Question 3: Co-design for well-being


The next question up for discussion is as follows:

Is co-design a useful approach for enhancing well-being, or it is really over-hyped?

The responses set out two critical perspectives:

  • the promise of co-design means it can also easily be exploited by those in the more powerful position, and it should therefore be deployed with care – read here
  • the aspirations of co-design processes and the realities are often two different things – read here



Question 2: integrating design with other methods


Should design be integrated with other disciplines and methods to enhance validity and impact, or does that fundamentally disrupt what design has to offer?

For designers who find themselves intervening or working in contexts where design methods and approaches may not be familiar, there is a common challenge around deciding how far to hold design apart, or to try and blend in. While the difference in approach can be what brings value, that difference can equally cause problems.

The responses set out two practitioner perspectives on this question:

  • design is no silver bullet – reflections on the value and tensions of integrating design and implementation science… read more here
  • differences in disciplinary approaches are due at heart to different views about what constitutes knowledge and evidence, and these may not be surmountable…  read more here

Question 1: effecting structural change through design


With our first round of blogs, we want to open up the following question:

Is it possible for design to address big structural issues, like inequality, or is it destined to the incremental tweaking of existing experiences?

The responses set out three perspectives:

  • the need for design practitioners to cultivate greater critical sensibility to the stakes embedded in their own culture(s) of knowledge and practice – read here
  • how design is already disrupting, creating and maintaining social structures – read here
  • the tension between design’s potential to propose alternative visions and narratives, and the reality of the constraints imposed by its positioning in the system – read here

3.2 Aspirations and realities


Question: Is co-design a useful approach for enhancing well-being or it is really over-hyped?


Co-design is becoming increasingly popular as a means of making change in the health care system (see work on Experience-Based Co-Design and Transformation Design). Co-design is often connected with emancipatory aims.  Researchers studying co-design talk about seeing users as partners in the process and having influence over the systems that effect your life is certainly connected to psychological well-being. Yet, I can say from experience that the aspirations of co-design processes and the reality can be two different things.  Often co-design processes lack attention to power dynamics and regularly the people involved in co-design processes do not, in fact, have equal influence over decision-making. All too often, co-design becomes a participation façade that ends up bolstering people in existing positions of power. Being involved in a process that advertises equal partnership, but fails to deliver is likely to have some pretty negative effects on well-being, but these not-so-great outcomes are rarely acknowledged in co-design literature.

“Participation without redistribution of power is an empty and frustrating process for the powerless.” – Arnstein, S. (1969, 216)

Plus, it is important to remember that design itself has its own culture that reflects the political and economic systems it is a part of.  This culture has not been and is not a safe place for everyone (see this video on respectful design and the decolonizing design website). Design and co-design are not politically neutral.  To better support well-being, co-design practitioners urgently need to build a better understanding of racism and inequity and recognize the often exclusionary nature of design. We must find ways to critically reflect on our co-design methods and the discriminatory nature of existing norms. I believe that we should not continue to advocate for co-design unless we acknowledge its ability to do harm. While these reflections seem to suggest that co-design is not well suited to interventions intended at enhancing well-being, I feel quite the opposite. Despite these very real challenges, I believe in co-design’s transformative potential. I just don’t think naively perpetuating this practice without acknowledgement of its failures will get us closer to the collective well-being we seek.

3.1 The means and the ends


Question: Is co-design a useful approach for enhancing well-being or it is really over-hyped?


Co-design often sits within a rhetoric or logic of empowerment – of users, patients, citizens – which assumes that participation in decision-making might have some beneficial effects. The potential for increasing wellbeing comes broadly, I think, from two places – the means and the ends:

1. The process itself: sharing power in decision-making, if it increases people’s sense of autonomy and agency, could have a positive impact

2. Better outcomes: involving users and other stakeholders in the design of something they are going to be affected by should lead to something that is more suitable to their preferences and needs

But there are other dynamics at play beyond the creation of wellbeing, and reasons why the above benefits may not transpire.

First, motives are rarely pure and power is rarely truly shared. Co-design or participatory design sits at the confluence of various design practices – some of which are about shifting power balances or providing opportunities for resistance, but others are explicitly about understanding how to design a solution to increase the likelihood of its working or being adopted. The latter privileges the interests of the actor inflicting the design, which may or may not align with the true interests of other actors. In other words, co-design can offer a way to make it look like the other’s interests are being incorporated while in fact working out how best to get your own way – and this potential does not escape the notice of people with agendas in government and business. Designers facilitating a co-design process don’t always have sufficient power within the system to push back and represent the interests of users.

Second, for myriad reasons, the supposed benefits of improved outcomes may not accrue to the people who have given their time through a co-design process. A lot can happen between the ‘fuzzy front end’ of design, and implementation. Projects halt or get diverted, goalposts (and political agendas) change unpredictably, and the ideas themselves often transform as they are stewarded through organisational and system cultures, processes and conditions.

So in multiple ways, the expectations raised through co-design can be disappointed.

In terms of the other possible benefits of experience of the process itself? Reflecting on projects I’ve been involved in, I’ve seen people go away more interested in or enthused about an issue – or simply more aware of what’s going on. The processes of self-reflection that occur can help people reframe something in their own head, which in itself can be refreshing. And the simple opportunity to be creative for an hour or two can be liberating. But equally – and especially when dealing with issues of policy or government – the complexity of the subject matter can be disorienting, and the firsthand experience of how governments manage decisions can be disillusioning.

This is perhaps why Greenbaum and Loi refer to participation as the camel of design: from one perspective, a very elegant animal perfectly designed for particular environments and challenges – but if used in the wrong place it can be awkward and cumbersome. The occasions when co-design can truly deliver on its promise of wellbeing are probably very few indeed.

2.2 Perspectives on ‘method’ from design and other disciplines


Question: should design be integrated with other disciplines and methods to enhance validity and impact, or does that fundamentally disrupt what design has to offer?


“What passes for theoretical generalizations are really only context specific insights produced by particular discourse communities.” Stephen Brookfield

We live in a world where disciplines and expertises are understood as crucibles of knowledge and authority. Deep disciplinary expertise has helped solve many of the ‘problems’ of the 20th century. It would be hard to imagine putting a man on the moon without long-term investment in a select number of brains and institutions becoming deeply expert in aerospace engineering. The term ‘rocket science’ exists because we think there are some things that a lay person has little hope of understanding.

There have been critiques of disciplinary and professional authority. Political ones, that suggest the boundaries constructed around expertises and professions serve to reinforce a particular world order, and that the ‘problems’ of the 20th century have been so-defined by the powerful. And more practical ones, that suggest silos of expertise may not suit all problems equally. Interdisciplinarity is required. Hannah Arendt has a lovely phrase about training the mind to ‘go visiting’ in other disciplines. Nate Silver’s theory of the failure of prediction draws attention to the value of ‘foxes’, who know many things (as opposed to ‘hedgehogs’, who know one big thing and cling on to it fiercely). Being open to more than one way of understanding allows ‘foxes’ to entertain and evaluate a broader range of possibilities. The kind of knowledge that is useful also depends on the kind of problem in question: it’s hard to apply ‘knowledge’ to new or emerging problems. Interpreting such complex problems* through the lens of single disciplines or professions will almost always lead to a sub-optimal outcome.

In the last year or so, consulting with a community of ‘QI’ (Quality Improvement) experts in health and care, but coming from a design perspective, I’ve been wondering whether the same critique would apply to method. In a literature review of theories of ‘implementation’, Nilsen (2015) finds around 60 different theories, models or frameworks for making change happen in health care systems. 60 different ways that people have codified, and sought academic authority for, a way of proceeding. This is ‘method’ as something to be developed, tested, evidenced, and enshrined in the knowledge system of higher education institutions – and then advocated to other people so they can replicate it. I’ve noticed that people with this worldview can be quite defensive about ‘their’ method being the best or right one.

By contrast, at Uscreates where I work, (an agency that to date has built a practice on a blend of service design, participatory design, behaviour change techniques and innovation strategies) I think we see methods as something more malleable – never definitive, relevant only according to how useful they are in the moment of need, and the choice of method is the selection of one out of many ways of proceeding. To appropriate a social science term, we have I think a kind of inventive practice: constantly designing the way in which we are going to address the problem. This means we are fairly agnostic about method, often splicing things together and borrowing from other fields. More interested in experimenting quickly to see what happens than seeking out pre-existing ‘evidence’.

These two beliefs about method are somewhat at odds. The first sees the second as lacking evidence, reliability, authority, and bound to produce imperfect results. The second sees the first as inflexible and unable to respond to new challenges, and seeking perfection as a fool’s errand. One way of overcoming this chasm is to say that each is useful for a different type of problem. Sometimes there is a known optimum approach to dealing with a problem, and creativity is unwelcome. Not everything needs to be worked out from first principles. But being inventive with method is probably the only way of tackling messy, complex, emerging problems.

But perhaps this is still to mask a deeper epistemic chasm: between an understanding of knowledge as something that is extractable from situations and people, and an understanding of knowledge as intrinsically linked to the ‘know-how’ of an individual or group. The second position would see the idea of creating a knowledge bank of 60 codified ‘methods’ as pointless – because what matters is the ability of people to respond creatively and manage challenges in their own contexts. So, to return to the opening question, it may be impossible to integrate design with some other ‘methods’, because of fundamentally opposing underpinning epistemologies. Rather, there is much to be gained from an ongoing productive dialogue between the two.

*Complex problems are described by Reos Partners as ‘social’ (involving diverse range of actors with different perspectives), ‘dynamic’ (enmeshed in systems that make it hard to relate cause and effect), and ‘generative’ (constantly changing and leading to new situations)

Thanks to Tom Ling for pointing me in the direction of Nilsen, and Alan Boyles for comments on this draft.

2.1 Design vs implementation science for systems change


Question: should design be integrated with other disciplines and methods to enhance validity and impact, or does that fundamentally disrupt what design has to offer?


Design is by no means a silver bullet for all problems and contexts.  There are a plethora of approaches out there that can help us make desired changes in our services, systems and communities. By employing design in combination with other approaches, we can strengthen our impact . . .but this doesn`t happen without tensions and trip wires.

Take my experience at the Center for Addiction and Mental Health in Toronto where I tried to integrate design into our systems change work that was primarily driven by an approach called implementation science. Implementation science (IS) is built from evidence on what influences the full and effective use of new practices. Connecting design and IS is particularly valuable because implementation is one of the great struggles for design.

First let`s, start by comparing the basics of these two approaches. Design involves practical methods and tools to imagine and create, whereas IS offers guiding frameworks for how to realize and sustain change. So in many ways, these two approaches are complementary. However, the tricky part is that some of underlying principles are conflicting. Design is based on intuitive and creative reasoning whereas IS is much more rational and analytical. Design is aimed at created preferred futures and IS is focused more on fit with present systems. This differences can create some pretty hefty (but mostly healthy) conflicts.


There are also some key process differences between the design and IS. Design invests a lot of time up front in framing a problem or opportunity and generating creative ideas to catalyze the desired change. IS focuses more on identify problems that are already defined and finding existing evidence-informed practices that might be able to meet the defined needs. When determining potential solutions design encourages people to converge valuable ideas and IS encourages selection between options. Next, design works to build an early prototype of an idea (or multiple ideas!) and test it in context right away and then pivot when something doesn´t work. IS on the other hand has detailed templates for how to plan components of the intervention and implementation and then focuses on improvement through ongoing feedback loops. Design tends to create a platform for people and embrace the emergence of how things transpire whereas IS emphasizes fidelity and doing a practice as intended. When thinking about scaling design explores creative ways of spreading the impact, but not necessarily the existing solution, whereas IS discussed how to scale existing interventions up and out.


While there are some pretty major processes differences, there is room for the strengths of both processes to inform each other. For example, problem framing, convergence and prototyping are huge strengths of design and planning, improvement and fidelity are amazing assets from IS. Practitioners need not only have one set of tools.

Overall, I would say that many strengths of design are in the fuzzy front end of the processes, whereas IS excels as clarity forms throughout the project. Perhaps it is about knowing where to place the emphasis when.


Upon reflection, I can say that it did feel like parts of design`s transformative potential were being stifled by the more rational approach of IS, but overall, I think a thoughtful integration of the two created much more impact than either one of the two approaches alone. Drawing from multiple disciplines, worldviews and methods, requires constant reflection and negotiation, but doesn`t anything worth doing?

1.1 Consider the Stakes, Consider Ourselves

o-mexico-poverty-900Question: Is it possible for design to address big structural issues, like inequality, or is it destined to the incremental tweaking of existing experiences?

Scott: There is plenty to be said about whether or not design is up to the task of addressing big, society level, structural problems. We can ask if their tools are up to the task, are there adequate means to assess the value of the work people are already doing, how do we even define structural issues?

I would say that before we can get there in a meaningful and ethical way, we must first ask what are the requisite critical sensibilities designers must have in order to make sense of the wicked problems they so desire to unravel. As the saying goes, the road to hell is paved with good intentions, and designers, the eternal optimists that they are, are chock full of good intentions. Being an eternal optimist might be the fuel needed to want to join the fray, but it can also be a powerful means of obfuscation that render the complexity of the stakes hard to see clearly.

By stakes, I mean this in a dual sense. On the one hand, there are the challenging, but perhaps more accessible, stakes of the big problems at hand. An issue like inequality has clear stakes. People’s lives, modes of governance, tools of finance, the list goes on. These are the stakes that are always seen as clearly high when dealing with big-scale social and political issues.

The other stakes I refer to, which are more sticky and difficult to parse, are the ways and means by which design approaches such problems. How do the very tools, techniques, practices, questions, habits of attention, and facts taken to be self evident, structure the kinds of outcomes and logical courses designers might take in addressing these kinds of issues? This granular level can be hard to keep in clear sight. Many in the field today, I would argue, are not even looking. It requires a capacity for both ‘doing design’ and thinking about your ‘doing of design’.

Being a trained anthropologist, I like to use the notion of culture to highlight this point. One’s culture is a system of belief and practice that, while always shifting and in negotiation, is nearly impossible to step outside of. Because of this, it can be difficult to maintain consciousness of the difference between what we perceive to be a given course of action versus one that is actually highly situated and can take many possible trajectories.

Action does not emerge from nowhere. Our work is inextricable from the muck and mire of context. Where we operate, who we work with or for, our training, our briefs, our personal history, our variegated proximity to the issue at hand, these all help to structure our ways of making sense of the world. The subjectivity of the designer helps to shape the questions that are self evident, or seem to be worth asking, as well as the kinds of approaches we seek to employ. For example, my conviction the right course of action between making the government form more efficient versus asking whether the form (in that form) should exist in the first place is laden with all kinds of social and political assumptions about what change can and should be.

So before (or perhaps in adjacency) we settle the question of structural change vs incrementalism, design would do well to cultivate tools for a greater critical sensibility to the stakes embedded in their own culture(s) of knowledge and practice.