System-wide transformation, commonly referred to as reform in the health sector, is messy business – just look at the current health ‘dialogue’ in the US (or reflect upon any attempt at health reform in any jurisdiction). Perhaps we might agree that the first challenge for health reform is deciding upon a future state. Then we must ask, who’s “we” and “how do we decide on that ideal state?” There is no single future state that will satisfy all stakeholders, so each stakeholder group attempts to imprint their vision and needs upon the emerging target state. The next hurdle is enacting supporting legislation. The same stakeholder influences that impacted the future state exercise are magnified during the legislative and implementation processes. The extended timeframe over which these activities transpire creates a sustained climate of uncertainty and takes a high emotional toll on all stakeholders, especially those directly impacted – patients and health professionals.

Organizational transformation depends upon creating a climate – persistent patterns of attitude, feelings, and behaviors – that reinforces the value and benefits of knowledge sharing, teamwork and innovation and positively influences the culture of the organization – its collective symbols, beliefs and commitments – and ultimately, its practices. In a networked, knowledge based, interdisciplinary, interdependent, client-centered environment, the old organizational structures and processes are no longer effective or efficient.

Individual transformation requires one to change one’s professional identity and practices in a manner that compliments system, organization and client demands.

The question for each of us is - How can design be used to positively influence organizational transformation?