Creating the conditions for collaborative decision-making in co-design

Research into co-designers' experience of co-design processes is uncommon, despite expanding use of co-design to improve and innovate in healthcare. This study aimed to identify how an online co-design was experienced, how it achieved its outcomes and the implications for healthcare co-design. Eleven co-designers were interviewed about their participation in an online, lived experience co-led, co-design that aimed to improve the physical healthcare of mental health service users in primary care and mental health settings. Analysis of group and individual interviews and co-design documentation involved an initial inductive coding process, followed by a more focussed theoretical coding process and the application of an existing conceptual framework to test the analysis. Three themes were identified - generating knowledge, creating space and influencing change. Each theme was characterised by underlying interdependent tensions - individual and collective, stabilising and transforming, internal and external, which operated together to facilitate collaboration. Time was an essential resource for engaging these processes. Efforts to create the conditions for co-design in healthcare may be enhanced when attention and time is given to underlying interdependent tensions that interact to support knowledge co-creation, collaboration and change.