Seeing the System

Design in health can help reveal what is unseeable — components, connections, dependencies — to foster understanding that's essential for change.

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José Colucci Jr., director for research and development for the Design Institute for Health

Maps help us find our way, showing us the terrain from a perspective that makes it possible for us to see beyond our limited vantage point — and to get from here to there.

Three years ago, a map of mine brought me from IDEO in Boston to The University of Texas at Austin to join the Design Institute for Health, the only design firm in the U.S. embedded in a medical school from the start.

Excited by Dell Medical School’s mission of revolutionizing how people get and stay healthy (in part by taking a health ecosystem approach to making Austin a model healthy city), one of the early interests of our team of designers was finding a diagram of how health care works in Travis County. This was important. To reimagine a system, we start by deeply understanding the current state: identifying all the components, including the connections and dependencies between them. The tool we as designers use to do this is called systems mapping, and it allows us to see what is otherwise unseeable.

There Is No Map?

The response to our inquiries was uniform: “There is no map. We all just know how it works.” This galvanized the design team and led to meetings with people and organizations throughout the community. What we learned was fascinating:

  • Every regional health care professional interviewed had a slightly different and partial view of the system.
  • The people experiencing the health care system but working outside it knew even less about how it worked or who the entities are and how they provide services.
A mockup of the Design Institute for Health's health ecosystem map drawn on a whiteboard.
A working map of the ecosystem of care in Travis County, Texas

Today, the Design Institute is actively and collaboratively iterating on an ecosystem of care map for Travis County. We intentionally describe it as “necessarily incomplete and possibly inaccurate, but urgently needed.” It shows the functioning of the machine of public health care represented by the flow of money going into the public system and the care delivered by the public system to the safety net population. It hasn’t described the commercial system at the same level of detail, but that is in future plans.

Embracing Uncomfortable Truths, Finding Meaningful Solutions

Releasing the map at this stage is unconventional. As designers, we are comfortable with putting something out in the world that is not quite right to elicit the feedback that will make it better.

The map is a work in progress — and it shows an imperfect system. At the Design Institute, we are excited by this state, because embracing the uncomfortable truths of where a system falls short is what enables us to see the opportunities to imagine a new way forward.

With a common view of the system, we can focus on finding meaningful solutions to key questions. How might we make an individual journey through this complex system feel more approachable and connected? How might we simplify and streamline the complexity of this system? And how might we move the focus of the ecosystem beyond health care, to health itself?


José Colucci Jr., Ph.D., is the director for research and development at the Design Institute for Health, a collaboration between Dell Med and the College of Fine Arts at The University of Texas at Austin.