The CoDesign Dilema

The Co-Design Dilemma


The CoDesign Dilema


Post written by Josina Vink


“Is this the beginning or the end of design?” asks Helen Kerr of Kerr Smith Design at a Toronto Offsite Design Festival event last January.  The question arose in response to the emerging notion that everyone is now a designer. It has been haunting me ever since.

The debate over co-design has been brewing within design communities for years.  Co-design is trendy, but is it effective?  Is it a façade or the next frontier? What value does it bring to solving our most complex challenges in health care?

Many seasoned designers are of the opinion that co-design is eroding the professional practice of design or, at best, that it is simply a tool for building project buy-in.  This camp sees co-design as little more than giving people Post-Its and a couple of hours, then getting excited about generating random solutions out of thin air. They argue that design is more than that.

As a service designer working to transform health systems,  I have used co-design in one-off workshops, at weekend design jams, as an input into larger innovation processes, to create new services, and most recently over a period of a couple of years with over 50 diverse stakeholders to enable systems change.

I have left some co-design sessions completely disappointed and others with the feeling that we are on the cusp of something truly transformative. I have seen firsthand how co-design can create empty excitement with no follow through, but I have also seen its promise.  It offers a means to achieving people-powered health and the transformation of a health care system that is far from being on a sustainable trajectory.

Co-design practice is relatively new and still evolving.   We have a lot of work to do to refine the craft, especially for the hierarchical, slow-to-change field of health care.  Research on co-design in health care conducted by Dr. Sangiorgi and others seems to echo the need for improving our approach.


To make the kind of impact that I am hoping for in health systems, co-design needs to shift:


  1. From ignoring power dynamics to addressing them head-on by integrating methods, like critical reflective practice, to build reflexivity into the process.
  2. From incremental improvement to transformative change by employing foresight (like this model) and systems thinking to deepen our understanding of context and future possibilities.
  3. From neutral facilitation to stewardship of a vision because participatory design does not mean that any answer will do, but rather that we can build a better solution together.
  4. From one-off workshops to long-term dialogue because system change requires shifting mental models and this takes time.
  5. From project-based activities to an embedded capacity in health care organizations to enable ongoing adaptation of services and systems.
  6. From the usual suspects to those most marginalized as the real power of co-design lies in the creative resolution of opposing perspectives to enable a healthy future for all.
  7. From being “magic” to employing transferable tools designed to enhance health service innovation.
  8. From conceptualization to implementation of designs using frameworks like Implementation Science.
  9. From talking about results to evaluating impacts so we can survive in an evidence-based culture and improve our process (through methods like developmental evaluation).
  10. From keeping it shiny to embracing the messiness because design is not linear, and thoughtful solutions involve wading through discomfort and periods of feeling stuck.


If we can make these shifts and support the ongoing improvement of co-design methods, I’d say this is just the beginning of design . . . and certainly the beginning of design in health care.



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