In a rapidly evolving context, multi-agent service systems need to adapt and respond to change as it occurs. We investigate how Service Design, as a human-centred, transformative and creative approach can support service systems transformation. Our healthcare case study on the utilisation of service design for systemic transformation indicates that collaborative participation and coordination, leadership, ownership, alignment of perspectives and arenas for experimentation are important precursors that foster resilience and support transformations. We reposition service design as an enabler of service system resilience and define systemic resilience as the collective capacity for intentional action in responding to ongoing change, coordinated across scales in order to create value.