Classical Pragmatism, Particularly The Work of John Dewey, has been foundational to the development of design as a discipline, although rarely directly acknowledged within the literature on design (Dixon 6–7). Recognizing the ways in which the dominant design paradigm reproduces coloniality and modernity (Akama et al. 60–62), I argue that going back to design's roots in pragmatism can aid in building a more embodied, situated, and pluralistic design practice. In an attempt to counter the epistemic and ontological injustices perpetuated by design, I support the effort of redesigning design by drawing on pragmatist thinking to present alternative design practices aimed at building reflexivity. In doing so, I bring forward demonstrations of how design practice might act as “engaged philosophy,” practically addressing issues in their social context (Hamington and Bardwell-Jones 1–6), with the aim of supporting intentional adaptation within a pluralistic, democratic society.Before I begin, it is important for me to position that I am writing this from Oslo, Norway, the city with the largest urban population of Sámi people, an Indigenous people that inhabit and have been stewarding the land across large northern parts of Norway, Sweden, Finland, and Russia for thousands of years. I grew up as a settler of Dutch ancestry on the land of the Anishinabewaki and Mississauga First Nations on Turtle Island, or what is now commonly known as Ontario, Canada. I am grateful for the opportunity to work and learn on these lands and thankful to all of the generations of people who have taken care of this land. I also want to acknowledge the historic and present-day injustices faced by Indigenous peoples, which require our collective responsibility and commitment to challenge and address. Recognizing the ways in which our democracies are entangled in coloniality, working intentionally toward decolonizing our societal structures is fundamental to respecting plurality with democracies.The design practice and research that I present here has taken place within the context of health and care systems in Canada, Sweden, and Norway. This work is positioned in relation to institutionalized Western medical systems that continue to perpetuate epistemic and ontological injustice, justifying the exclusion of divergent ways of knowing and being. Health care systems are recognized as carriers of modernity, perpetuating social structures that reflect care as a commodifiable resource (Gallagher 65–67). Design is entangled within these systems both implicitly, through the intentional actions of a wide variety of health care stakeholders, and explicitly in the work of a growing number of professional designers hired within Western health care systems (Mager 9; Molloy 16–18). Take, for example, Bardwell-Jones's study of placental ethics within hospital settings in Hawai‘i. She illustrates how the universal health policies associated with “modern” biomedical approaches can actively undermine local knowledges, in this case, of Indigenous Hawaiians (103). Here, I position this research in response to Bardwell-Jones's call for health care administrators to cultivate epistemic humility and resistant imaginations (108). I bring forward design practices that may aid in integrating the incommensurability of a perplexing situation (Addams 20) and support people's ability to stay curious about other ways of being within and across diverse communities.I enter into this dialogue by first opening up the conversation about the role of the dominant design paradigm in advancing “the modernity project” and highlighting the need to decolonize design. I move into explorations of how we might redesign design by focusing on building reflexivity and sharing stories of alternative design approaches that draw on the thinking of both classic and feminist pragmatists. Finally, I end with a discussion of the role of design as an everyday world-making practice that can aid in resisting epistemic injustice and ontological occupation to nurture plurality amid democracy.Design is an intentional world-making practice in which people shape their environment and, in turn, the environment shapes people (Willis, “Ontological Designing” 70). The dominant Eurocentric design practice emphasizes commercialized, standardized, and disembodied practices of designing, inadvertently, and sometimes even overtly, contributing to the erosion of democratic life. As highlighted by Willis (Design Philosophy Reader 2), “when a question of a philosophical character is posed, such as ‘what is design?’ the answer is mostly already over-determined by the model of professional design as the model of all designing.” In this way, globally dominant Eurocentric professional design practice has become synonymous with what is understood as being within the boundaries of the design discipline (Fry, “Design for/by ‘The Global South’” 25). This dominant understanding of design undermines the domestic design work that women have been doing in the home for centuries (Weltge 58) and relegates traditional forms of design in Indigenous communities and the Global South to the distinct label of “craft” (Tunstall 235).Increasingly, the design profession has adopted common frameworks to guide design practice, such as the double diamond (popularized by the UK Design Council), which presents a universal approach to problem solving, and a variety of human-centered design toolkits that tout the applicability of design methods to support problem solving across contexts (Akama et al. 60–62). Through these frameworks and toolkits, the designer convinces “non-design experts,” from other professions to grassroots communities, that following their structured, universal process can get the desired results (Ansari, “Politics and Method”). In this way, design methods are seen as something that can be separated from the practicing designer, exported and commodified for repeatability (Akama and Prendiville 32). The portability of methods within human-centered design has the potential to undermine the deep cultural differences within local contexts (Duan et al. 272; Lee 21). For example, the application of a common design method, often referred to as the “user journey,” where a person maps the steps of a “user” as they move through the use of a product or service, emphasizes the individual experience and may inadvertently undermine the importance of relations, which are central in cultures that emphasize collectivity.Popular practices of superficial empathy within these design methods often promote single-mindedness, projection, and otherness (Vink and Oertzen 473). In addition, some popularized methods associated with “design thinking,” such as the use of Post-it Notes to brainstorm ideas, emphasize the Cartesian divide between mind and body, furthering a cognitivist perspective that inadvertently downplays the role of the body (Wetter-Edman et al. 5). While the common narrative is that these methods allow for creative participation, there is growing acknowledgment that many design methods act as effective tools of coloniality, disciplining participants’ perception of the world (Tlostanova 53). Design tools are not value-neutral, as is often claimed, but are rather created through the politics of their makers (Ansari, “Politics and Method”). These methods often suppress the mess and multiplicity of realities, directing participants toward a predefined understanding of what is good [Vink et al., “Designing Good(s)?” 967]. Such tools often perpetuate imperialism by reinforcing the hierarchy of Western design companies and undermining local ways of designing (Tunstall 236). This dominant practice of design, honed in the Global North, is a product of colonialism working to further Eurocentric notions of progress and modernity (Fry, “Design for/by ‘The Global South’” 7).To exemplify the ways in which dominant design practice can contribute to the reproduction of coloniality and modernity, I draw from my own experience as a designer. Approximately ten years ago, I was assigned to work on the design of a housing plan for elders in the North Shore Tribal Council. The North Shore Tribal Council includes seven First Nation communities—Batchewana, Garden River, Mississauga, Thessalon, Sagamok, Serpent River, and Whitefish Lake—distributed between the cities of Sudbury and Sault Ste. Marie in so-called Ontario, Canada. The firm I worked for was hired by the Tribal Council as consultants to develop a plan that recognized a growing number of elders, the dire state of repair that many homes were in, and the lack of cultural fit between the needs of local elders and the existing long-term care options off-reserve. Many of these elders had been forcibly removed from their families when they were children and placed in residential schools in order to reduce cultural ties and indoctrinate them into the dominant culture of Euro-Christian Canadian society.This exercise, one of many supposedly replicable design methods, shows how professional design practice can contribute to the erosion of other ways of knowing. Instead of fully supporting local knowledge and approaches to self-governance, we replicated the dominant design practice, informed by the institutionalized approaches of design that I had been taught in school, seeing it as the most promising way forward to deliver progressive housing options for this community. Through our process, we ended up mirroring “solutions” considered progressive in settler communities, such as supportive housing services. While we attempted to consider local culture in the design of the facilitation, I see now that the underlying methods used, such as dot voting to select promising predetermined solutions, perpetuated a narrow, colonial mind-set focused on modernity. In doing so, our approach failed to learn from the ways of designing that generations of ancestors had been enacting on this land in harmony with nature for thousands of years.However, it was not until years later when these blind spots were pointed out to me by black community organizers and activists that I came to appreciate the ways in which I was imposing a standard model of design onto communities, even amid participatory design practice. Several years later, when I was working at a hospital in Toronto, I was facilitating our first “town hall” meeting to kick off an initiative to improve the local mental health service across sectors in Northwest Toronto. We had prepared several months for this launch and worked actively in the weeks leading up to the meeting to invite participants from across sectors and cultural backgrounds, attempting to ensure that the diversity of the community was reflected within this collaboration. Figure 2 and the story below describe what transpired at the beginning of that initiative.This was one among many lessons over the next several years that taught me, through the labor of mostly racialized community members, about the tensions inherent in the model of design that I was taught and that was increasingly being promoted by and integrated into Western health care systems. Through this project and reading the work of critical design scholars, I began to understand the colonial nature of dominant design and recognize the urgent need to decolonize design practice. By my use of the term “colonial” here, I refer to European political domination that undermines the self-definition of people (Tunstall 233). The calls for decolonizing design make reference to a political project that requires a substantive redesigning of the dominant culture of design practice (Schultz et al. 82). Such calls demand challenging and reconfiguring modern institutions through a critical examination of how the material-symbolic aspects of the artificial, brought into being through design, contribute to modernization through colonialism (Schultz et al. 83). As a world-making practice, which often fails to recognize its own influence and pervasiveness, there is a need for a more explicit engagement between design and critical societal issues, such as democracy (Escobar, Designs for the Pluriverse 133). This work demands exploration into how design can support the de-centering of dominant ways of knowing, and more consciously engage in “collective world-making projects, in all of their heterogeneity and contradictions” (Escobar, Designs for the Pluriverse 143).As an offering to this political project of redesigning design, I explore the ways in which pragmatist philosophy might be leveraged to redirect and re-imagine design practice. While the design discipline has been largely oriented around a professional practice that facilitates progress toward modernity, or what is often touted “as the common good,” the generic activity of designing is actually much more pervasive, mundane, and pluralistic. Designing has been around even before humans existed, as the creation and use of tools was part of the evolution of the human species (Fry, “In the Beginning” 15). Fundamental to the activity of designing is intentional or purposeful shaping (Nelson and Stoltermann 19), but this can take on many forms. While all individuals and communities design, “the problem is that although design capability is a widespread human capacity, to be usable it must be cultivated. This does not usually happen, or it happens in an inadequate way” (Manzini 1). In particular within culturally diverse democracies, the challenge becomes not how to deliver the tools of dominant design to the masses, furthering coloniality through design, but rather how to cultivate the unique design capabilities of these individuals and communities so that they might take up a more active role in shaping their worlds in their own way. Here, the goal becomes “autonomous design” where the conditions exist for communities to change their worlds from within (Escobar, Designs for the Pluriverse 184). This is aligned with the vision of “designing communities” in which all those who serve, are served by, or are affected by a social system are part of its ongoing redesigning (Banathy 237).What would it mean for the design discipline to reorient itself toward such an aspiration? It is here that I believe the central concept of “reflexivity” from pragmatist George Herbert Mead can offer some valuable insight into how design capabilities might be cultivated without pre-determining the design process or direction. I define “reflexivity” as a dynamic process of cultivating an awareness of the multiplicity of social structures internalized by oneself and others. Mead (134) highlights that reflexivity is the means by which individuals are able to consciously and creatively adjust themselves through a given social act. As such, reflexivity is the foundation for the more generic human activity of designing as intentional shaping. For Mead, the consciousness of oneself can only come about through a social process of taking on the role of the other informed by a conversation of gestures. Mead also acknowledges that the self is a reflection of the social structures of society and that through individuals’ actions, they shape those social structures, transforming society. He articulates the ideal of human social progress being a society in which all humans possess a reflexiveness, which allows them to consciously adjust their actions and their society.Like Mead's process of reflexive thinking, John Dewey's (107) process of inquiry suggests that reflexive capabilities are triggered by the experience of an unsettling situation where the context does not align with one's habits, and thus the doubtful experience invokes a process of sensemaking. Both Dewey and Mead recognize that human experience is mainly guided by habit rather than reflexivity, acknowledging the guiding influence of social structures toward conformity. However, it is the experience of discomfort, disturbing and confusing the experiencer, that opens up for the possibility of intentional action. Pragmatists offer a robust understanding of “situated creativity” in which people intentionally construct their environments, while their environments are shaping human subjectivity (Collins 10). This can help to inform a more embedded and experiential understanding of designing amid social context. In particular, pragmatist philosophy informs how building reflexivity provides a foundation for the autonomous designing of communities. Figure 3 shows the embedded feedback loop of reflexivity and reformation that I understand as design, which works within an ongoing process of reproduction (for more details, see Vink et al., “Service Ecosystem Design” 175).Taking this even further, the thoughts and actions specifically of feminist pragmatists become increasingly relevant to inform the development of alternative design practices that actively resist the forces of modernity and open up for divergent ways of designing amid democracies. Feminist pragmatists offer a contextual, action-oriented approach to philosophical activism (Lake 29) and an “engaged philosophy” that supports the local transformation of society toward social justice and pluralism (Hamington and Bardwell-Jones 1–6). This work highlights how pragmatist philosophy can help to inform social justice projects, such as advancing the understanding of intersectionality (Collins 1) and challenging systemic racism (Sullivan, “Reciprocal Relations” 49), but also the ways in which pragmatism itself must advance to more effectively address these pressing concerns in society. In what follows, I present alternative, situated design practices partially inspired by the thinking of feminist pragmatists. These practices were designed to cultivate reflexivity among Scandinavian health care administrators and designers so they might resist the arrangements of dominant social structures that perpetuate coloniality and modernity. Below, I introduce practices that explore the cultivation of reflexivity at the micro-level of individuals and groups, as well as at meso-level of organizations and communities. At the end, I briefly touch on how this might contribute to intentional, emergent change at the macro-level within democracies.One alternative design approach that supports building reflexivity at the micro-level of individuals and groups is the act of prompting aesthetic disruption. Catalyzing aesthetic disruption involves intentionally creating bodily situations whereby individuals experience conflict or contradictions through their senses, thus triggering a process of inquiry (Wetter-Edman et al. 14). This process has the potential to destabilize individual habits and, in doing so, cultivate reflexivity and enable the intentional reshaping of social structures. In previous research, we have also shown how this embodied experience, prompted through heterogenous objects and ways of relating, can shed light on taken-for-granted mental models—the assumptions and beliefs that guide individuals’ behavior and interpretation of their environment and underpin institutionalized social structures (Vink et al., “Designing for Aesthetic Disruption” S2169; Vink et al., “Reshaping Mental Models” 84). In this way, such an act works to reconcile the dichotomy between mind and body often perpetuated through design methods, and instead leverages the ways in which the mind is intimately interlinked with the experience of the body and its environment.This approach of prompting aesthetic disruption can be connected to promoting the embodied experience of perplexity, the emergent sense that something does not feel right, or is out of balance, when personally involved in dealing with difference. As outlined by Jane Addams, this process can alert us to the blind spots of existing epistemologies (Bardwell-Jones 107). Inspired by feminist pragmatists, purposefully prompting aesthetic disruption is one alternative design practice that confronts dominant epistemologies and opens up rigid epistemological frameworks for reconfiguration. Such an approach could aid in the development of resistant imaginations that enable the adjustment of epistemological frameworks by learning from diverse social contexts. In this way, perhaps design practice could aid health care service providers in building humility toward “the burdensome task of ‘knowing what's best’ . . . and also to become intellectually curious of other ways of viewing processes of health and well-being in a diverse community” (Bardwell-Jones 111). To contextualize the act of staging aesthetic disruption, I will share an example of a local intervention made by my colleague, designer Felicia Nilsson, in her work collaborating with Experio Lab in Eskilstuna, Sweden. The story that follows describes this example paired with an illustration of this attempt at aesthetic disruption in Figure 4.This act of staging aesthetic disruption through corporal engagement with the double stethoscope prompts reflection on the dominant epistemology of professional medical practice and challenges the assumptions of the technological and modern within our health care system. This staged situation confronts medical practitioners with a moment of perplexity where they are then invited to acknowledge the ways in which their habitualized actions are undermining the diverse ways of knowing of patients. In this way, this local design practice acts as a form of epistemological resistance prompting clinicians to reflect on their blind spots and habitualized ways of knowing within the clinic. The embodied, social act of working with the double stethoscope helps those participating to cultivate reflexivity on their everyday action and enables the opportunity for redesigning their ways of working.Sullivan (Across and Through Skins 13) highlights how such a process is indeed ontological as corporeal existence and environments are dynamically co-constitutive and engaged in an ongoing process of being formed. By being confronted with the double stethoscope and working through the discomfort of how it can be used in the transaction between bodies, this experience aids health care clinicians in reflecting on the ways in which their bodies are composed of habits. Building on Sullivan's (Across and Through Skins 15) metaphor of the stew to illuminate the ways in which bodies and environments are co-constituted in transaction, this embodied experience prompts clinicians to reflect on the ways in which they are “onion-y carrots,” in that their transactions with their environment (including with the patients, stethoscope, chairs, room, etc.) make them what they become. As well, they start to see the ways in which patients are “carrot-y onions,” in that patients’ ways of being and interacting are intermingled with and informed by that of the clinician and their tools. The act of aesthetic disruption makes this process of stewing—a dynamic back-and-forth between entities that are both separate and together—more visible. The reflexivity it cultivates allows for a critical examination of the benefits and harms of what bodies do in medical interactions. This reflexivity enables slippage and divergence from the habitualized actions that constitute the dominant social structures of “modern” universal health care through more intentional actions.Prompting aesthetic disruption is one example of a design practice that might support building reflexivity through relational and embodied approaches. It is important to note, however, that such practices are not just needed for designers to support the disruption of others, but that there is also a strong need for practices that support people, including designers, in disrupting themselves. Myself and my colleagues have been experimenting with a number of other related approaches (Vink et al., “Designerly Approaches” 247). Another approach we have explored is day in my life, where individuals are invited to draw a storyboard of their typical day and share it with a small group. Then the other group members help them unpack some of the underlying social structures at play within their habitualized actions, including entrenched rules, norms, roles, and beliefs. A further approach we have been exploring is what we call social structure archaeology. This experimental approach involves doing ethnography in a specific context with attention to the embedded social structures and then re-creating the artifacts that were understood to play a prominent role in upholding existing social structures. For example, when doing social structure archaeology in the context of an infection ward, we reconstructed in paper the antibacterial hand pump and the hallway before a patient's room as they played important roles in upholding social structures related to hygiene. These design approaches are meant to explicate some of the taken-for-granted social structures guiding our actions, helping us to understand the “stew” that we are in and our own role in it.While prompting individual reflexivity is an important opening for situated creativity amid dominant social structures, feminist pragmatists reinforce that cultivating collective reflexivity requires sustained community efforts. In particular, the foundational work of Jane Addams shows how political engagement can play out as a way of life, rather than a one-off activity, including by creating and maintaining relations between social groups (Sullivan, “Reciprocal Relations” 54). Addams offers a model for how one can work at the system's edge in an ongoing way, moving along and across borders and attending to expulsion and exclusion created through system boundaries (Dorstewitz 369). Grace Lee Boggs is another example of a feminist pragmatist who lived out a commitment to relational dialogue across difference (Lake 31). Boggs's life work demonstrates the importance of ongoing dialogue and interaction between worlds that moves through cyclical processes of reflection and creative action. What is consistent across the practical engagements of feminist pragmatists is joint critical examination and action over time that works toward situated, relational, sustained, and transformative action.For the project of redesigning design, the model demonstrated by feminist pragmatists suggests the need to co-create lasting infrastructure that supports ongoing collective reflexivity amid plurality. Aligned with this model, I take further inspiration from the concept of the “uncommons” coined by Blaser and de la Cadena (185), which is illustrated in Figure 6. The uncommons challenges the idea of the world as shared ground and implies that people come together amid an ever-changing process of divergence. Rather than assume ontological continuity as is done in the discussions of the “commons,” the uncommons sees that below the surface of the commons, there are productive divergences—not simply comparable cultural differences, but uniquely different worlds. The uncommons is a coming together of heterogenous groups where ongoing negotiations can take place toward a commons that never fully manifests, recognizing its ever-divergent starting point (de la Cadena and Blaser 19). This concept is aligned with Sullivan's metaphor of the stew in that it recognizes the simultaneous continuity and discontinuity amid the heterogenous, but also co-constitutive, assemblages of transactions.To show how the design approach of sustaining the uncommons might take place, I share an example of the work that I have been doing with my colleagues as part of the Center for Connected Care (C3) in Norway. At present, the center is focused on supporting the transition from a centralized model of health care, where patients go to the hospital for care, toward a decentralized model where new health care services are being developed and implemented to provide “remote” care in patients’ homes. This piecemeal transition that is taking place has been significantly expedited over the last year in response to the Covid-19 pandemic. Rather than simply facilitating this system transition based on an assumption that there is a shared vision, or that it supports the common good, we established a three-year design initiative called the “perspectives in transition project” that brings diverse stakeholders together—from hospital staff and administrators, municipal health care providers, designers and innovators, technologists and strategists from health technology companies, nonprofit organizations supporting informal care, researchers, and students as well as patients and family members—with divergent ways of knowing and being. This initiative puts these stakeholders into regular dialogue in which they explore their divergences.As this project has continued over the last year through in-person and online dialogues supported by physical artifacts and prompts, we have come to better appreciate the ways in which this shift toward decentralized care that is highlighted as “the common good” risks the unquestioned replication of “modern” universal health care onto diverse communities with different ways of viewing and enacting health and care. We have seen through examples how different realities within this transition are being enacted through different practices in health and care. Here, realities of patients and families guided by cultures different from the dominant Norwegian culture are often ignored, perpetuating a colonial “one-world world” that emphasizes one reality and discounts others (Law 127). Within this three-year project, these disruptions move beyond temporary moments of unease and start to act as ongoing friction, not necessarily in trying to halt this shift toward decentralized care altogether but to help those serving, being served, and affected by these systems to become aware of and challenge the underlying social structures guiding this transition. Through this collective awareness, these organizations and communities can work togethe