When Dr. Rushika Fernandopulle founded Iora Health in 2010, he didn’t ask how to deliver primary care more efficiently within existing models. Instead, he started with design questions: If we could create primary care from scratch without constraints of current systems, what would it look like? Who would deliver it? How would teams organize? What would appointments involve? This design-first approach produced primary care that looks nothing like traditional practices health coaches outnumber physicians, appointments last as long as patients need, teams proactively reach out rather than waiting for patients to schedule visits, and group appointments address both medical and social needs. The results validate the design approach with Iora achieving 12-17% lower total medical costs while improving patient satisfaction and outcomes. Fernandopulle’s success illustrates healthcare leadership’s fundamental evolution from care delivery executing established protocols and managing operations efficiently to care design reimagining systems from first principles to solve problems existing models cannot address. This shift from manager to designer represents healthcare leadership’s next frontier as incremental improvements prove insufficient for challenges requiring systemic transformation.
Understanding the Care Delivery Mindset
Traditional healthcare leadership operates within care delivery paradigm emphasizing operational excellence, protocol adherence, efficiency improvement, and risk management. Leaders in this model focus on staffing adequacy, procedure throughput, regulatory compliance, and financial performance. Success means running existing systems well reducing wait times, preventing errors, maintaining quality standards, and achieving margin targets.
This care delivery orientation served reasonably well when healthcare primarily involved treating acute conditions through established protocols. A well-managed hospital could treat heart attacks, repair fractures, and remove appendices efficiently using standardized approaches refined over decades. Leadership required operational competence ensuring systems functioned reliably but not necessarily innovation or system redesign.
Contemporary healthcare challenges expose care delivery thinking’s limitations. Chronic diseases requiring behavior change and continuous management over years don’t fit episodic treatment models. Health disparities rooted in social determinants can’t be solved through better clinical protocol execution. Mental health crises overwhelming emergency departments won’t resolve through improved ED efficiency. These challenges require designing new care models rather than delivering existing models better a fundamentally different leadership mindset.
The Care Design Paradigm Shift
Care design leadership starts from different premises, viewing healthcare challenges as design problems requiring creative solution development rather than operational problems requiring execution improvement. This mindset involves questioning fundamental assumptions about how care should be organized, who should deliver it, where it should occur, and how success should be measured.
Design-oriented leaders ask questions that care delivery leaders rarely consider. Why must primary care happen in 15-minute appointments? Must physicians lead all care teams? Should diabetes management center on medication titration or cooking skills? Could community health workers prevent more hospital admissions than emergency department efficiency improvements? These questions challenge embedded assumptions that care delivery thinking accepts as constraints.
The design approach doesn’t reject operational excellence but recognizes that optimizing flawed systems produces suboptimal outcomes regardless of execution quality. A perfectly efficient system addressing the wrong problems at the wrong time in the wrong setting will never achieve the outcomes possible from redesigned systems attacking root causes through appropriate mechanisms.
Design Thinking in Healthcare Context
Healthcare leaders increasingly adopt design thinking methodologies developed in product design and innovation consulting. These approaches provide structured frameworks for moving from delivery to design mindsets through phases including deep empathy with end users and stakeholders, problem definition focusing on root causes rather than symptoms, ideation generating multiple potential solutions without premature filtering, rapid prototyping testing concepts before full implementation, and iteration refining based on real-world feedback.
Kaiser Permanente’s innovation consultancy demonstrates design thinking application in healthcare. The organization employs designers, anthropologists, and ethnographers alongside clinicians to observe care delivery, identify pain points, and prototype solutions. This multidisciplinary approach produced innovations like nurse knowledge exchange spaces improving communication, bedside shift reports enhancing care transitions, and quiet zones reducing patient sleep disruption improvements that operational management alone rarely generates because they require fresh perspectives on familiar problems.
From Patients to People: Design for Human Needs
Care design leadership centers human experience rather than clinical protocols as starting point. This shift involves spending time with patients in their homes and communities rather than only clinical settings, understanding barriers to care access and adherence, recognizing how care fits within lives filled with competing demands, and acknowledging that medical needs represent subset of holistic human needs.
ChenMed’s approach to Medicare beneficiaries demonstrates human-centered design. The company’s physicians limit panels to 450 patients rather than industry standard 2,500, enabling genuine relationship development. Clinical teams spend time understanding patients’ lives including housing stability, food access, family support, and life goals. This deep understanding enables designing care addressing actual barriers to health rather than simply prescribing medications patients can’t afford or recommending diets impossible in their food environments.
Prototyping and Experimentation
Care design requires tolerance for experimentation and controlled failure foreign to care delivery culture emphasizing standardization and risk avoidance. Design-oriented leaders create safe spaces for trying new approaches, learning from failures, and iterating toward solutions through successive approximation rather than demanding perfect execution of untested plans.
Geisinger Health System’s Fresh Food Farmacy illustrates experimentation mindset. Rather than simply counseling diabetic patients about nutrition, Geisinger piloted providing fresh produce and recipes directly to food-insecure patients. Initial pilots revealed implementation challenges including distribution logistics, cultural food preferences, and cooking skill gaps. Iterative refinement addressing these discoveries produced a model reducing hemoglobin A1c levels significantly while lowering overall medical costs. This outcome required tolerating initial imperfection and learning through implementation rather than planning comprehensively before acting.
Multidisciplinary Collaboration as Design Imperative
Care design demands perspectives beyond clinical expertise. Effective design teams include patients and families bringing lived experience, community health workers understanding social contexts, behavioral scientists explaining human motivation, data scientists revealing patterns, designers applying human-centered methods, and operations specialists ensuring feasible implementation.
This multidisciplinary collaboration challenges healthcare’s traditional hierarchy where physician expertise dominates decision-making. Design thinking recognizes that while physicians understand clinical pathology, patients understand their own lives, social workers understand community resources, and designers understand experience creation. Optimal solutions emerge from synthesizing these diverse perspectives rather than privileging single expertise types.
Systems Thinking and Interconnection
Care design requires systems thinking recognizing that healthcare operates as interconnected ecosystem where interventions in one area affect others often unpredictably. Design-oriented leaders map these interconnections, anticipate ripple effects, and design holistically rather than optimizing individual components.
Oregon’s coordinated care organizations demonstrate systems thinking in practice. These entities integrate physical health, mental health, and addiction treatment under unified governance and financing. This design recognizes that treating physical disease without addressing mental health or substance use disorders produces poor outcomes, that siloed funding creates perverse incentives, and that coordination requires organizational structures enabling it rather than simply encouraging it rhetorically.
Measuring What Matters
Care design demands different success metrics than care delivery management. Traditional measures emphasizing efficiency, volume, and process compliance give way to outcome-focused metrics including health improvements sustained over time, total cost of care across all settings, patient activation and engagement levels, health equity across population segments, and system adaptability to emerging needs.
Developing Design Capabilities
Transitioning from delivery to design mindsets requires deliberate capability development. Healthcare leaders need exposure to design thinking methodologies through formal training, time with patients outside clinical settings building empathy, practice with rapid prototyping and iteration, comfort with ambiguity during exploration phases, and collaboration skills working across disciplinary boundaries.
Progressive healthcare organizations now invest in innovation labs, design consultancies, and leadership development programs building these capabilities. They recognize that future competitive advantages belong to organizations that can design new care models as challenges evolve rather than those that merely execute current models efficiently.
Conclusion
Healthcare’s transition from care delivery to care design represents fundamental leadership evolution from operational management to innovative system creation. The challenges confronting healthcare chronic disease, health equity, behavioral health, social determinants require designing new approaches rather than delivering existing models more efficiently. The leaders and organizations making this transition successfully demonstrate that care design isn’t abandoning operational excellence but building on it with creativity, experimentation, and human-centered innovation.
For healthcare leaders, the imperative involves developing design capabilities alongside operational competencies, creating organizational cultures where experimentation and learning are valued alongside execution and compliance, and recognizing that healthcare’s future belongs to those who can imagine and build care systems matching 21st century health needs rather than perfecting 20th century models designed for problems we no longer face.
