Hi, Ken. Regenstrief is one of two places I have worked in the past 15 years I would return to and I wholeheartedly agree with you — they made a difference and challenged the norms. I have nothing but good things to say about them. So, there are organizations in this country where much of what I have written here does not apply.
On design systems: I am not entirely opposed to them (as I have made clear in my responses above/below). I believe they are a necessary quality measure and as you so aptly put it, “a guide.”
Great comment and thanks for taking the time to read and engage!