Valuing Processes and Outcomes: A framework for planning co-design in complex systems of health design

Purpose: This paper sets out a framework for planning co-design processes for complex systemsbased projects typical in healthcare settings.

Background: Healthcare systems and environments are complex. Innovation often requires the redesign of physical spaces or objects, social processes, and the complex associated layers of service systems. Co-design is an established methodology for catalysing innovation in products and services because the scope is often well-defined but can be more challenging when working in systems where complexity impacts boundary definition. Co-design uses interdisciplinary and multi-level engagement with diverse stakeholders to catalyse innovation at the intersection between disciplines, experiences, and knowledge sets. The evaluation of these processes often utilises control over decisionmaking as a defacto measure of participation quality, reflecting potential for stakeholders to influence key outcomes. Yet there are also practical and theoretical reasons to value well-designed participatory processes in their own right.

Methods: The framework presented in this paper combines the evaluation of participation in codesign processes and in decision-making as two distinctive activities, applied to real-world and hypothetical case studies that demonstrate the potential of this framework as a transparent planning and evaluation tool.

Results: The framework allows participation to be planned and valued independently without defaulting to control over decision-making processes as the (only) valued option. The case studies demonstrate its potential in structuring a range of collaborative processes that suit different types of system innovation.

Conclusions: The formalisation of a framework for planning co-design activities that values participation in co-design processes in parallel with participation in decision-making provides a more transparent and beneficial way to structure co-design for complex systems-based challenges that recognises the humans at the heart of co-design.