True Transformation Requires the Right Conditions

Part 1: My Story of Working to Transform the Healthcare System

Written by Marie-Hélène Fokias

While I know I am not alone in my desire to transform our public systems to become efficient, caring, and collaborative, I have felt quite isolated, and at times like a villain, in my endeavours to make real change.

I worked in an Ontario mental health hospital for 25 years in a multitude of environments and teams. During my career, I gravitated toward improvement initiatives and large-scale change projects, including website creation, design and deployment of electronic documentation systems, policy development, and systems improvement. It was only in the last fifth of my career that I discovered my hunger for innovation to transform systems. I had always felt unsettled in my work, asking myself why the problems I was working on were problems in the first place. I often felt frustrated that I wasn’t able to contribute to fixing the bigger picture issues, and I didn’t understand why others were not doing that work. When I was finally in a role where I could contribute to systems transformation, it became apparent that even though leaders say they want to make radical changes, transform, reimagine, or innovate, they are held back by the structures in place. Their actions end up opposing their spoken desires.

The healthcare system in Ontario struggles to consistently define what it means practically when it uses the term “innovation.” These activities are consequently incremental rather than transformational, meaning that new solutions are found to solve specific smaller problems but don’t address broader system-level challenges. 

I dream of shifting paradigms of well-being and care, to set the conditions for caring communities to flourish and for our healthcare system to take bigger-picture approaches to providing inclusive care. This includes centring people’s needs of the healthcare system by taking into account their fuller context of wellness, illness & recovery, and community. I wish that healthcare be designed with approaches that include technology use, accessibility and timeliness of services, the significance of economic, environmental, and social factors in health, and political policy-making and resource allocations. This means acknowledging that the current system is under too much pressure and is too self-reinforcing in its design to participate in this change without the right spaces and conditions being carved out. Looking at the points of system intervention, what I’m talking about here is the toughest type of change.

Reflecting on my experiences in healthcare, I recognize that public service organizations often aim to innovate, transform, work strategically, and centre equity in service design. However, the extent to which these organizations foster environments that are receptive to transformative change and future-focused thinking greatly influences their ability to achieve these goals. When designers engage with such organizations, we may encounter unexpected behaviours or attitudes toward transformation efforts.

What do we do then about this intention-behaviour-action disconnect when doing transformative work? How does an organization understand or define its own expectations in light of its limitations, and how do designers know what they are getting into when organizations hire them to help innovate, reimagine, or transform? 

This series attempts to highlight tension and discomfort in transformation work and explore what elements in organizations lend themselves toward meaningful transformation. If this series resonates with you, feel welcome to drop a comment or get in touch with us at www.ocadu.co/contact. Stay tuned for part two!