Co-design in Health Care: from Idea-Generation to Decision Making

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A few months ago I wrote a post for a conference on health and design (MedLove) about the importance of process in designing for health care.

Starting with the Double Diamond from the Design Council I made the case for the importance of introducing Co-design in public services and namely in health care. I came up with a tailored version above of the Double Diamond of which the main phases are:

·       Co-discover
·       Co-define
·       Co-design
·       Deliver

Three steps of the process have been renamed Co-discover, Co-Define and Co-Develop, where the prefix ‘co’ is a significant and powerful one indicating the shift in power and roles among the different stakeholders involved (designer, patients and professionals).    More about this hijacked version of the double diamond for co-design is available in my original post.

Examples of co-design across the public sector are emerging in different countries. Participatory design approaches are seen as a way for public services to deal with the increasing pressure from new challenges and as a way to address disengagement and disillusion from citizens about politics and democracy (Demos, 2008, ledema et at, 2011, Lenihan & Briggs, 2011).

Expectations are high, and design seems to be the way forward to meeting needs, saving money, humanising services and engaging citizens (Restarting Britain, 2013).  It might sound a little bit ambitious and emphatic, but design has already proven to be much more than just an add-on for public services.

Among the highly innovative initiatives on healthcare improvement, co-design projects are definitely playing a role and new examples are constantly appearing.

We can count over 40 applications of Experience Based Co-design (EBCD) around the world.  EBCD is the result of an ‘expedition’ (Bate and Robert, 2007) into the field of design and design sciences to see what the health care system could learn from design professions. It enables the health sector to engage patients “(…) with the goal of making user experience accessible to the designers, to allow them to conceive of designing experiences rather than designing services.”

A District Health Board in New Zealand has developed, through the experience and learning of a co-design intervention for health improvement in breast services, a useful directory of resources for health service co-design along a six-stage design process (Engage, Plan, Explore, Develop, Decide, Change).

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Co-design is definitely a resource for public services, and users’ involvement in health and social care, i.e. in the UK, can be tracked back to the 70s (Barnes and Cotterell, 2012), but true user participation can still be considered a radical step into the unknown (Sanders & Stappers, 2008), since when users involvement is genuine, final results and directions of co-design interventions are not predictable.

As it becomes more and more popular in health, the term co-design is used to refer to a wide range of different forms and levels of users’ participation (from transformative interventions of co-production to more traditional user feedback exercises) and this in turn dilutes its radical contribution.

I am aware that co-design cannot always be radical but we need to make sure it is not just used as an exercise to produce solutions to practical problems. Take what emerged from a co-design programme in emergency health services in New South Wales:

“… besides being defined by the effects of a renovated waiting area or a new triage process, codesign deliberation has the potential to register as successful collaboration and shared creativity (…) that mobilize not change authorized from above, but dialogical innovation through “deliberative democracy”’ (Iedema et al (2011)

In order to allow this dialogical innovation to happen, one-off events of co-design are not enough; we need systems and organisations to change significantly (Cottam & Leadbeater, 2004):

  • patients should have access to the same level of information and knowledge as professionals
  • patients should be able to initiate a co-design process at any point within the health system, as well as being invited/involved to be part of institution-led co-design project
  • management and boards should actively participate and contribute to co-design events, as opposed to only front-line staff
  • sufficient time and resources should be ring fenced in annual budgets
  • governance and internal policies must be aware and flexible enough to include patients’ contributions

Good will and emphatic declarations on the importance of co-design are not enough.

Citizens’ participation in design for health should expand from the idea-generation to participation at the moment of decision and then we will see how radical co-design can be.

Paola Pierri works with Mind to improve the co-production of local services for mental health. She is a PhD candidate at King’s College London and is studying using Experience Based Co-Design for improving the care of patients with genetic rare diseases.

References

Barnes, M. and Cotterell, P., (2012), Critical Perspectives on User Involvement, Policy Press
Bate, P. and Robert, G., (2007), Bringing User Experience to Healthcare Improvement, Radcliffe Publishing Ltd
Lenihan, D. and Briggs, L., (2011), Co-Design: Toward A New Service Vision For Australia?
Sanders, E.B.N. and Stappers, P.J., (2008), Co-creation and the new landscapes of design, Co-design, 4:1, 5-18

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