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As someone who has spent the last decade of her academic career focusing on the role of human-centered design in health care systems and delivery, Associate Professor of Healthcare Design and Design Methods noticed a glaring problem: there was practically no communication happening among the growing number of designers working in the healthcare industry today.

“It became clear to me that the number of designers in U.S. health systems was growing, but none of us were talking to one another,” says Erwin. “We had little peripheral awareness of what other designers in health systems were doing.”

After becoming director of the Institute of Design’s in 2021, Erwin realized that it had been nearly 20 years since designers had been first hired in health care institutions by industry leaders Kaiser Permanente (2003) and the Mayo Clinic (2004). Yet there was little to no documentation or list of the health systems in the U.S. that were employing designers.

Assistant Director of the Equitable Healthcare Lab (MDes 2023), who joined the lab in August 2023, also saw this knowledge gap as an obstacle—and an opportunity.

“There lacks a holistic, industry-wide analysis of these efforts, making it difficult to understand what design brings to health care,” she says.

Erwin and Prakash knew these designers were out there. But where? What kind of work are they doing?

Eager for answers, Erwin, Prakash, graduate research assistants Arrenius Karunakaran (M.Des. + M.B.A. ’23), and Diana Nguyen (M.Des. ’23) worked to find these designers and health systems and collect their work and impact. Associate Professor of Visual Communication Tomoko Ichikawa and graduate student June Kulwadee Pruksananonda (M.Des. + M.B.A. ’25) supported, converting the data into a cohesive visual format. This became the foundation for the first-of-its-kind report: .

To begin, Erwin activated her professional network, but she found that she needed to widen her sample size. She and her team then scoured LinkedIn and requested referrals in hopes of finding more.

They found that more than 40 health systems across the U.S. employed designers.

After identifying the 40 systems, the team conducted 30-minute interviews with organizational leaders to get an understanding of the design roles, the nature of the design work being done, organizational hierarchies, and how design and its impact is measured. They then translated these interviews into a standardized template to make cross-system comparison easier.

But Erwin and Prakash wanted to make sure that their findings were authentic and accurate. After the templates were created, the team sent them back to the interviewees for review and approval. Each one of them sent back modifications, then the findings were made into visualizations to help readers easily scan and compare the teams and work of participating health systems.

These were then sent back to the health systems for review and approval once more.

“We took extreme pains to be inclusive in the shaping of any individual team’s story,” says Erwin. “We felt an obligation to allow them to shape that in a way that was both accurate, of course, but also comfortable. I think this makes the report feel more like creating a community rather than extracting information from people.”

The interviews helped Erwin, Prakash, and the rest of the team identify nine contributions that designers bring to the U.S. health system, with most of them engaging in four or more of those roles as part of their work.

“This broad application of design in what is typically a highly siloed organization suggests designers may be performing a unique role—acting as connectors and bridges between functional units, between strategy and frontline care, between processes and people,” says Erwin.

This highlights that designers may be the right resource to fill the gaps in care delivery.

In February 2024, when the team had developed a full draft of their findings, they held a meeting with an advisory council made up of 10 clinician leaders and design leaders to review the report and discuss the current state of design in the U.S. Erwin authored a commentary based on the discussion to serve as the forward for the report—reaffirming and solidifying that their findings were valuable to both audiences.

“I hope this report sparks an optimism in designers and health system leaders about the application of design in health care, and how they can work together to bring about process, organization, and system-level impact in the health system. Everyone—including clinical staff—benefits from care delivery that is more effective, patient-centered, and equitable,” says Prakash.

After nine months of interviewing designers, collecting data, analyzing findings, and putting their findings through the intricate approval/review process, Erwin and her team officially published The Role of Design in U.S. Health Systems in June 2024.

“I feel like I finally put a bow on something that I’ve been exploring for 10 years,” Erwin says.