Using Co-design to transform our services, policies and systems

What is Co-design?

What is Co-design?

 

Despite the increase in popularity, confusion remains around what Co-design is and is not. It’s easy to get lost in the messy landscape of design, innovation and research methods. It’s also easy to dress up other methods that do not involve power sharing (e.g. consultation) and call them ‘Co-design.’ Labelling something ‘Co-design’ does not make it so.

This section includes:

  • A series of definitions

  • Key principles of Co-design

  • A guide to recognising authentic Co-design

  • A tool to differentiate Co-design from other approaches

  • Conditions for Co-design

  • Benefits and outcomes

  • What Co-design isn’t (myths)

Co-design is a movement, method and mindset

Co-design recognises that people know their lives best and are deserving of playing an active role in the decisions that shape their lives. It acknowledges that they are creative, given the right conditions. As a social movement, Co-design is about challenging the imbalance of power held within select groups of individuals, who make important decisions about others lives, resources and bodies. Often, with little to no context about them, let alone meaningful involvement of those who will be most impacted by the change. By contrast, Co-design is about bringing together those who will be most impacted, with those tasked to deliver the change. It is about working and learning together. Sharing knowledge and most importantly, sharing power.

How might we encounter each other in new ways that fix each other less, demean each other less and allow for new potential to emerge?
— Christian Penny

Co-design is one aspect of Co-production. Without Co-design there is no Co-production. Slay and Stephens (2013) describe Co-production as “a relationship where professionals and citizens share power to plan and deliver support together, recognising that both partners have vital contributions to make in order to improve quality of life for people and communities” (p.3).

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In contrast to Co-production, Co-design often happens after an agenda has been set. I focus predominantly on Co-design as many of our systems are still grappling with venturing outside their offices, let alone moving to Co-Production. Jumping straight to Co-production would be equivalent to moving straight from travelling by foot to going via a high powered sports car. Accidents and casualties are galore. While I see Co-Production as our ultimate aim - I believe Co-design is a transformative approach that can build capacity and capability towards getting there.

Principles

Alongside the Mindsets for Co-design, I focus on four fundamental principles for Co-design. They are drawn from my own practice, as well as several other frameworks and ways of working (The ReCollective Way, Equity-Centred Design, Liz Sanders work, Co-Production, as well as Penny Hagan’s work).

  1. Sharing power

    Acknowledging, exploring and addressing power differentials is essential to Co-design. Power can be related to our inherited privilege, financial position, our ability to communicate influentially, who our friends are, and where we are from. When differences in power are unacknowledged and unaddressed, those with the most power have the greatest influence, regardless of the quality of their ideas. Exploring power is challenging as it tends to be highly visible to those who don’t have it, and often mostly invisible to those who do. We must find ways of sharing power in decision making, allocating resources, deciding on and delivering outcomes. Without it, there is no Co-design or Co-production.

  2. Prioritising relationships

    Co-design starts with relationships, social connection and trust. You cannot buy commitment, it can only be earned. If we want our systems to produce better outcomes, we need new relationships between professionals and people with lived experience of an issue or challenge. Relationships grounded in mutual learning, curiosity and respect. The quality of social connection has a direct to the quality of what is produced through Co-design. Strong alliances between Co-designers pave the way for challenging conversations. Conversations where we confront the elephants in the room.

  3. Participatory means

    Across all Co-design effort is a commitment to working in participatory ways. Participatory approaches move people from passive participants into active partners. They focus on building people’s comprehension of critical information, providing entry into complex decision making, enable people to play a role in designing and refining. It is about making information highly accessible. Drawing on visual and audio approaches, over-reliance on writing and onerous reports. Participatory approaches aren’t about teaching people, they are about people making their own discoveries. That is what really imprints learning and fosters commitment.

  4. Building capability

    Many people require support to build their capability and self-efficacy to become Co-designers and play an active role in a Co-design process. Without that capability uplift, we risk taking along passive recipients. We have not created the right conditions for their active participation. Capability development often involves building trust in the value of our voice, learning and embodying the mindsets, practical skills around research and design, systems thinking, and practising interpersonal flexibility. While it’s not easy building capability or self-efficacy, we must be in the business of doing so if we’re to promote inclusion and community-led action — as opposed to further exclusion.

Recognising Co-design

I think it is less helpful to prescribe a strict process and instead describe a range of conditions to be met. If the conditions are present - we are doing Co-design. If they are not, nope.

  1. Are people with lived experience and professionals involved as active partners (Co-designers) throughout the innovation process from problem-seeing to problem-solving?

  2. Are we building the capability of Co-designers? For example, in research, identifying opportunities, conceptual design, prototyping, implementation, monitoring and evaluation.

  3. Are proposed approaches evaluated from the perspective of whether they create value for the people they’re intended to serve? Are they naming the outcomes that matter most to them?

  4. Is power named, challenged and negotiated?

People are not merely repositories of need or recipients of services, but they are the very resource that can turn public services around.
— Stephens et al, 2000


Differentiating Co-design and other approaches

Being in the landscape of design can feel like the wild west. Approaches can be hard to tell apart for both funders and those being invited to take part in a project or initiative. Unlike many other fields and disciplines, Co-design currently lacks a set of standards that can be applied to judge it’s quality, efficacy and safety (among other things).

The table within this section describes how I see the differences in approaches, focusing on:

  • Where power is held, especially when it comes to decision making

  • Whether the people who are intended to benefit have a role (and if so, what?)

  • The suitability of approaches to particular contexts.

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Conditions for Co-design

It’s common to set out boldly, only to be derailed through a lack of sponsorship and resource or a lack of broader organisational or community commitment. It’s crucial we understand the conditions for Co-design. Not to stop us from acting, but rather help us to understand what kinds of obligations and structures need to be established to have Co-design stay and thrive within our context.

I’ve worked with many teams to assess their team and organisation against the conditions, and develop strategies to create a more favourable set of circumstances. While we should not let a lack of conditions stop us - we do have to be honest about the genuine chance of process failure and share that with Co-designers. If we have very few to no conditions - perhaps our focus should be on building the conditions, instead of doing the work. While we can do both, that does require a set of specialist skills - and honesty with Co-designers.

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My experience

I’ve used a wide range of approaches to work with people to understand and better meet their needs through programs, services, policies and systems. What I know to be true is:

  • There is a significant need for Co-design in places where power imbalances are substantial, historic and enduring. For example, in mental health, hospitals, policing and justice, welfare. Applying Co-design to those settings is an important task that requires specialist skills.

  • Being able to tell our story and have it taken seriously matters. However, telling our story isn’t always enough. Sometimes we need action and want a seat at the table. We have to make more seats available.

  • If our systems are to produce better outcomes, we need new relationships between professionals and people with lived experience. Relationships grounded in mutual learning and respect. We have to stop keeping people in different groups and different rooms. Nothing changes when we do that.

  • Co-design changes us, and we have to let it.

Benefits

The benefits of Co-design sit across several levels. I classify them into three main categories, pictured below:

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When it comes to process outputs, practice-based evidence suggests Co-design produces:

  • Better matching of services to people’s needs, improved outcomes of service and service utilisation

  • Increased staff satisfaction in delivering an useful service that people value

  • Better use of resources reduced waste.

  • When it comes to personal and professional outcomes, Co-designers often report:

    • Increase self-efficacy

    • Strengthened social connections

    • Strengthened understanding of their condition/situation and where to access support

    • Skill improvement (critical analysis, research, design, evaluation etc.)

    • Identification of new career opportunities, including Co-design and lived experience work.

    For professionals:

    • a deeper understanding of the people they serve (including the diversity of their needs)

    • a deeper understanding of how people experience the care they and others provide

    • improved curiosity and ability to challenge assumptions (leading to improved outcomes in working with clients).

  • When it comes to systems outcomes, we hope to see (among other results):

    • Improved capacity to manage and commission Co-design

    • Increased and improved involvement of people with lived experience in critical decision making

    • Improved trust in systems, including their ability to listen and respond to user feedback

    • New relationships between those helping and being helped - moving away from paternalistic and assumption-driven models of care.


What Co-design isn’t

Co-design is not:

  • Throwing out professional expertise. Instead, we’re bringing professional experience alongside lived experience to develop a more robust understanding and foster mutual learning. That can produce stronger solutions and provide immense professional and personal development for professionals.

  • Too expensive to consider. Investing in a Co-design process can be more costly than a consultation in the short term. However, with Co-design, we pay now to avoid paying later. Co-design builds long term commitment. By contrast, consultation often gives the illusion we’ve bought people on board - only to have them then fall overboard. With consultation, we pay later - often in costly, public and damaging ways.

  • Ignoring evidence. Co-design should not ignore the evidence. Instead, the Facilitator or Design Coach must work hard to bring relevant evidence into the process in accessible ways. They must also help the group to evolve their understanding of what ‘evidence is’ (bringing value to everyday people’s stories and experiences).

  • Having workshops to ask people’s opinions, but excluding them from critical decision making.

  • Having different meetings with various groups of people and making decisions across them (e.g. if you’re designing a new youth service and you’ve got adults and young people in different working groups, you’re not doing Co-design).

  • An elaborate form of coercion, useful for convincing people something was ‘their idea all along’.

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