure progress on any given week and it changes how you define success.

Signals to watch

Designer disillusionment is becoming a directing force. More designers are questioning what they’re applying their skills to, and the infrastructure to redirect that energy is starting to exist. Hard Problems is an early example. Watch where the next generation of product talent actually goes.

AI at the edge is underreported. Mahima’s oral cancer project runs a model on a low-cost smartphone, offline, in a frontline healthcare worker’s hands in rural India. The design constraints are producing solutions worth paying close attention to: offline, low-cost devices, frontline workers with minimal training.

The history a team has with technology shapes every decision they make before you’ve shipped anything. As AI adoption accelerates, the organizations that audit that history first will build differently than the ones that assume they’re starting from neutral.

What to try this week

Watch someone use your product without coaching them. Pay attention to how long it takes to do the core thing, what unexpected observations you have. Given the volume of AI-generated products being built right now, the value of direct observation is worth remembering.

Map the work your product creates before it creates value. What does a user have to do before they get anything useful back? Paper never added steps before delivering.

Run a data power audit on one feature. Who sees this information? Who doesn’t? What assumptions did you make about access, and whose interests do those assumptions serve? Knowing the permanence of data, what feels irresponsible to gather?

Follow along

00:54 — Introduction

02:05 — Who they are, what Hard Problems is, and why they named it that

07:12 — Paper as competition: the real brief for Simple

10:51 — The psychology of change: why new tech isn’t automatically better

12:44 — 13 seconds: designing a clinical visit with nothing extra

17:49 — What they had to let go of (Bluetooth, digital scribes, and the shiny tech trap)

20:34 — Data, surveillance, and who your system actually protects

25:02 — Co-design at the ground level: sitting with nurses

29:21 — Co-design at the systems level: governments, ministries, overnight prototypes

32:22 — Switching your mindset from shipping to sustaining

35:52 — The beachhead analogy: impact as infrastructure

37:37 — Entering the space: where to start if you want to work on hard problems

39:27 — Oral cancer screening: AI at the edge, offline, in rural India

44:09 — The unmissable

Guest bios

Daniel Burka is a product manager and designer focused on solving complex global health problems in simple ways. He co-founded Hard Problems and Simple (simple.org), an open source tool used by thousands of hospitals across India, Bangladesh, Sri Lanka, and Ethiopia to manage over 6 million patients with hypertension and diabetes. Previously, he was a design partner at Google Ventures and helped write the book Sprint. He was early at several startups including Tiny Speck, which became Slack.

Mahima Chandak is co-founder of Hard Problems, where she creates space for designers and technologists to take on complex public interest work. She previously worked on Simple and leads an oral cancer screening program at the Indian Institute of Science, enabling frontline healthcare workers in early detection and treatment.

Elyce Cole is an organizational psychologist and social researcher who supports multidisciplinary teams working on public health, technology, and social care challenges. She led the largest global study on neurodiversity in the tech industry and has designed large-scale organizational change programs across healthcare, social care, and community health. Earlier in her career she worked in leadership development for Fortune 500 companies across healthcare, biopharma, and finance.