Key elements and principles of co-design
There is not a step-by-step best practice and universal approach to co-designing programs and services; there are, however, a set of underlying principles that should underpin any co-design effort.
According to work previously commissioned by the King’s Fund in the UK (The Point of Care Foundation’s experience-based co-design toolkit), the four key principles of co-design are participation, development, ownership & power, and outcomes & intent.
If you read our last blog What is good co-design?, you will already have some understanding of what co-design is, but here is a quick refresher:
Co-design is purposefully collaborating with people - which we call a co-design team - to identify and understand what the problems are. It’s then continuing to work collaboratively with those same people to develop solutions to those problems they have identified and then, again, working with those same people to test the implementation of those solutions. At the heart of that co-design process is improving consumer outcomes and experiences
You’ll notice throughout the literature you research that there are different points of view on what the principles of co-design are. Broadly, the principles you’ll find are pretty similar or have the same underlying themes. What we'll talk about today are four key principles from the UK, overlaid with some points reflecting what other established authors and agencies have identified.
So, assuming that you are working with a co-design team and recognise that they will be the people determining the design of the service or program, the quality of their involvement is going to be especially important for success. For this reason, it is essential that the entire co-design team, such as consumers, health professionals and any other representatives, have a shared understanding of these four principles.
Principle 1: Participation
There should be a participatory approach taken by the co-design team, plus the people or organisations leading the co-design process. Several elements support effective participation which we explore in the points below.
Transparency
Firstly, to be transparent, members of the co-design team should be made aware of and understand the co-design methodology being used to design the program or service. There needs to be an upfront discussion about what is required from them so that they can participate meaningfully.
Secondly, we need to be clear about the available inputs (or resources) to support the project and the expected outputs of the co-design process. To do that, we need to be transparent about any limitations. This could relate to resourcing or out-of-scope activities for the program or service we are developing.
As an example, say we are looking to develop solutions for the problem of long waitlists for psychological services in your region. We may need to be upfront that a systems-level change, like recruiting more psychologists, isn’t within scope because we know that the workforce isn’t available to achieve that.
Co-design team members participate in all parts of the ‘design’ process from end to end and are considered co-decision makers.
Broad input
Broad input means having diverse experiences and perspectives on the co-design team and supporting the building of relationships outside of the co-design team in the community or sector. This diversity allows us to go deep with the co-design team and test ideas with a wider audience. In our projects, we might do this through a feedback loop.
As an example of how this might work, the co-design team will identify some problems and develop solutions for them. Before testing their solutions, we might go and present those proposed solutions to impacted individuals outside of the co-design team to ensure that what's been documented and developed thus far aligns with the experiences and perspectives of others.
Person-centred and inclusive
It's important to remember that we are asking members of the co-design team to walk in each other’s shoes, hear about the experience of others and listen non-judgmentally. To do this, as the facilitator of the co-design team, we need to be able to create a safe environment for it to happen, and how we do that relates to power (another principle we will explore shortly). It’s important to highlight that people's experiences are evidence and they are valid. Sharing these experiences can allow us to break down silos that exist between consumers and health professionals, between different types of health professionals, or between organisations or sectors.
Diversity
This point refers to the diversity of perspectives included in the process. It’s critical to ensure that we have a comprehensive inclusion of people who will use the service/program, as well as the people who deliver the service. With diversity, we must also ensure that a culturally appropriate and trauma-informed approach underpins our facilitation process so that people feel safe to participate and the safety of the entire co-design team is considered. This is particularly important when working in the mental health context.
Principle 2: Development
Co-design is considered to be a developmental process. During the co-design process, we share information, knowledge and expertise about the topic of focus, however, we also want the co-design team members to be actively learning from each other and building their capability in co-design.
As a facilitator leading this developmental process, we must make ideas, experiences and possibilities visible and tangible to the co-design team members by using interactive and engaging methods, for example, storytelling through media sources, graphics and video.
Principle 3: Ownership and Power
Ownership
A good co-design process will foster collective ownership and equal partnership of the processes and outcomes amongst all co-design team members. In our recruitment of participants to the co-design team, we need to ensure that we engage people who will be committed to contributing to the entire process from end to end.
Power
We must also provide an environment that fosters the sharing of power, acknowledging that in many settings, the power to make decisions about how healthcare is delivered doesn’t often sit with the consumer – or even health professionals – even though the decisions impact their lives.
With that in mind, co-design places equal value and importance on input from all participants regardless of their role or status - whether they are a service user, health professional, commissioning organisation or government representative.
The co-design facilitator must address any power imbalances early on so that people feel safe sharing their views and experiences openly and freely. This includes providing critical feedback about a service or program.
As facilitators, if we aren’t receiving some level of negative or critical feedback about the topic area, we might want to start to think about any potential power imbalances in the room and whether these have been addressed so that people feel comfortable enough to share what they truly think.
Principle 4: Outcomes and Intent
Activities in the co-design process should be focused on outcomes and built backwards from there, in a pragmatic and practical way.
To do that, we must have a clear vision and direction of what we want to achieve from the outset, and have realistic expectations about what is and isn't within scope.
This is important to ensure mutual understanding amongst the co-design team and give them creative licence when developing solutions, whilst still maintaining a shared purpose and keeping within realistic and achievable boundaries.
If you take away just one thing from this blog, these principles should be it:
Participation
Development
Ownership and power
Outcomes and intent
If you undertake a co-design process that incorporates all of these principles into your approach, then you will probably launch a quality co-design process that is likely to produce high-quality outputs!
Want to know more?
Head across to our co-design home page where you can read more about our approach to co-design, access our co-design online course, take our co-design readiness assessment, use our co-design cost calculator and read more co-design blogs.
