Creative Co-Design: A messy, crucial business

Naomi Stockley 01 February 2024

Naomi Stockley explains how creativity can be fuelled by the uncertainty and messiness of sharing ownership of service design between staff and patients.

“I’ll do it tomorrow. I promise” has a familiar ring to it. I said it to my parents to get them off my case, and I hear it all the time from my children.

When it comes to improving healthcare services, getting staff and patients to work together to co-design changes can feel like too much work. We put it off. We take shortcuts. For those of us delivering services, it is often quicker (at least in the short term) and can feel easier and safer to go ahead and make changes based on what we think is needed.

And yet if we take the shortcut of tokenistic involvement, we miss something essential about true co-design: ownership. Methodologies like Experience Based Co-Design (EBCD) involve a sharing of power and responsibility (no Spider-Man reference intended). And it’s that joint ownership that is so powerful in effecting real, long-lasting improvements.

Fear of the unknown

But, sharing power and allowing others to take ownership of services can feel uncomfortable. Who knows what ideas people will come up with! What if people want to do things that we don’t have the resources for? And what if we try something and it doesn’t work?

We talk about these and other co-design fears on the EBCD course. But ultimately in any design process, there is a period when things can look and feel quite messy. Designers are well acquainted with this feeling, and it’s an important part of the process. The best co-design projects don’t retrofit solutions that someone had in mind from the beginning. They encourage people to stay open-minded and imagine what could be.

So, it’s important that we get comfortable with the uncomfortable – that we find ways to sit in the discomfort of the unknown long enough to allow new ideas to bubble up.

Creative licence

Most patients and healthcare professionals want to make care more humanised. We want to improve things for staff and patients. We might even be sold already on the benefits of co-design. But it can be hard to know where to begin, and it rarely feels like the ‘right’ time to begin. We’re short on time, resources, motivation, people — and there might be all sorts of barriers in the way.

And yet creativity is at the heart of co-design. The design process is an inherently creative one, giving people freedom to come up with ideas and try them out. So perhaps we need to give ourselves permission to get creative in the way we run co-design projects, rather than waiting for the stars to perfectly align.

Creative Co-Design

Here is just one example of creative co-design in action.

Have you ever wondered how hospital staff know that a patient has dementia? Most UK hospitals use visual identification systems – things like butterfly stickers on the patient’s notes and special-coloured wristbands. Here’s a really good thread on Twitter/X that explains more.

Last year we published research into what makes the visual identification system work better. We followed the stages of EBCD to come up with the principles of an effective visual identification system. I say ‘followed’, but at almost every stage in the process we had to get creative to overcome challenges:

The Covid pandemic meant we had to run events with carers of people with dementia and healthcare staff online rather than in person.
Some participants didn’t feel confident using Zoom, so we offered informal calls ahead of events to support people to use the technology, and we sent slides out in advance.
We couldn’t film the patient interviews to create a catalyst film, so we wrote scenarios about fictional patients and healthcare professionals, which were based on what people had told us about their experiences during the interviews.
We had people audio record the scenarios, and we played them to participants whilst showing them related images. This prompted people to discuss their own experiences and identify the key issues for co-design.
We then showed participants some more future-focused scenarios, prompting participants to co-design the key features of an improved system.

What did we find?

Staff and carers who would have struggled to attend in-person events due to caring and work commitments were able to get involved.
Our adapted co-design approach sparked rich and useful discussion of the issues with both staff and carers.
The approach allowed us to pinpoint current issues with the visual identification systems and develop a set of design principles for their improvement.

In short – it pays to be creative and embrace the chaos!

So what?

So, don’t kick co-design into the long grass. Lean into the discomfort of the unknown and when challenges arise, ask ‘Is there another way I could do this?’ Grab all the tools, resources and support that you need, and trust the power-sharing process.

In our experience it can be highly motivating for staff, patients and carers to be involved in authentic co-design, where there is a sense of joint ownership and a shared desire to come up with improvements that make a genuine difference to the people who give, as well as receive, care.

We often get asked on our EBCD courses how exactly groups come up with ideas and refine them until they have something that feels like an improvement. There is no single correct way to approach ideation and prototyping, but there are some practical techniques that can help.

We’re running this half-day online workshop in March, with a leading expert from the School of Design, Glasglow School of Art, to give you the tools and confidence to apply design approaches to your co-design projects.