True co-design in healthcare is hard – something is better than nothing.
We know that following a complete co-design process will not always be possible in the public health context.
Despite these barriers, you can use co-design practices in any project. You don’t need to commit to a full co-design every time.
- Barriers to true co-design include:
- Predetermined solutions and deliverables
- Reactive environments and short timeframes
- Resource limitations
- Consumer and staff availability
- Limited staff capability and knowledge of co-design and power sharing
- The scope of the project is too broad
Co-design case studies - overcoming limitations
These examples show ways to overcome some of the limitations.
Abbey was asked to lead a co-design project to develop a patient rights charter with a group of patients and staff. Abbey had facilitated a co-design process before, so she was confident to lead the process. She felt uncomfortable that the solution had already been decided by the service before the co-design team had formed.
Solution: Abbey spoke to her manager, who was the project sponsor. She explained that to engage in true co-design, the co-design team would need to understand the problem first. They would then decide together the best way to address the issues, which may or may not be a patient rights charter. She asked her manager to allow the team to come up with a solution to the issue together. After learning more about co-design, her manager agreed. The co-design team decided to develop a staff-facing communication resource instead of the patient rights charter that was initially planned. This had a positive impact on the service.
Muhammad, a clinician who had previously been involved in co-design projects, was asked to co-lead a co-design project. The project had to be completed by the end of the financial year, which as eight weeks away. Muhammad knew that this wouldn’t be enough time to recruit a co-design project team, establish psychological safety and complete the co-design process.
Solution: Muhammad spoke to the other co-leads and explained his concern. The project needed to be finished by 30 June. The co-leads together decided that co-design wouldn’t be the best engagement method to use. They decided to run some focus groups and solution design workshops with consumers and staff instead. This led to valuable input from both service providers and consumers to influence the solution.
Jun had begun their co-design project, which was going well. However, they were struggling to manage their usual clinical workload along with being the lead facilitator for the co-design.
Solution: Jun spoke to their project sponsor about the difficulties they were experiencing. They identified that re-allocating some of their administrative duties would be helpful. This would give Jun another half-day each week to focus on progressing this co-design. Their sponsor agreed and enabled this to occur.
Lakshmi was supporting a co-design project. One of her roles was to arrange the co-design meetings. She was having difficulty finding a time that worked for both consumers and staff. The consumers on the co-design workshop worked full time and were not available before 4pm on most weekdays. Staff finished working at 4.30pm and preferred the meetings to be in the mornings. She also wasn’t sure how to arrange for consumer remuneration.
Solution: Lakshmi brought this challenge to the co-design team to solve together. She created a quick availability poll using Microsoft Forms. With some flexibility from everyone, Lakshmi managed to create a series of meetings that alternated times. The team agreed on meetings at lunchtime or at 4pm. Lunchtime worked for the consumers as they could join virtually from work on their break. As part of their ways of working, the co-design team agreed which priorities they would progress offline or in smaller groups. This made the meeting length shorter.
Being able to remunerate consumers for their time also helped make this work. Lakshmi spoke to her local consumer engagement lead to make sure she was following the correct remuneration process for her local health district after reading the NSW Health Consumer, carer and community member remuneration guideline
Carlos was asked by his director to lead a co-design project. Although Carlos was an experienced facilitator, he had never been involved in a co-design project before. He didn’t know how to build his co-design capability.
Solution: Carlos contacted his local health district consumer engagement lead and they had an initial discussion with him about co-design. The consumer engagement lead suggested he read this toolkit and the All of Us Guide to consumer engagement.
Carlos found these resources and templates very helpful. He developed some session plans and ran them past the consumer engagement lead for feedback. Carlos was open with the group that this was his first time leading a co-design. Carlos asked for ongoing feedback and input from the group on the process they’d follow. Thanks to Carlos’ honesty, the group felt empowered to support each other through the process. They offered their own experience and suggestions.