How do you harness the collective strengths and diverse perspectives that come from working together, rather than apart? 

An increasing emphasis on user-centred design in recent years suggests a reorientation of team objectives towards patient-centric care. Yet, it's crucial to recognise that the patient's needs should never be the sole focus; the professionals' needs and systemic factors are equally important. 

This article explores the role of co-design in transforming team dynamics to improve patient care, highlighting the enhanced outcomes achieved through a collaborative convergence of expertise. 

We present a set of steps - each building on the last - towards creating and maintaining the right conditions for co-design. It’s best if we take these steps together, but in practice it often requires a bit of leadership to get this going. Perhaps from a Service Owner or Digital Transformation Manager (and hopefully supported by an experienced service design team).
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Step 1  - Set up a service community

We start with a rallying cry to all those involved in service delivery. We need to reach out and bring together all of the professional and voluntary run organisations, the patients and carers. Essentially every involved in making the service happen.

It’s important to build on the hard work that everyone is already doing and so our rallying cry must focus on the desire to collaborate, the value of cross-functional teamwork and the sharing of knowledge and insights. 

Co-design, facilitated well, leaves behind a legacy of integrated understanding and a framework for continued collaborative innovation. The shared endeavour will increase efficiency, reduce duplication of effort, address gaps and complexity (not only for the patients). It’s this that the community offers. It’s this that makes it worthwhile to tackle the challenges of relationship building.

Members of a thriving community must commit to attend regular meetings, to share their research, to work in the open and to get involved in journey mapping and co-design activity.
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Example 1: Weekly ‘Project Postcards’ provide a simple way to keep a growing Service Community uptodate and engaged. Example taken from our project for NHSE exploring video use to improve health outcomes.

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Step 2 - Include the right people

Co-design is paramount in achieving genuine, impactful outcomes in healthcare. By actively involving patients, caregivers, and health professionals in the design and implementation processes, we ensure that the services and solutions we provide are not only effective but also tailored to the real needs and insights of those at the ground level.

Moving away from the traditional top-down design, the key is to adopt structures that empower individuals and foster collaboration. To show up as facilitators for each other. To create safe spaces for the right mix of people to do the design work together. And the point is not just to aim at bringing people together for workshops or for a specific project - you’re aiming to bring people together in ways that see them forging lasting bonds, and commitments to work together across silos in long-lived team-work.

Including diverse thinking styles is part of the job you’re doing here. You’re understanding the complexity of the real world by appreciating multiple perspectives, and recognising that no one lens offers a complete view.

Each person’s thinking style needs to leave space for other thinking styles. This starts with looking within. Some Service Designers and Researchers might hold an underlying presumption that the designer's mindset is superior. However, we are every bit as biassed and skewed as anyone else.

We may, for example, leap towards digital transformation, overlooking myriad other avenues for change. And while digital aspects are important, focusing solely on them misses out on the intricate dance of real-world collaboration and the multitude of concerns that matter more than screens.

Example 2. In our work with NHS Mid and South Essex ICB, we reached out to diverse voices, including those from local charity-run groups, ensuring a broad range of perspectives. We didn't just speak to the people who volunteered in advance (to take part in our research). We made time to go and find people to talk to. This helped us to avoid volunteer bias, and to include the voices of those who might otherwise be left out.
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Step 3  - Prototype and research together

“You really brought this to life!” is one of the best compliments you can receive as a Service Designer. It's wonderful to hear such praise. But it isn't so difficult to come up with an idea or to bring it to life. The difficult part is bringing that life into the world and then sustaining it. Making the vision a reality.

People we work with love the way prototyping ideas makes previously intangible concepts easy to understand and facilitates gathering early feedback. Mock-ups speed up the process of testing a design idea against reality. 

They also love hearing stories from our research that help them to walk for a moment in the shoes of the user. We help our clients to empathise with the pain that service users experience and to understand the meaning and value of ways to address this pain. It's creative and engaging work that often provides a pleasing contrast to other dryer documents that our clients deal with more regularly. 

This is valuable stuff - but of course it's at its most valuable and worthwhile when the stories we tell become true stories. When they move beyond fictions and into reality. When we move past describing what we could (and maybe should) care about, into embodying those values in some sort of transformation that makes a material difference in the real world. This means patients, caregivers and health and care professionals getting better outcomes. Few things are more important.

By working together on every step we bring the right ideas to life, whilst remaining laser-focused on how to make the ideas go live (in new or existing products and services). And also how to make sure the ideas are flexible and resilient - so that they live on, in ways that are adaptive to changing circumstances and useful in contexts that we hadn't dreamed of.

Example 3. We co-designed Scope’s ‘Support to Work’ service with a group of disabled job seekers. We led them through a process that explored their real-world experiences, identifying points where they needed support. We then used this as a foundation towards designing the service moments that would have met their needs.
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Step 4 - Target small, realistic improvements

Avoiding overreach is key to sustainable progress - to gather momentum and a rewarding feedback loop.

Engaging with senior stakeholders is vital here. The biggest challenge might be in connecting different types of leaders. The strategic leaders, who shape vision and direction, with operational leaders who manage daily operations. It's about managing expectations, not overcommitting, and ensuring support across the board. Having their 'air cover' can be instrumental when navigating challenges, ensuring consistent momentum and support throughout the journey.

Rather than diving headfirst into complex issues, we place emphasis on swift prototyping—making things sooner rather than later. We look for ways to operationalise initiatives that have already shown local brilliance. We bank on proven successes, starting from strengths that already exist. 

We also aim for small, but impactful service iterations. These can often be the catalysts for broader system-wide changes, producing ripple effects and unintended benefits. More importantly though, they offer the chance to learn how well our ideas fit in the real world, before we bet too heavily on them.

Example 4: We worked with the NHS to discover ways to improve the autism diagnosis pathway. At the time of our work, one of the most significant unmet user needs for patients, carers and staff was around progress tracking, and the ability to spot problems that need attention and investigation. To start small with this, we considered how a dashboard might behave if it were embodied in email updates. This gave us an opportunity to explore aspects of the solution (e.g. content types and visual components) before committing to something more ambitious (e.g. a fully blown case management system).
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Let’s recap

It can feel overwhelming to know where to start with any digital transformation or service design initiative. Services within health and care are often very complex. The sheer number of people involved can make it seem impossible to orchestrate collectively agreed improvements.

These four steps provide a good answer to this. Not only as a set of activities to start with, but also as ongoing practices to keep health and care teams and professionals engaged in co-design.

Step 1 - Set up a service community: is all about recognising and remembering that we need to build on the strength of years and years of collective endeavour. Identifying what’s working well and also what’s not working well (e.g. the gaps, the complexity, the duplication and the timing issues) is best approached in the open as a team effort.

Step 2 - Include the right people: is where we do the planning and networking activities that create the right project teams. We want to make sure that we’re designing with and not for patients and care-givers. Inclusion of diverse mindsets is how good design happens. Miss this step at our peril!

Step 3 - Prototype and research together: is where we do the exploration work together. Designing service ideas that fit the context of need, testing them and making iterative improvements. Until the ideas become real-life moments in a service - this is story telling work. But it’s critical that those stories are based firmly on reality.

Step 4 - Target small, realistic improvements: provides a reminder to get things done, however small. Small but regular improvements are better than lofty ideas that take years to get into the World. They’re better for service users, and they’re also better for the morale of the health teams and professionals who can start to see their collaboration time deliver real world impact.
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How we can help

We run service co-design and digital innovation projects across health and care and the public sector. Get in touch to see if we'd be a good fit for your situation. Contact sam@macementer.com, 0117 251 0177.