The Experts:

Dr Lynne Maher

Dr Lynne Maher is the Innovation and Improvement Clinical Director at Ko Awatea. She is a recognised international leader in healthcare improvement and innovation, with an extensive career ranging from critical care nursing to operational and board posts at local and national level. Dr Maher has published guidance on innovation, co-design, culture change and sustainability of improvement, and has worked with a wide range of healthcare organisations and charities to provide advice in these fields.

Renee Greaves

Renee Greaves is Patient & Whānau Care Advisor at Ko Awatea, CM Health – a role she has held for the last four years. She co-leads the direction of consumer engagement, co-design, patient experience, and patient- and family-centred care across CM Health. In her role, she draws on her lived experience as an intensive care survivor, her professional learning, and her skills in leadership and change management to lead change and inspire other patients and their families to become advocates for themselves and get involved in healthcare services.

Their View:

Co-design has gained prominence as an approach to designing healthcare services which works better for everyone involved.

The co-design approach works by actively involving all stakeholders in the design process to help ensure the result meets their needs. Stakeholders may include staff, patients, whānau and others involved, such as social workers, suppliers, charities and support organisations.

Nonetheless, much confusion exists about what co-design actually is. Closer scrutiny of the claim “I’m co-designing!” often reveals a project or initiative that is not truly using co-design methodology.

True co-design is part of a wider process of working with patients, staff and other stakeholders. In a previous short paper,Six tips on co-design, we summarise the co-design process:

The first part of the process is the identification of a challenge or opportunity for improvement. The second part is to engage consumers, whānau and staff, and the third part is to capture their experiences of the care journey and any ideas they have that could improve it. The fourth part is to create new understanding of the care journey and the emotions associated with it by learning from the experiences captured. The fifth part of the process is for consumers, families and staff to work together to plan and implement ideas for improvement based on their deeper understanding of the care journey. The final part is to review what difference improvements have made to peoples experiences of receiving and delivering care and any other key measures that were collected within the baseline.[1]

Misuse of the term ‘co-design’ most often occurs when project teams involve people by capturing  their experiences of the care journey but do not continue to include all stakeholders in developing and testing improvement ideas. Although the wider co-design process includes listening to and capturing people’s experiences of giving and receiving care, this alone should not be confused with co-design. The distinction becomes apparent when we consider the three approaches we typically use to design services with patients:

  1. We don’t listen very much to our users and we do the designing.
  2. We listen to our users and then go off and do the designing.
  3. We listen to our users and then go off with them to do the designing.[2]

While both the second and third approaches involve listening to the experiences of patients, only the third approach can be described as co-design. Healthcare teams who capture the experiences of patients, staff and other stakeholders but fail to work with them to develop and test improvement ideas are at risk of misinterpreting, misunderstanding or embellishing the input from patients and their families.

True co-design, which involves all stakeholders as partners through every stage of the design process – identifying a challenge, engaging people, capturing experiences, understanding experiences, planning improvements and measuring the impact of changes – helps to mitigate these risks and produce a process, service or information that works for all.

A glossary of terms

Patient experience – The thoughts and feelings of a patient involved in a health or care journey. These are shaped by the clinical, personal and emotional interactions they have throughout that episode or journey of care.

Co-design – An approach to design which actively involves people, such as staff, patients, whānau and other stakeholders, in the design process to help ensure the result meets their needs.


[1] Maher L. (2019, Dec 16). Six tips on co-design. Retrieved from

[2] Bate P. & Robert G. (2007). Bringing user experience to healthcare improvement: The concepts, methods and practices of experience-based design. Abingdon, UK: Radcliffe Publishing.


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