Mitigating unintended consequences of co-design in health care

Background: Co-design and associated terms are increasingly being used to facilitate values-based approaches to health-care improvement. It is messy and complex, involving diverse actors. Methods: We explore the notion that initiatives have outcomes other than initially planned is neither new nor novel but is overlooked when thinking about co-design. We explore some of the unintended consequences and outline some optimal conditions that can mitigate challenges. Discussion: Although co-design approaches are being applied in health care, questions remain regarding its ability to produce gains in health outcomes. Little is known about determining whether co-design is the most suitable approach to achieve the given project goals, the levels of involvement required to realize the benefits of co-design or the potential unintended consequences. There is a risk of further marginalizing or adding burden to under-represented populations and/or over-researched populations. Conclusion: Undertaking a co-design approach without the optimal conditions for inclusive involvement by all may not result in an equal partnership or improve health or care quality outcomes. Co-design requires on-going reflective discussions and deliberative thinking to remove any power imbalances. However, without adequate resources, a focus on implementation and support from senior leaders, it is a tough ask to achieve. Patient or Public Contribution: This viewpoint article was written by two academics who have undertaken a significant amount of PPI and co-design work with members of the public and patient's right across the health system. Our work guided the focus of this viewpoint as we reflected on our experiences.