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How co-design delivers agency, advocacy and real-world impact

Collaborating with end-users to clarify problems and develop solutions can be the difference between making something that works – and something that doesn’t.

In the 1970s, the introduction of computer technology to the Norwegian iron and metal working industry resulted in an unexpected outcome: the development of a new and improved way of designing systems and products. It was founded on the principle that the people most likely to be affected by those systems and products should be deeply involved in their development. At the time the process was called ‘participatory design’. Now it’s commonly known as ‘co-design’.

The Norwegian workers’ involvement in the co-design of new technology was prompted by legislative changes in Norway that sought to give workers more control over their workplaces. The Norwegian Metal Workers Union (NJMF) wasn’t just consulted prior to the design of the new systems – it was involved at all stages of the design process, achieving important changes in the systems themselves, and how workers were trained to operate them.

Since then, the concept has been used across sectors and industries, from education to software design to healthcare services and promotion. In Australia, it played a notable role in the development of the National Disability Insurance Scheme, specifically the Information, Linkages and Capacity Building (ILC) Commissioning Framework. The purpose of the ILC – to give people with disability greater access to mainstream services – was never in question, but it was widely agreed that the original policy framework was too broad in scope and failed to define how the policy should be implemented. In 2015, the National Disability Insurance Agency initiated coast-to-coast workshops involving over 50 disability sector organisations and over 1000 individuals, inviting participants to get specific about funding priorities, desired outcomes and measures of success. A draft was circulated and further co-design work carried out in 2016. Pilot programs are now underway. 

Consultation isn’t co-design. It’s just one part of co-design.

Co-design may have its success stories but the term has also been broadly and erroneously applied to just about any project where end-users were surveyed for their opinions.

“People often feel like they’ve ticked the box on co-design if they involve people at the beginning, even if they aren’t participating in the rest of the process,” says Irene Verins, VicHealth Manager of Mental Wellbeing. “That’s just not true. Consultation isn’t co-design. It’s just one part of co-design.”

The Mental Wellbeing team is working on a resource kit for community groups that are looking for support and guidance when it comes to co-design, particularly with young people. She explains that it’s best to consider co-design as a “very strong thread” that needs to run through all stages of a process: “the outreach, the need, the solution and everything in between”. And it is fundamental to the delivery of successful health promotion initiatives.

Why use co-design?

Advocates of co-design principles point to a number of benefits and not just in terms of a better fit between the service offer and the user or client. Improvements to creative processes and more effective project management, even better interdisciplinary co-operation and greater enthusiasm for innovation within an organisation, are all cited as potential benefits1.

Underlying the rise of co-design in the social space is the idea that a collaborative, cooperative and community-centred approach leads to more effective services and greater social impact2.

Dr Timo Dietrich is a research fellow at both the University of Queensland and Griffith University. He works extensively with the Centre for Youth Substance Abuse Research and is widely regarded as an expert in co-design, although he prefers the term ‘enthusiast’ (“please don’t call me an expert!”).

“When I introduced co-design to the Centre, people were very sceptical, worried it was just another focus group,” says Dietrich. “I said ‘no, no – it’s a very different philosophy’. We’re flipping the table in terms of how we listen to the consumer and I’m a big advocate for this approach.

Sometimes we’re just too top-down in our problem assessment.

Dietrich sums up the benefit of using co-design for programs as creating a “better and more relatable” end-result.

“Co-design gives us the opportunity to better orient any program we design to really meet the needs of an audience,” says Dietrich. “Co-design can even be a first step to understanding the problem at hand before you even consider the solution. Sometimes we’re just too top-down in our problem assessment.”

 Effective co-design in health promotion also has the effect of empowering the communities of interest. 

“The notion of user experience is a very important one in healthcare,” says Verins. “In the case of health promotion, it’s important that we go back to the Ottawa Charter principles which say ‘health promotion is about empowering people and giving them the ability to take control over their own health’, and in that case co-design is fundamental.”

 

Co-design and young people

That sense of empowerment can be particularly effective when it comes to engaging young people.

“Co-design gives young people a sense of agency and even autonomy that they often feel is lacking,” says Verins. “Young people will want to be involved in something that resonates with them.”

Happily, this benefit works both ways. Having young people involved in co-design helps to ensure that their needs and values are genuinely being addressed. It also creates opportunities for the organisation behind a project to have a better understanding of the issues faced by young people, and to use those insights to explore new possibilities for solutions3.

Verins and her team have been collaborating with Deakin University to investigate best practice approaches to co-designing with young people. Their findings were shared with local governments in a series of workshops ahead of the Bright Futures Challenge, a VicHealth initiative that encourages co-design projects between young people and local government bodies.

“We looked at the issues that young people are facing, not just now but in the future,” says Verins. “We know that social isolation is a big issue, and a contributor to stress, anxiety and depression.

“We can’t just address this by creating ad hoc solutions – we need solutions that are evidence-based and properly targeted – so we work with young people to make this happen.”

 

Co-design in action

Co-design principles were fundamental to an alcohol education program developed at Griffith University in collaboration with young people under Dr Dietrich’s stewardship. Dietrich had analysed the effectiveness of previous expert-designed alcohol campaigns and concluded that a co-design-led campaign would “differ substantially” from an expert one, offering more “interactive activities that engage and challenge"4.

The resulting program, Blurred Minds, uses a virtual reality ‘house party’ to deliver lessons aimed at changing attitudes and behaviours around binge drinking as well as reducing susceptibility to peer pressure and offering strategies on how to abstain from or moderate alcohol consumption.

They were really passionate about what they had created, asking us ‘when is this going to be rolled out, how will it look?

Dietrich’s team has also been working on a project with parents, holding co-design sessions on how they might be involved in campaigns related to the topic of youth alcohol abuse.

“At the end of sessions, we had the parents do two-minute power pitches to show off their program solutions and ideas,” says Dietrich. “They were really passionate about what they had created, asking us ‘when is this going to be rolled out, how will it look?’”

Co-design requires dedication

This isn’t to suggest that co-design is a walk in the park. It requires dedicated and often intensive resources, and can result in additional expenses. A co-design strategy needs to be targeted and aimed at getting the best outcome from the group involved.

“If you’re working with, for example, a group of young people with an intellectual disability, then you will need to structure in more resources and more time to ensure you create an environment in which those young people can co-design something,” says Verins. “Or if you’re working with a group of people who are difficult to reach because they’re not typically online, that requires people power and face-to-face engagement. In both cases, the efforts will be well worth the outcome.”

Initiating co-design can be a significant challenge, explains Dietrich. By way of example, he notes that he and his team found it hard to recruit parents to the co-design of the campaign around youth alcohol abuse. In the end, they resorted to highly inventive means.

“After a few different approaches, we ended up leveraging an existing network,” he says. “In this case it was someone my boss knew who owned a wine bar. They put the word out via Facebook and offered drinks and nibbles to get people to come.”

But all that effort is, according to Verins, worth it. “Co-design can be the difference between something being an effective, well-used resource and, bluntly, something that isn’t.”

 

Co-design case study: ReachOut Parents

 

In May last year, the online, youth-oriented mental health organisation ReachOut launched a new digital initiative called ReachOut Parents. Both the content and the functionality of the new platform were informed by a variety of co-design techniques involving 24 parents from both metropolitan and regional areas.

“Although parents reported a range of concerns relating to their teenagers, such as school and study stress, bullying, and drugs and alcohol, their biggest concern was how to communicate with their child about these issues,” ReachOut CEO Jono Nicholas told the Huffington Post at the time of the new platform’s launch.

The co-design process generated fresh insights, such as a general dislike of online courses (they were perceived as too generic to be useful) and a hesitancy around joining discussions on social media that might compromise family privacy.

In response to those findings, the final version of ReachOut Parents features one-on-one personalised coaching sessions with a professional coach from The Benevolent Society, and a moderated peer-to-peer support forum for parents5.

“Today's parents are incredibly time-poor and like the idea that they can access a web-based service that’s based on Australian evidence,” said Nicholas.

 

Co-design case study: Whittington Hospital Ambulatory Care Centre

 Co-design principles drove the redesign of the Whittington Hospital Ambulatory Care Centre in north London, opened in 2014. Studio Tilt ran workshops with a group of 70, including managers, clinicians, administrators, infection prevention and control staff and patients, ensuring that staff processes and departmental flows were balanced alongside the needs of everyday users. Those needs as captured in the workshops included clearer signage (‘Paedriatics’ appears as ‘Children’s Department’ in the new centre), a place to get a cup of coffee and something to eat, and access to natural light. The resulting space, designed by Levitt Bernstein, is a hospital department with an unusual sense of calm, ease and informality6,7

References

1 Steen, M., Manschot, M., & De Koning, N. (2011). Benefits of co-design in service design projects. International Journal of Design, 5(2), 53-60
2 http://www.design4socialinnovation.com.au/news/co-design-social-good-ingrid-burkett/
3 Hagen, P, Collin, P, Metcalf, A, Nicholas, M, Rahilly, K, & Swainston, N 2012, Participatory Design of evidence-based online youth mental health promotion, prevention, early intervention and treatment, Young and Well Cooperative Research Centre, Melbourne. https://www.westernsydney.edu.au/__data/assets/pdf_file/0005/476330/Young_and_Well_CRC_IM_PD_Guide.pdf
4 Timo DietrichSharyn Rundle-ThieleLisa SchusterJason Connor, (2016) "Co-designing social marketing programs", Journal of Social Marketing, Vol. 6 Issue: 1, pp.41-61, https://doi.org/10.1108/JSOCM-01-2015-0004
5 http://about.au.reachout.com/wp-content/uploads/2016/05/ReachOut-Parents_Research-Summary.pdf
6 http://www.designcouncil.org.uk/resources/case-study/whittington-hospital-pharmacy
7 http://www.levittbernstein.co.uk/project-stories/whittington-ambulatory-care/