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.