But is it co-design? And if it is, so what?

This article follows the Youth Health Forum National Summit. A virtual conference on youth health which took place on September 15th, 2021. The Youth Health Forum, part of the Consumers Health Forum of Australia, is a group of diverse young health consumers interested in improving the health system.

The use of the language of co-design is everywhere – from organisational strategies, to policy mandates and within the recommendations of Royal Commissions. But what do we mean when we use the language of co-design? How can we identify what is and isn’t co-design? And, why does it matter either way? Is co-design good while other forms of engagement are less impactful? We begin to explore these questions.

Introducing co-design practices

As designer Ingrid Burkett (2012) notes: “In practice, co-design will inevitably mean different things to different people. A relatively simple version may mean incorporating the voices and experiences of service users in improving outcomes – and this may indeed result in some positive changes in the way things are done. A more radical version may mean seriously challenging traditional roles and relationships between service providers and citizens.” (p.7)

At the Summit, KA shared a few practices of co-design. These included:

Starting with questions, holding solutions lightly
Engaging in community and peer-to-peer research (and action)
Caring for everyone involved in co-design (read more)
Trying things out, using prototypes to learn
Professionals sharing power and their positionality

How can we assess if what we’re doing, or asked to take part in, is co-design?

Announcing the co-design quick test

To support conversations about co-design, KA has developed a Co-design Quick Test. The quick test is an interactive tool for you to think about four key elements of co-design:

Mutual learning
Designing
Co-deciding
Recognising lived experience

Take the quick test

Image description: illustration of three young people sitting down beside each other. The first gender non-conforming young person wears a red skirt, a grey t-shirt and has a short black hair do. The second uses a wheelchair, is wearing a denim shirt and black pants, has bright pink curly hair and dark sunglasses. The third is femme-presenting, wears a head covering, a long yellow shirt and dark red pants.

Widening our focus

Some models of consumer engagement frame co-design as the peak of a pyramid. Other forms of engagement are lower down, labelled “less participatory”. In implication, less worthwhile. This framing is narrow. While co-design can be powerful, even the best tools aren’t suitable for every task. And, as Ani Difranco said: “every tool is a weapon if you hold it right.”

Participation that isn’t focused on making something (non-generative) can be valuable. Consider activities like consumer training and networking, co-mentoring, consumer board membership, advisory groups or consumer representation on interview panels and in choosing new vendors or service providers (procurement). None of these are generative, so they won’t pass the co-design quick test (though they could connect to other activities which are design focused). Still, these can be beneficial when done well.

Similarly, non-collaborative activities can contribute towards transforming organisations and systems. Exploratory research and data gathering can identify gaps in knowledge and community awareness not identified in co-design. We don’t know what we don’t know, after all. Sharing resources and informing consumers, often framed as the least collaborative type of engagement (Arnstein, 1969), is a foundational part of communication and building trust. It’s value should not be understated, or skipped in the rush to co-design.

We need ‘methodological pluralism’ (Barker, Pistrang, & Elliott, 2002) – many forms of data, methods and approaches. If we only pedestal co-design, we risk erasing other approaches to change.

We notice the term ‘co-design’ used in two different ways. One, to refer to collaborative, generative design (Sanders, 2002), and, as a shorthand for good, equitable, participatory practice. To be clear:

Not all participatory practice is co-design, and not all co-design is good, fair or participatory.

It is possible to co-create, while at the same time, re-producing the status quo. As KA described at the forum, this might include:

Recruiting only white, cis-gendered and non-disabled people to working groups
Running formal, non-participatory meetings where young people are talked at and about
Relying on long written documents for decision-making and to communicate findings
Professionals share young people’s stories, often through lengthy reports
Asking young people to work within your problem-frame or with a pre-existing solution
Running a single event or workshop and expecting systems-change

As June Holley reminds us “it is not just what we do but how and with whom we act and interact that brings about transformation.” (2012, p.11)

Checking our language and intention

We worry about the misuse of the term co-design, within projects that would not pass the quick test. Those that involve little to no power-sharing or the expectation that people with lived experience contribute their expertise for free.

While there is a growing evidence base of what co-design can be (see Tindall et al, 2021), the social movement of co-design is at risk if ‘co-design’ means consultation or placation. This:

Re-produces the status quo
Damages enthusiasm for genuine co-design
Reinforces power ‘over’
Destroys trust systems (Evans & Terrey, 2016)

Closing and a call to action

Co-design can be a powerful tool. But,co-design is not a synonym for good participatory practice. We need many tools, methods, and approaches (methodological pluralism) to improve health systems. And, to transform relationships between consumers and service providers. The co-design quick test is a simple way for consumers and practitioners to know if their projects are co-design.

The question remains for us all, whatever we’re working on: how can we make this the best it can be?

About the authors

Georgia Gardner (they/them) is a Youth Health Forum Young Leader. They have been volunteering in the health sector since their teens, with experience in rare disease advocacy, peer support, rural and remote health. They currently work in community engagement and are completing post-graduate study in psychology.

Kelly Ann (KA) McKercher (they/them) is a designer and design educator, author and public servant. They are the author of ‘Beyond Sticky Notes: Doing Co-design for Real.’

References

Arnstein, S. R. (1969). A ladder of citizen participation. Journal of the American Institute of Planners, 35(4), 216–224. https://doi.org/10.1080/01944366908977225

Barker, C., Pistrang, N., & Elliott, R. (2015). Research methods in clinical psychology: An introduction for students and practitioners. John Wiley & Sons.

Blomkvist, J., & Segelström, F. (2014). Benefits of external representations in service design: A distributed cognition perspective. The Design Journal, 17(3), 331–346. https://doi.org/10.2752/175630614×13982745782849

Burkett, I. (2012). An introduction to co-design. Knode. https://www.yacwa.org.au/wp-content/uploads/2016/09/An-Introduction-to-Co-Design-by-Ingrid-Burkett.pdf

Evans, M., & Terrey, N. (2016). Co-design with citizens and stakeholders. In G. Stoker & M. Evans (Eds.), Evidence-based policy making in the social sciences (pp. 243-262). Palgrave. https://doi.org/10.1332/policypress/9781447329367.003.0014

Holley, J. (2021). Network weaver handbook: A guide to transformational networks. Network Weaver Publishing.

Kelly, J., Saggers, S., Taylor, K., Pearce, G., Massey, P., Bull, J., Odo, T., Thomas, J., Billycan, R., Judd, J., Reilly, S., & Ahboo, S. (2012). “Makes you proud to be black eh?”: Reflections on meaningful Indigenous research participation. International Journal for Equity in Health, 11(1), 40. https://doi.org/10.1186/1475-9276-11-40

McKercher, K. A. (2020). Beyond sticky notes: Co-design for real: Mindset, methods and movements. Beyond Sticky Notes.

McKercher, K. A. (2020, January 25). Who cares? Introducing a model of care for co-design [Post]. LinkedIn. https://www.linkedin.com/pulse/who-cares-model-care-co-design-kelly-ann-mckercher-them-they-/

Sanders, E. B. N. (2002). From user-centered to participatory design approaches. In J. Frascara (Ed), Design and the social sciences (pp.1–8). Taylor and Francis Books Limited. https://doi.org/10.1201/9780203301302 .ch1

Tindall, R. M., Ferris, M., Townsend, M., Boschert, G., & Moylan, S. (2021). A first‐hand experience of co‐design in mental health service design: Opportunities, challenges, and lessons. International Journal of Mental Health Nursing. https://doi.org/10.1111/inm.12925

Issue: Youth Health Summit – voices for the future