Co-design is a participatory approach to design. It involves bringing patients, healthcare providers, and other key players together to make and refine processes and tools in ways that make sense to everyone. It focuses on making decisions together and being sure that our services fit the collective needs of patients and staff. The approach aims to improve quality, efficiency, and the overall healthcare experience.

Yet, even when co-design seems like an obvious approach to adopt, sometimes you need to justify spending money on it. Don't worry though—that’s simpler than it sounds.

Starting Simple

You can begin making the case for co-design by asking three simple questions:

1. To what extent are we working in isolated groups or 'silos'?

2. Could we be more effective within our collective teams and resources?

3. Can we try it on a small scale first?
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1. To what extent are we working in isolated groups or 'silos'?

Working in silos—where departments or groups work separately—leads to duplication of effort, as well as disjointed user experiences. It’s the underlying reason why patients and staff end up repeating themselves. It’s what leads us to give different labels to the same processes. 

The cost of these duplications or confusions is easy to guess at. How much time is spent on those repeated steps? How much time do we spend supporting each other answering frequent questions because of confusion? How much time could we save on training new employees if our processes were simpler and shorter? 

In my experience, no one minds seeing an estimate of these costs, as long as you show how you reached this estimate. Presenting these costs alongside a commitment to use co-design to reduce them is the backbone of your business case.

We might ask the following questions to work out where best to aim your co-design activities:

1. To what extent are projects / programmes of work funded as cross-departmental initiatives? 
2. How often do teams share information, insights, or resources? Does this lead to a reduction in repeated work and missed opportunities for synergy?
3. To what extent are different teams working on similar projects or tasks without being aware of each other’s efforts, resulting in wasted resources and inefficiencies?
4. Do departments or teams have different or conflicting goals, KPIs, and performance metrics? Are they working towards common organisational objectives or just their own priorities?
5. Are different parts of our service competing with each other in confusing ways? For example, a diabetes patient might be offered yearly monitoring via their GP surgery, their Primary Care Network and their local Hospital Outpatients Service. This is a type of competition that can feel muddled.

Coming together, with curiosity, in a co-design process, we might start to see early signals that we’re getting a return on our investment:

• New people being heard
• Better understanding of what everyone is doing
• Changes in language reflecting new perspectives
• Commitments to solving problems together
• Formation of new collaborations and trust-building
• Agreements to meet more regularly
• Identification of unmet needs, unnecessary steps, and duplicated efforts

These initial signs can lead to significant changes, that we can quantify as saved time and service quality improvements. 
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2. Could we be more effective within our collective teams and resources?

Look at any health service, pathway, clinic, or community team - and you’ll find dedicated, well trained, brilliant people. These are people who care, and have expertise and skill that can be used to save lives, or to help people have access to the best life they can have.

So, it’s heart-breaking to encounter moments where this collective expertise meets systemic failures. We know that services can be better orchestrated. System-wide negative feedback loops reveal stark inefficiencies. The more patient data captured, the less likely it will be used effectively. The more time spent diagnosing conditions, the longer the wait for interventions.

These inefficiencies not only frustrate healthcare professionals but also lead to compromised patient outcomes. The potential for early detection and timely treatment is lost in the mire of bureaucratic inertia and resource misallocation. 

Consequently, the gap between optimal care and the reality of patient experiences widens, fostering distrust and diminishing the overall efficacy of healthcare systems. This vicious cycle emphasises the need for reform to prioritise seamless integration of data, streamlined processes, and a patient-centered approach. 

Without such changes, the promise of advanced medical knowledge and technology will remain unfulfilled, leaving both patients and practitioners grappling with preventable challenges.

So the business case needs to show how we can get more value from our collective expertise. A relatively small amount of additional expertise and resources are required to be effective:

1. Facilitators skilled in health and care, design thinking, team working and process management
2. Committed involvement from representatives involved in delivering services and from the people who use these services
3. Suitable spaces for collaboration, meetings 
4. Support for a research-led approach

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3. Can we try it on a small scale first?

During a single co-design workshop, we will likely uncover multiple ways to deliver operational impact. Together with the co-design participants, we explore the following questions: 

1. What problem are we solving for patients or healthcare professionals?
2. How does it impact them? 
3. Why is this solution better than alternative solutions?
4. What would be a conservative estimate for the cost savings of investing in this change?
5. How might we measure the actual cost saving once (this solution) has been implemented? 

We don’t have to wait for a lengthy costing process, the participants themselves can help to prioritise what the service should focus on next and refine how they intend to measure the benefits.

Let’s say that we identify some instances of poor coordination between outpatient and inpatient care that led to unnecessary repeat visits and hospital readmissions. A simple cost analysis can put a rough price on these things. Let’s say that the inefficiency is costing X annually in avoidable repeat visits and patient dissatisfaction. This can then be compared against the cost of further co-design activity (let’s call this Y) that would streamline patient handoffs between departments. 

And as long as Y is a good deal less than X, you’ll know that the investment is worthwhile. 

Of course, the real business case is not just about avoiding financial losses. You’ll have important additional benefits to include in your business case: improvements in patient outcomes and satisfaction. These might be harder to anticipate and quantify in advance - but they’re not unreasonable to aim at. They should certainly be included in business case documentation.

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Maybe you are already doing this?

If so, what impact might doing more of it have?

Are you bringing people together effectively - in ways that strengthen or forge new relationships? Are you experimenting enough? Are you allowing your teams to generate new knowledge and insights? Are they taking a hands-on approach to ensure solutions are theoretically sound, tested and refined in real-world contexts, matching the contextual needs of the community, including patients and caregivers? 

Are you capturing and representing the community's values? Are you generating outputs that resonate deeply with the human aspects of health and care? Are you empowering your health and care services to be more effective, adaptable, and patient-centred, meeting the evolving demands and expectations of service users and care providers? 

Co-design addresses these questions - and can help to target systemic issues. Starting with acceptance and ownership of service problems, it enables a shared approach to dealing with some of the knottiest problems worth solving.
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‍How we can help

We run service co-design, digital innovation and research projects across health and care and public sector. Drop us a note to see if we'd be a good fit for your situation: hello@macementer.com.

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