Monday, November 5, 2012

Co-designing the healthcare: the importance of the design process

By Paola Pierri, Published: November 06, 2012

Anyone using design tools and techniques for designing a service needs, at the very first step, to design the process itself.

Usually I refer (as many others) to the Double Diamond (fig. 1), from the Design Council, as a very good way to visualise the design process. It is, as many other frameworks available in literature, a non linear, iterative process made of four iterative steps:

  • Discover
  • Define
  • Develop
  • Delivery

Figure 1: The Double Diamond from the British Design Council

I have tried to use this model for introducing a co-design approach in the work I was doing with some health professionals but I have realised that, to make the most of it, I needed to adapt it to my needs.

Talking with colleagues and friends with a UX background (which is not mine) I’ve tried to draw something that was more fit for my purpose. But why starting from scratches if you have something that works and that very well express the divergent and convergent stages of the design process? So I came up with a tailored version (figure 2) of the Double Diamond.

My tailored version of the Double Diamond proposes a different weight for the different phases and renames the steps to be more suitable for the co-design approach (see also the double diamond from “The Mobile Frontier”, Rachel Hinman, 2012 - Rosenfeld Media for a different example of redesigning the Double Diamond model).

I propose that the main phases of the Double Diamond for Co-design are:

  • Co-discover
  • Co-define
  • Co-design
  • Deliver

Figure 2: Double Diamond for the Co-design process

Three steps of the process have been renamed as Co-discover, Co-Define and Co-Develop, where the prefix ‘co’ is a significant and powerful one making explicit the shift in power and roles among the different stakeholders involved (designer, patients and professionals).

The first diamond size is different to show that with the co-design approach (i.e. Experience Based Co-design) the ‘co-discover’ phase will need more divergent thinking, include different stakeholders and require a more in-depth ethnographic research. And we know that ethnographic research is a hazardous sport: it takes time (as Paul Bate explains very well in a brilliant article when he also talks about "organization anthropologists - that - rarely take a toothbrush with them these days” in spite of the contact with the field that anthropology would very much require).

The first diamond is also larger to show that the first stage of the process (Co-discover and Co-define) could take longer than in a normal design process. That is because working with others in an equal relationship means negotiating findings and priorities.

But time is also - and foremost - needed because the co-design process should be a learning opportunity for all those involved (patients empowerment; shift in the professionals’ role). The two diamonds overlap to indicate that the Co-design starts when the Co-define phase is still in place. Being a dialogical process the boundaries between the two tend to be blurred.

The dashed line at the end of the co-design phase indicates where I see the potential for further development through a full patient’ engagement in all the phase of the design process. In many of the examples available of co-design in the healthcare sector the delivery stage is mainly lead by professionals but I think this is (or should be) about to change.

The next (r)evolution I would like to become mainstream in healthcare, in fact, is towards proper co-production of health services. As a participative process this should be non-linear, and iterative, like any proper design process, but also democratic and inclusive.

Any model that will try to visualise this should highlight the continuous overlapping of divergent and convergent thinking that comes with the full involvement of patients and the absence of a vertical and professional-led delivery phase; the shared process of creating values; the building of awareness and common grounds; the adoption of the citizenship model in public services.

There are tools, best practices and theoretical frameworks available for bringing co-production into the mainstream, but I think that a new model is also needed to shape the design process pushing for co-production in public services.

About the author

Paola Pierri works with Mind to improve the co-production of local services for mental health together with the network of local Minds. She is also studying for her PhD with the King’s College on using Experience Based Co-Design for improving the care of patients with genetic rare diseases.

Also by Paola Pierri: Designing a better experience for patients and Personalisation in the health sector: from ‘Mass Production’ to ‘Mass Co-production’