Herbert Simon, the great computer scientist, created the best definition of design that I can think of. He said, "Whenever we intentionally shape our world to suit ourselves, we're designing." Right? Whenever we're not doing that, the world is happening to us.
When somebody 100,000 years ago picked up a stone and a flint and started hacking away at it to make something that could cut hide better, they were designing because they were intentionally shaping the world. So at some level, we have always done it.
The Shakers were great designers because they wanted to make the world that they lived in more efficient, and somehow for them beauty was efficiency, and so we tend to think of chairs or spinning wheels or farm implements or flatware as the things that we shape in the world around us.
But the fact is that our systems are the same, or can be the same. When we start to connect all these things up together in healthcare or education we are beginning to design a system. So we can do it; it's just that sometimes we don't think to do it.