What Happens When We Build Grief Into Infrastructure?
Introducing the Susan & Mark Feinglos Grief Initiative ~ and the questions that brought us here.
Every institution is designed to hold certain things.
Hospitals are designed to diagnose illness, deliver treatment, coordinate care, advance research, and improve outcomes. Schools are designed to educate. Libraries are designed to connect people with knowledge. Workplaces are designed to produce, collaborate, and create.
Yet every institution also becomes responsible for experiences it was never explicitly designed to hold.
Hope.
Uncertainty.
Joy.
Fear.
Loss.
And grief.
Whether acknowledged or not, grief moves through every system we build. It shapes the way people communicate, make decisions, form relationships, experience belonging, and remember moments that forever alter the course of their lives. It influences how clinicians care for patients, how families navigate impossible decisions, how colleagues support one another after difficult days, and how communities make meaning after loss.
Despite its presence, grief is often treated as something that exists outside the work of institutions rather than within them. It is understood as deeply personal, but rarely as something that also has organizational, cultural, and systemic dimensions.
At PAUSE, we have spent years exploring grief in communities, workplaces, libraries, schools, and public spaces. Again and again, we have found ourselves returning to the same realization: grief is not simply an individual experience. It is relational. It is cultural. It is shaped by place, by history, by identity, and by the systems we move through every day.
The question that has continued to emerge for us is a simple one:
What happens when we begin designing with grief in mind rather than treating it as an afterthought?
That question has become the foundation of the Susan & Mark Feinglos Grief Initiative.
Rather than beginning with solutions, this initiative begins with curiosity.
Rather than assuming what is needed, we are asking what can be learned.
Rather than arriving with a program to implement, we are spending time listening to the people who already understand these systems best—the clinicians, patients, families, researchers, community members, advocates, and partners whose lived experience offers insights that no report or framework could provide on its own.
We believe this distinction matters.
Too often, institutions respond to complex human experiences by asking, "What should we build?"
It is an understandable impulse. When we recognize a need, we naturally want to create something that addresses it.
But some of the most meaningful work begins with a different question.
What already exists?
Who is already holding this work?
What relationships have already been built?
What quiet acts of care happen every day without recognition?
What wisdom already lives within communities?
What barriers make care difficult to access?
What assumptions have gone unquestioned for so long that they have become invisible?
These are not questions that can be answered quickly. They require time, humility, and the willingness to sit with complexity.
That is why this first phase of our work is intentionally centered on listening.
Listening is often described as a preliminary step—a means of gathering information before the "real work" begins.
We see it differently.
Listening is the work.
Listening changes relationships. It uncovers patterns that data alone cannot reveal. It surfaces tensions, contradictions, strengths, and possibilities that remain hidden when organizations move too quickly toward intervention. It creates space for people whose experiences are often overlooked to shape the direction of what comes next.
Perhaps most importantly, listening reminds us that no institution exists in isolation.
Healthcare, like every system, is part of a larger ecosystem. The experiences people carry into hospitals and clinics are shaped long before they walk through the front door and continue long after they leave. Families, neighborhoods, faith communities, cultural traditions, artists, caregivers, libraries, schools, and countless other places all contribute to how grief is experienced and supported.
If we hope to strengthen care within institutions, we must also be willing to learn from the communities that surround them.
This initiative is rooted in that belief.
Over the coming months and years we will be documenting what we are learning through this work. Some of these reflections will explore questions about healthcare, grief, systems, and design. Others will introduce ideas emerging from conversations with providers, families, researchers, and community leaders. Still others will wrestle with topics for which there are no easy answers.
These essays are not intended to present definitive conclusions. They are invitations into an evolving conversation.
You will see us ask questions more often than we offer answers. You will see our thinking change as we learn. You will see moments where community wisdom reshapes our assumptions and where research challenges our instincts. That is not a sign that the work lacks direction. It is a sign that we are allowing the work to do what good listening always does: transform the people doing the listening.
At PAUSE, we know that grief asks something different of us.
It asks us to slow down when everything around us encourages speed. It asks us to pay attention to what is difficult to measure. It asks us to notice relationships that are easy to overlook. It reminds us that care is not only found in extraordinary moments, but also in ordinary gestures that communicate, "You are not carrying this alone."
Perhaps institutions are invited into that same work.
Perhaps the future of compassionate systems will not be defined solely by the technologies they adopt, the treatments they develop, or the efficiencies they achieve. Perhaps it will also be shaped by their willingness to understand the full complexity of the human experiences they are built to serve.
We do not yet know exactly where this project will lead.
That uncertainty is not something we are trying to eliminate.
It is something we hope to explore with openness, rigor, humility, and imagination.
We are grateful that you are here at the beginning.