The Missing Middle
In February 2025, 42 healthcare designers and physician leaders from across the US and Canada convened at the Institute of Design for Level Up.
Post-event, participants formed writing groups and developed their ideas with support from the Equitable Healthcare Lab.
The following pre-publication is one output of a Level Up writing group, released for community discussion and review.
Pre-Publication
The Missing Middle
The Missing Middle:
Why US Health Systems Need a Development Capability
By Gary Waymire, MArch; Kim Erwin, MDes;
Jan Yeager, MDes; Aimee Feuser, MS; and Saurabha Bhatnagar, MD
Most US health systems rely on quality improvement processes designed for incremental change. But today’s challenges—AI, value-based care, workforce shortages—require something different: a development capability that can prototype, test, and launch new solutions before rolling them out system-wide.
This paper from ID’s Equitable Healthcare Lab argues that hospitals need a “missing middle”—teams of designers, engineers, and researchers dedicated to translating strategy into real-world implementation. It’s the difference between fixing what’s broken and building what comes next.