What is involved?
This phase is about gaining a deeper understanding of the problem. This is done by learning from the lived experience of those who use and deliver the service.
This involves looking at the data you have about your problem, and looking outwards, to the data and insights you don’t yet have. ACI redesign methodology covers the key steps of capturing data as part of diagnostics.
Within NSW local health districts, the local Business Analytics and Consumer and Community Participation teams may be able to provide additional guidance.
As a co-design project, consumers and health service staff will be working together to capture the lived experience. There are some key steps you will build into your approach to ensure your project is set up for partnering.
How: key steps
Use creative ways to observe and understand the experience of people who use and deliver services. Focus on critical points – good and bad moments that matter, and the emotions associated with these moments.
Tip
Run a focus group with consumers and ask them to share their experience of your service. Also interview carers and family members about what worked for them. Using visual and audio techniques to record consumer and staff experience can be a meaningful way to engage stakeholders.
- Map what you know and don’t know using the Gather the experience tool – identify where there are gaps in your knowledge.
- Decide who you need to learn from (think outside the box; possibly even outside of health).
- Decide how you want to learn from them (observation, interviews, diary study, etc).
- Double-check ethics considerations (don’t panic, often this is minimal for redesign and quality improvement work).
- Recruit people.
- Talk to and observe people.
- Capture and review notes.
- Tip If you have concerns about managing challenging situations and complaints, try our Guide on difficult conversations, complaints and adverse information.
Who is involved?
At this point, your team will be up and running and the best approach is to have everyone involved gathering the lived experience. Agree together who will do what to plan and run this phase.
Read more about the co-design team.
Tip
Having just one or two consumers and health service staff on your project team won’t be enough to be confident that the experience of ALL consumers or staff is well represented. Capturing many perspectives on the same problem will create confidence that you are focusing on the most important problems to solve. For the ACI Low Vision project, NSW Health staff and consumers from the project team paired up to co-facilitate patient interviews.
Check out the consumer partnership foundations pages for more ideas.
Key challenges and ideas to address them
CuriosityValuing diversity and individualityCommunicationCommitment to co-design
Working with Aboriginal communities
Refer to our guide on how to apply the 8 Aboriginal Ways of Learning in your co-design project.
Land linksLearning mapsStory sharingDeconstruct reconstructNon-verbalNon-linearSymbols and images
Useful resources
Working with consumers templates
See our resource library for templates to assist health services in informing consumers about how they can be involved in a co-design project.
Other resources
See our tools and resources to support the Gather phase.
Balancing power
When you balance the power within your co-design team, everyone involved feels represented in the final solution. This enables them to feel comfortable and ready to act on the outcome.
How will your team behave to ensure everyone provides an equal contribution to your co-design project?
Model best practice behaviours
- I recognise power imbalances can exist and I work with others to shift the dynamic.
- I acknowledge everyone's contributions and lived experience as equal.
- I seek the views and experiences of others.
- I will recognise when to let go of control, and when to take more on, so I am contributing equally.
- I will approach the collaboration with compassion and care for others.
- I use language that is inclusive and respectful with no jargon or acronyms.
- I understand that 'expertness' comes from a range of sources.
What contributes to power imbalance?
Differences in:
- life experiences and ‘knowledge’
- roles and responsibilities
- remuneration for participation
- relationships and motivations within and outside of the sponsoring organisation.
8 ways and co-design
More about working together with Aboriginal communities
Challenging assumptions
When you challenge assumptions, you build confidence that you have the best solutions for the problems that matter most. Challenging assumptions in a respectful way builds team cohesion and momentum.
How will your team challenge assumptions to get to the best outcomes in your co-design project?
Model best practice behaviours
- I am sensitive and understanding when resolving conflicts and disagreements.
- I listen and value everyone’s views and ask about their beliefs and assumptions.
- I take time to understand and question my own assumptions and beliefs.
- I support others to be open and examine their own assumptions and biases.
- I reflect on the collaboration to understand what is working well and not working well.
Try this activity from the BC Patient Safety and Quality Council.
What are the key points to challenge assumptions?
- Working as a team: as individuals and as a team, it is easy to hold on to assumptions and beliefs (consciously or unconsciously) – they could even be creating team conflict.
- Gather and understand: we are seeking to see something for what it really is, not what we think it is – check your assumptions about the problem.
- Improve: to design and implement solutions, we need to be open to new possibilities and to check that we haven’t made risky assumptions about how our solutions will work or be received.
8 ways and co-design
Story sharingDeconstruct reconstruct
More about working together with Aboriginal communities
Creating a shared vision
When you create a shared vision, everyone finds a sense of shared purpose and direction. This helps them to feel motivated to deliver outcomes together.
How will your team work together to agree what you want to achieve through your co-design project?
Model best practice behaviours
- I will ensure there is shared understanding about the way we are working.
- I seek a sense of unity and trust within the co-design team.
- I seek the views and experiences of others.
How and where can your team benefit from a shared vision?
- As your team forms and before you create a project plan, workshop a vision statement for the project together.
- Be future-focused, clear, concise and inspiring.
- Make your vision statement publicly available with a commitment of action.
- Come back to your vision statement at any point when you feel the team or stakeholders are at risk of getting side-tracked.
8 ways and co-design
Community linksLearning mapsStory sharingDeconstruct reconstructNon-linear
More about working together with Aboriginal communities
Curiosity
When you ask questions and seek to learn, your solutions will shift from taking small steps to changing outcomes.
How will you bring a beginner's mind and explore new possibilities together?
Model best practice behaviours
- I am non‑judgemental, curious and respectful.
- I can ask difficult questions in a considerate way.
- I am enthusiastic about change and I don’t have existing solutions.
- I will explore opportunities to the fullest.
Ways to be curious
- Have a beginner's mindset and challenge your assumptions – ask ‘why?’
- Step out of your comfort zone; immerse yourself in the project and the experiences of others; and learn from others by setting aside bias.
- Take an empathetic approach – recognise feelings in others and communicate that.
- Ask 'what is possible?'.
- Use play, prototype and experiment to learn – be excited by failing.
Resources
- Try this activity from the ACI’s experience-based co-design resources: The Five Whys.
- Dr. Brene Brown explains empathy in this animated video.
- For more co-design resources, visit our library.
8 ways and co-design
Land linksLearning mapsStory sharingDeconstruct reconstructNon-verbalNon-linearSymbols and images
More about working together with Aboriginal communities
Responsiveness
When we recognise and embrace the uncertainty of design and become comfortable to change course, we are more likely to deliver a solution that meets the real needs of the people it serves.
How will you be more open to feedback and changing course?
Model best practice behaviours
- I am open to feedback from everyone in the co‑design team.
- I can change my course of action based on experiences and data in a purposeful and thoughtful way.
- I am open to change, even when the solution is not defined.
When will you need to be responsive, and how?
- In the gather and understand phases, are you jumping to solutions before you have truly understood the problem?
- In the improve phase, how often are you checking that your solution addresses the needs you uncovered as you gathered data and experience?
- When working together throughout the project, how open are you to receiving feedback from one another and from others; and are you using active listening?
Resources
- Watch this video from Patrice Martin, a human-centered design specialist: Embrace ambiguity.
- Try this activity from the BC Patient Safety and Quality Council on Debate and dialogue.
- For more co-design resources, visit our library.
8 ways and co-design
Land linksStory sharingSymbols and images
More about working together with Aboriginal communities
Transparency
When you communicate and share all information openly, you build trust and encourage participation.
How will you show vulnerability, communicate honestly and create trust in your team?
Model best practice behaviours
- I speak with meaning and passion.
- I always share all information, whether it is good or bad.
- I am consistent in my messaging.
- I can show vulnerability and share power.
Things to consider
- How will you be transparent about the co-design process, including the methods used, decisions and outcomes?
- How will you ensure there is transparency and agreement from the beginning about how decision-making processes will work?
- What might it mean for others in your team to be vulnerable and transparent?
For more co-design resources, visit our library.
8 ways and co-design
More about working together with Aboriginal communities
Valuing diversity and individuality
When we are inclusive and value other's perspectives and experiences, we can build on ideas and create together. This enables breakthroughs and solutions to emerge.
How will you ensure there is a feeling of confidence, equity, inclusion and trust among your co-design team?
Model best practice behaviours
- I am understanding and I value individual differences.
- I am empathetic and non‑judgemental.
- I care about the different perspectives and backgrounds of the people in our team, and I am thoughtful of my impact on others.
- I respect expertise, experiences and reasons for involvement.
- I am objective, enabling and open.
Things to consider
Make an agreement around equal participation and involvement, including:
- recognising and reducing barriers to participation
- ensuring there are equal numbers of staff and people with lived experience on the co-design team
- ensuring all people feel empowered to share their thoughts and perspectives
- make co-design resources accessible to different groups.
Resources
- Read these case studies published by the Canadian Foundation for Healthcare Improvement Diversity in patient engagement learning exchange.
- Watch our video and read about working together with Aboriginal communities
- For more co-design resources, visit our library.
8 ways and co-design
Community linksNon-verbalNon-linear
More about working together with Aboriginal communities
Communication
When teams practise strong communication, they have clear direction; problems are avoided or resolved quickly; and engagement, trust and productivity increases.
How will you ensure that your team maintains strong communication that helps to build relationships and enables participation?
Model best practice behaviours
- I listen to ensure I understand others.
- I ask questions to get people to think about the impact on others.
- I can share my experiences and ideas without fear of judgement.
Things to consider
- Does your team have a plan to manage conflict respectfully?
- Encourage all team members to ‘pause’ to check in on the opinions and perspectives of others.
- How will you ensure that the language used is inclusive and respectful, with no jargon or acronyms?
- How will you match communication and methods to individual’s needs and preferences?
- Storytelling as a communication method plays a huge role in design from hearing stories and sharing findings in the gather phase to selling your solution to stakeholders in the improve phase. How might you use storytelling?
Resources
- Try this communication activity from the BC Patient Safety and Quality Council.
- Watch this TED talk from sound consultant Julian Treasure on 5 ways to listen better.
- For more co-design resources, visit our library.
8 ways and co-design
Learning mapsStory sharingNon-verbalSymbols and images
More about working together with Aboriginal communities
Commitment to co-design
When your team and stakeholders believe in (and follow) the principles of co-design, the outcomes are authentic and powerful.
How will your team commit to co-design?
Model best practice behaviours
- I am present, physically and mentally.
- I will make time and resources available to support the co‑design process.
- I will be open to a different way of collaborating and ask questions if I am unsure.
- I am motivated to see a service improvement and follow the project through to implementation of outcomes.
- I value and elevate the voice and contribution of people with lived experience.
- I recognise power imbalances can exist and I work with others to shift the dynamic.
Things to consider
- How will everyone be given the time to participate?
- What different ways can people be involved to support the co-design process?
- What support and training are available to the team to build capacity and contribute?
- Is there full and equal trust placed in all team members on the project?
- How will you ensure the project remains outcome-focused and continues through to implementation?
Resources
- Read this article from the Patient Experience Journal: "Anyone can co-design?" A case study synthesis of six experience-based co-design projects for healthcare systems improvement in New South Wales, Australia.
- For more co-design resources, visit our library.
8 ways and co-design
Learning mapsNon-verbalNon-linear
More about working together with Aboriginal communities
Knowledge of co-design
When you have a clear understanding of co-design, you can plan and adapt the tools, techniques and activities that suit your problem and team.
How will you decide if co-design is right for your project; and what will your approach look like?
Model best practice behaviours
- I understand the process of co-design.
- I understand the ways of working and behaviours of co-design.
- I know how to apply the method appropriately, using the relevant tools and techniques.
- I support the principles of co‑design.
- I share knowledge and information about co-design with the team and stakeholders.
- I understand the common barriers to using a co-design method and commit to addressing these as they come up.
How can you learn more about co-design?
- Watch, read, or listen to something about it. Talk about it and question it.
- Reach out to people who do it every day.
Resources
- Watch something about it: Glenn Robert: experienced-based co-design approach to delivering excellent patient care.
- Listen to perspectives about it, such as this podcast from the Australian Centre for Social Innovation?
- For more co-design resources, visit our library.
8 ways and co-design
More about working together with Aboriginal communities
Setting expectations
When everyone is clear about objectives, scope of the co-design process and the ways that the team will work, people feel enabled and motivated to participate.
How will your team set clear expectations for your project and ways of working?
Model best practice behaviours
- I am clear about the objectives, roles and responsibilities of all individuals participating in the co‑design process.
- I recognise my strengths, boundaries and vulnerabilities.
- I feel trusted and place trust in the expertise of others.
- I feel and foster a feeling of confidence, equity, inclusion and trust.
Things to consider
- Will the project vision and approach be publicly available and adhered to?
- How will everyone's contributions be acknowledged and valued?
- Will the team have access to support and training to build capacity to contribute to the process?
- How will the team build understanding of common barriers to using a co-design approach and build shared active commitment to address them?
Resources
- Working with consumers – partnership foundations
- For more co-design resources, visit our library.
8 ways and co-design
More about working together with Aboriginal communities
Leadership
When you partner in collective leadership, motivation and effective, sustainable outcomes will follow.
How will you create a positive environment in which people are encouraged to grow, develop and succeed together?
Model best practice behaviours
- I seek to build a shared vision.
- I focus on outcomes over outputs.
- I am accountable.
- I demonstrate self-awareness and seek personal growth, building on strengths.
- I model behaviours and values of co-design, including shared decision making.
- I facilitate effective team processes with trust and respect.
- I harness talent and diversity and create a culture where all team members can contribute.
- I partner and collaborate across boundaries.
How might you think of leadership as an enabler for co-design?
- How does shared decision making and respectfully seeking diverse perspectives challenge group thinking?
- How might defining a clear vision and strategic purpose be transformative for your team and project?
- Be vulnerable to not having all the answers – how might this lead to different and better outcomes?
Resources
- NSW Health Leadership and Management Framework
- ‘Why leadership is not about having all the answers’ from Tim Brown, author of Change By Design and Executive Chair of IDEO.
- For more co-design resources, visit our library.
8 ways and co-design
More about working together with Aboriginal communities
Community links
We bring new knowledge home to help our mob
What is it?
- Localise learning through connection to community through traditional practices, stories, languages and protocols.
- Bring new knowledge back to the community.
8 Ways and co-design
In the start-up and improve phases of your work:
- identify appropriate stakeholders and consumers
- seek permission to go into communities
- work with influential community members on project working groups from the start (be sure you are the right person to be involved in this work with them)
- explore the opportunity; come up with solutions and test them together be sure your content and approach are meaningful and appropriate for local community.
Core capabilities
Creating a shared visionValuing diversity and individualityBalancing power
Tools and templates
Land links
We work with lessons from land and nature
What is it?
- Relate learning to land and place; and take time to locate where the knowledge is from.
8 Ways and co-design
- Every step of the way, there is no one-size-fits-all approach, so it’s important to adjust your co-design approaches, by considering land links.
- Take a place-based learning approach and head out to community wherever you can.
- Individualise concepts to the local land and environment.
Core capabilities
CuriosityResponsivenessKnowledge of co-design
Tools and templates
Learning maps
We understand when we can see the whole journey
What is it?
- Diagrams or visualisations that map a process or unit of work from beginning to the intended end.
- Make a plan: map visual processes for your work.
8 Ways and co-design
- Together, map the approach the whole project (or just a meeting) will take.
- Understand the findings from the ‘Gather’ phase by mapping current state consumer and community stories and experiences of services.
- Map the ideal future state for a service from the consumer and community perspective.
Core capabilities
Creating a shared visionSetting expectationsCommitment to co-designTransparencyCuriosityCommunication
Tools and templates
Story sharing
We connect through the stories we share
What is it?
- Tell a story.
- Yarn and tell stories as a way of introducing learning.
- Tell personal stories and share experiences.
- Use the word ‘yarn’.
- Use yarning /story circles.
- Invite community members to share their experiences.
- Credit the activities as an Aboriginal way of learning and sharing experience.
8 Ways and co-design
- Story sharing and related approaches will be useful when seeking to understand community stories and patient experiences in the ‘gather’ phase.
- You will return in the ‘understand’ phase with your project team to share what you learned. You might also use story sharing to paint a picture of the future in co-design workshops, and as prototypes for the future solution.
Core capabilities
CuriosityCommunicationChallenging assumptionsValuing diversity and individualityCreating a shared visionResponsiveness
Tools and templates
Deconstruct reconstruct
We work from the biggest to the smallest; we watch, then do
What is it?
- Watch first, then do.
- The first part of deconstruction (reflected in the drum design) is watching, while the second part is about ‘doing’. The whole drum represents learning.
- Model, then try.
- Look at the big picture before getting down to details.
- Model assessment tasks before doing them.
- Credit that this is an indigenous way of teaching and learning.
8 Ways and co-design
- The whole co-design process is reflected in deconstruct – reconstruct: When we gather the experience, we look at the whole picture through the eyes of community and consumer.
- In the ‘understand’ phase, we break it down, look at it from different ways.
- In the ‘improve’ phase, we seek to reconstruct it into something new that better meets the need.
- Model an activity step-by-step. Get your colleagues to show you their version.
- Mini cycles of de-construct and reconstruct are practised in the ‘improve’ phase as we prototype and test solutions to learn about how people see and experience our solutions, and how we can improve it.
Core capabilities
Challenging assumptionsCuriosityCreating a shared vision
Tools and templates
Non-verbal
We see, think, act, make and share without words
What is it?
- Learning through observation.
- Use kinaesthetic skills to encourage thinking and learning (physical activities, rather than listening to presentations).
- Retaining information, then replicating observed behaviours.
- Role-modelling.
- Change champions.
8 Ways and co-design
- In the ‘gather’ phase, we might observe the way that people interact with (or use) a product or service; or how they live in their own context with a health condition.
- In the ‘improve’ phase, we might act, make and share our solution through prototypes, and we observe what is working well and what needs to be improved.
- As we pilot solutions and engage new stakeholders in our solutions, we might role-model the behaviours we seek to see change.
Core capabilities
CuriosityValuing diversity and individualityCommunication Commitment to co-design Leadership
Tools and templates
Non-linear
We put different ideas together to create new knowledge
What is it?
- Two different paths meet at the same point.
- Learning occurs by putting different ideas together to make new ideas.
- Creative ideas come from paths that are not straight.
8 Ways and co-design
- When preparing to gather experience, seek to explore, discuss and understand different cultural viewpoints.
- Place yourself in someone else’s shoes.
- Try different ways to make sense of data and to create new solutions (draw, build, write) when brainstorming and building concepts out.
- Think about how different ways of working might strengthen your approach – what might you learn from trying another way?
Core capabilities
CuriosityValuing diversity and individualityCreating a shared vision Commitment to co-design Knowledge of co-design
Tools and templates
Symbols and images
We keep and share knowledge with art and objects
What is it?
- Draw it!
- Create visual cues as well as print texts (mind maps, diagrams, etc.)
8 Ways and co-design
- In the ‘gather’ and ‘understand’ phases, explore how you can use visual cues for discovery; to prompt discussion and learning. Use drawings as a memory aid.
- Use mental short-cuts to help understand the information you collect in the ‘gather’ phase.
- Remember that Aboriginal art communicates important stories and messages. Draw a view of the future when brainstorming, coming up with new ideas and mapping a view of possible futures.
Core capabilities
CuriosityResponsivenessCommunicationSetting expectations