My theory of change of has, perhaps unsurprisingly, shifted drastically in the recent years. As I child, I understood change to be inevitable, a slow march forward without giving us much agency in choosing direction. As I grew older and began carefully laying the tracks for my life, I chose a career based on the direction I wanted that slow march to continue; I wanted to dedicate my life to healing and helping people, one person at a time. I believed through these singular exchanges, and the ripple effects of positivity and goodness they cause, the world changes for the better, if not for just one person’s world. I worked this way for a while, a part of a team that helped people in some of their worst moments of their lives, doing sometimes challenging but immensely fulfilling work. I will always cherish that work and I believe those small scale changes keep the world alive and turning. However, the Pandemic has made me reevaluate the sustainability and price of these changes when the institutions they exist within are built to deter or profit from them.

The healthcare industry had always had some ethical quagmires, but I believed every industry did, and caring for people outweighed these issues. During the Pandemic, I was forced to confront that the change I wished to effect was often in spite of the industry I worked within. Patient care was hindered by stretched staff and company instituted time constraints, patients and staff alike passed away from the disease, and masks calloused faces. Chick-Fil-A was left in the staffroom as hazard pay, time off for COVID was reduced to five days, pots and pans clanked on. Eventually the pots and pans stopped, we were left to carry on, and the facility had a great quarter. I came to the realization that I was helping but the march came at a price and was unsustainable. In the ‘unprecedented times’ the solutions, the movements for better treatment of healthcare workers were wholly precedented and neglected the needs of healthcare workers. We were willing to step over each other to continue our marching orders.

I began to see this in reflected in other institutions as well: cheap, placatory solutions meted by people with the means and power to assert their solutions and changes were the only ones possible. It became more clear to me that change needs to exist in both arenas with equal strength; if our institutions and environments don’t support behaviors and qualities we want to see in the world, the changes we create on a smaller scale are limited in impact. Similarly, without small scale changes occurring to support it on an everyday basis, large scale change on an institutional level feels disingenuous and worthless.

The decision to leave healthcare was difficult, a bad break up. I ultimately left, as did several of my colleagues, feeling as though saying ‘no’ to a system I no longer believed in was it’s own method of effecting change. In “Design’s Lost Generation” Mike Monteiro, asserts asking why and saying no are essential skills to shape change and design. In the healthcare field I found myself in the role of a bellhop rather than a gatekeeper, a stakeholder with the tools to advocate and dissent. Monteiro’s commentary on the responsibility of every individual to resist becoming the hands of unethical men spoke the agency I felt I had lost in the healthcare institution; sometimes the best thing we can do accept something is broken, straighten our spines, and walk away.

I’ve also learned that walking away from one thing isn’t a solitary action. In walking from one thing, we walk toward something else; my walk from healthcare led me to the door of AC4D. I’m no longer satisfied in participating in that slow, inevitable march toward the known, and AC4D promises opportunity to shape new paths and new ways of doing. The mission to assist in designing a more equitable and just world is one that speaks to me. I look back at the system I left and I know there are infinite ways in could be better. The design of the healthcare system no longer functions to serve the problem it was built to address, yet the world of healthcare is so deeply entrenched in hierarchy, ritual, and traditions, change and growth are stunted. Through Walidah Imarisha’s "Rewriting the Future: Using Science Fiction to Re-Envision Justice” I find inspiration to imagine systems from scratch that would address some injustices and issues within the healthcare system. Thus far, many corrective measures instituted to address problems have been grafted into a failing system; what if the solution is a different system? Before anything is a reality, it is a work of art, or a dream, or science fiction. Imarisha’s call for disruption of realistic institutions is one that begs for unprecedented solutions in unprecedented times; the space for opportunity with this thinking is as large as we allow it to be.

The importance of co-design is another philosophy that will guide my future in design and a philosophy the healthcare system would benefit from. The more I understand design as a profession, the more firmly I believe that everyone is a designer and good design exists in abundance beyond the walls of design collectives and Silicon Valleys and Hills. Michelle Jia in “Who Gets to Be Innovative”, contends that “innovation is encoded in culture” and that those cultural touchstones exist because they were well designed solutions. As companies and institutions demand realistic disruption, they demand design solutions that are novel and innovative, inadvertently demeaning the people they seek to design for. When we focus wholly on novel solutions, we ignore millennia of good design solutions and the communities that design them. The philosophy of co-design is especially important to implement when considering design solutions to improving the healthcare system. The healthcare system at times feels as though it was design for no one-not the patient and certainly not the staff. The reason for this may lie in the design’s heritage; I’m now more aware of how the design of the current healthcare system traces it’s lineage’s to patriarchal, white supremacist, and ableist ideologies. If current systems are broken, designing new ones is too radical to be adopted, change through the advocacy of use of pre-existing wisdom and experiences of communities can be innovative. Change to a system does not need to be an abrupt and complete excision of the system itself when the players within it can offer overlooked insight to adjusting it.

It’s hard to know how my theory of change will shift once more as I enter a new stage of life and my career; it’s easier to know change retrospectively than it is as change occurs. However, I am positive my theory will change and shift as it is tested. As I walk into this new change of life I feel more sure of my footing and the direction the march will take me in. And so the with the rest of the world, we march on.