My Theory of Change: From Healthcare to Design
If you had asked me 10 years ago, I never would have expected myself to be in design school. In fact, I am not sure if I recognized design as a tool for inspiring change. When I was 18 years old, I decided that I was interested in health and working with people. I therefore decided to pursue a career in Physical Therapy. At the time, I dreamed of being able to take those skills and work with children and underserved communities around the world. I thought one day, I would maybe study public health, as I was passionate about access to community health resources. Throughout school, I resonated more with the role of working with people, rather than the rote memorization of anatomy and body mechanics. Our teachers taught us how to prevent burnout and practice ethically, but this was just the beginning of understanding and experiencing a corrupt system that ultimately led me towards a career in design.
In this post, I will discuss the challenges I faced while working in healthcare, my attempts to improve situations, and how design frameworks I learned at AC4D have altered my perception of the potential for change. Throughout this paper, I will be using the design justice principles to reflect on my experience.
Design Justice Principles
While in physical therapy school, I believed that my profession was a way to make positive change in the world. As I began my career as a Physical Therapist, I worked in various settings all over the country. I found that my passion lay in connecting with the patients I worked with. I quickly began learning about people from all walks of life and hearing their stories, furthering my understanding of the world and gaining perspectives. I did my best to make people feel listened to, knowing that the hospital is not a place of comfort for everyone.
One of the biggest issues that patients shared with me was that they often did not feel listened to by clinicians and therefore felt powerless in their care. Hearing this feedback from patients influenced my practice, which was to actively listen to their stories and get to know their individual selves during each physical therapy session. As I have learned more about design justice principles, the following one came to mind:
“We believe that everyone is an expert based on their own lived experience, and that we all have unique and brilliant contributions to bring to a design process.”
I think there is often a power dynamic between the doctor and the patient that makes the people feel powerless, when really, they know their body more than anyone else in the room. If healthcare prioritized this design principle, we would listen to patients and understand where they were coming from before making recommendations that do not align with their values, culture, or what just doesn't work for them. While people have good intentions going into healthcare, the lack of listening is a symptom of the “one method fits all” fallacy, as well as overworked clinicians who are experiencing empathy fatigue.
While working in healthcare, I tried to make changes by learning the thoughts and needs of my patients and trying to advocate for them to managers and physicians so that they got what they needed to be safe. During my longest hospital tenure, we had many unfunded homeless patients who were being released onto the streets upon discharge from the hospital. I often had to jump through hoops to make sure they got what they needed and that they were discharged when it was safe for them to leave the hospital.
Change is hard to make in a hospital setting. Oftentimes, as an employee providing direct patient care, you feel powerless when it comes to making changes. It is frustrating dealing with upper management, who often have no experience working on the ground level, but ultimately make all of the decisions without a full understanding of the issues at hand. In my time as a physical therapist, we were often given unrealistic expectations for my productivity standards while upper management simultaneously tried to empathize with us. Our managers knew that these expectations were difficult, but rather than advocating for us, they would educate us in ways to look more productive on paper, often promoting unethical practices. We would have annual surveys where we would express what we felt needed to change, but nothing seemed to happen. These resulted in the staff feeling powerless and no longer attempting to make changes or switching companies or careers. Recalling these experiences reminded me of the following design principle:
“We prioritize design’s impact on the community over the intentions of the designer.”
Consider substituting “designer” for “hospital” in this scenario. If upper management prioritized the impact that the staff providing direct patient care has on the community rather than the intentions of the hospital (which are always based on profit and staff retention), this would likely result in better care for the patients and job satisfaction of the care providers. It is deeply important that people feel listened to, including the staff and the patients. The Power Mapping exercise we learned from the co-design Equalizer cards by Lauren Weinstein could be a powerful guiding principle to see where dynamics could be shifted for the patient and the employees providing direct patient care.
Furthermore, the lack of equity that exists in healthcare needs to be addressed when we think about the future. Everyone should have equal opportunity to access health resources despite their lack of privilege. People have different abilities to access healthcare and health prevention resources as a result of economics, gender, sexual identity, race, etc. This reminded me of the design justice principle:
“We use design to sustain, heal, and empower our communities, as well as to seek liberation from exploitative and oppressive systems.”
It is clear that discrimination occurs within hospital settings, both against the patients as well as the staff. This stems from a lack of empathy and understanding, culminating from a “one size fits all” approach to providing care. Healthcare needs to be approached at an individual level, and the current approach of treating everyone the same way lacks understanding that we all have different privileges in regards to health. In the future, I would love to see more learning opportunities for staff to help increase understanding of community issues resulting in people not receiving equitable care. Ultimately, the more connected leadership is to the patients and staff, the better the outcomes will be.
What I learned from these experiences in healthcare informed the ultimate change that I now believe is necessary in the United States:
Healthcare should be recognized as a human right, not a privilege. The current system profits off of individuals' poor health, which leads to further inequity. We should focus on accessible preventative resources to improve equity in healthcare as well as a reform of the entire system. Our healthcare system in its current state is unsustainable, and a radical shift needs to be made.
In the future, I hope to inspire change for more equity in the world. Currently, people choose not to see doctors out of fear of being judged or not understanding insurance and fear of owing more than they can afford. A redesign of the healthcare system in the United States will be necessary for an equitable future, and using co-design principles would create the best solution for the community.
So my most recent decision to inspire change was the decision to leave healthcare to work towards a career in design, inspired by the change I hope to see in the world. I am confident in saying that I do not regret my experience as a physical therapist. I was able to connect, empathize, and learn from individuals that I will truly never forget – people that I likely never would have crossed paths with otherwise. They taught me more than just my experience; they taught me about all the different lives they have lived and how they experience the world. I hope to carry these experiences with me as I enter the design realm. I want to continue learning people’s stories, understanding more about their individual experiences in the world, and help make actionable changes to make people’s lives easier.
During my time at AC4D, I aim to gain as many skills as possible to jump into the design field. I have been finding my voice and learning how to effectively communicate and inspire change. I must unlearn practices and thought patterns that do not create an equitable future and replace them with the ones that do. My theories of change have inspired a passion to express my thoughts while being open to listening about people’s differing perspectives. I will continue to use my skills of working directly with the community and also practice zooming out to see more of the big picture. I plan to incorporate design justice principles and co-design practices in my future design work.
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