Better Healthcare Together: Co‐Designing a Framework for Health Service Co‐Design

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INTRODUCTION: Co-design in health services is increasingly recognised as essential for creating services and policies that address patient and community needs. However, genuine co-design can be challenging, with existing toolkits often catering to professionals, reinforcing power imbalances and limiting community leadership. This paper aims to present a novel co-design framework for health services and describe the co-design process taken in its development. METHODS: The co-design process involved a series of engagement activities (online forums, focus groups, discussions and workshops) with health consumers, health professionals and researchers within a metropolitan health service in Queensland, Australia. This process, co-led by a clinician researcher and health consumer, explored the implicit meaning of co-design and the barriers and enablers to co-design within the local setting, and the strategies required to support operationalisation of co-design. These data were combined with research literature, existing frameworks and lived experience to iteratively co-design the online framework. RESULTS: Eight focus groups, forums and workshops across five hospitals and multiple community health services involved 128 individuals who contributed their professional and lived experience with co-design to inform the development of the co-design framework. The resultant 'Better Healthcare Together' framework includes three main components: (1) before you start co-design, (2) the co-design team and (3) the co-design process. A key feature of the framework is its deliberate focus on power, inclusion, equity, and bringing together diverse lived and professional experience to solve healthcare problems. CONCLUSIONS: This co-design framework provides a flexible approach to consumer partnerships, with reflections on the process highlighting the relational nature, the need to avoid expert mindset and the evolving landscape of consumer engagement. While widely used, the framework alone may not build true health system co-design capability due to the need to address systemic and organisational barriers to co-design. PATIENT OR PUBLIC CONTRIBUTION: Members of the public contributed to this work across all stages of this project, including as project co-leads and co-researchers, members of the steering committee, workshop co-facilitators, and co-design participants. They are also co-authors on this paper.

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