Written by Dr Rachel Tindall (PhD) – Barwon Health

As an active and passionate co-designer in the public mental health arena, I enjoy having conversations with diverse groups of people around how to build better conditions for co-design. A recurring theme over the last six-months has been how to build a tolerance for, and a readiness to sit within the grey.

Kelly-Ann McKercher describes the grey as the discomfort of not knowing, recognising, and grappling with complexity (McKercher 2020). As humans, most of us cannot tolerate high levels of ambiguity and discomfort for long periods of time, and we drift back to our (perceived) safe places of certainty. But the grey areas of co-design are where the magic happens (Tindall et al. 2021).

In codesign practice, I often see this as the space that sits between the experiences of all involved, a space where all co-designers are repeatedly called into and a space where innovation can occur. This is where the hard, robust conversations happen, primarily about how and why the opinions and ideas of the co-designers are influenced by their experiences, perspectives, and knowledge.

When the grey is embraced, and the why and how behind opinions and ideas are shared, I have witnessed the creation of solutions that transcend one person. The process of having these conversations can often have more meaningful impact than the final design outcomes (Cataldo et al. 2021) but it requires high levels of vulnerability. When done well, these types of conversation can facilitate the cultural change that is nearly always required to sustain design and change. When done poorly, they can lead to distress and the potential for harm.

So, how do we best embrace the grey? From my experience, three key requirements for facilitating the grey are: trust, curiosity, and supportive structures.

Trust

Co-designers require the opportunity to build trust with each other before they embark on the conversations that require vulnerability. Brene Brown (2021), in her recent podcast and her Dare to Lead work states: “Trust is not built in big sweeping moments. It’s built in tiny moments every day”. This makes me reflect on the time that is needed to establish good conditions before any design activities occur. From my experience in the public sector, this is very difficult when timeframes are tight and the process of finding the best people for any project reduces opportunities for extensive team building. However, overlooking this formative stage poses the risk of real harm to co-designers, and is therefore essential. Some of the strategies I use to promote early trust within the co-design teams I participate in and lead include linking co-designers early, embarking on non-design related activities that allow the opportunities for connection and facilitating spaces where co-designers get to know each other beyond their work personas. We drink a lot of coffee, eat a lot of cake, and laugh a lot.

Curiosity

Being in the grey requires participants to enter with a high degree of curiosity and a desire to learn. Ideas and solutions emerge through dialogue, and there needs to be an appetite for more questions than answers. If co-designers enter with a sense of certainty or defensiveness, there is no space for creativity. In my experience, and informed by Kelly-Ann McKercher’s work, the role of a ‘provocateur’ is very beneficial for facilitating this (McKercher 2020, Tindall et al. 2021). The provocateur enters codesign without specific content knowledge or experience, and this allows them to question assumptions and norms. Their core role is to be a questioner, and this opens a space for others to question each other and themselves. I have found that this role also shifts conversations away from dichotomies, allowing nuances to be noticed and discussed. However, if someone is unable to specifically undertake this role, any person within a co-design process can model these behaviours, and in doing so, facilitate a safe place for curiosity.

Supportive structures

Whilst the grey is ambiguous, it needs to exist within a framework of safety. Co-designers benefit from clearly understanding the value they bring to the design process, their role and purpose, and who they can escalate any concerns to (McKercher 2020). It is helpful to have dedicated, named people to escalate concerns to. These people generally sit outside of the immediate team but remain known and accessible to the co-designers. I have also found it useful to have regular spaces where the process of co-design itself can be reflected on, for example through communities of practice, coaching or supervision.

What other strategies do you have for building your (or your teams) tolerance for sitting in the grey?

References

Brown, B. (2021). Braving trust part 1-of-2, viewed 9^th July 2022, https://brenebrown.com/podcast/braving-trust-part-1-of-2/

Cataldo, M.L., Street, B., Rynehart, S., White, C. and Larsen, K., 2021. Remembering radical roots: Lived experience participation movements and the risks and responsibilities of co-design in community-led change. Parity, 34(6), pp.13-16.

McKercher, K.A. (2020). Beyond sticky notes: co-design for real: mindsets, methods and movements. Sydney, Australia: Beyond Sticky Notes.

Tindall, R.M., Ferris, M., Townsend, M., Boschert, G. and Moylan, S., 2021. A first‐hand experience of co‐design in mental health service design: Opportunities, challenges, and lessons. International Journal of Mental Health Nursing, 30(6), pp.1693-1702.

About the writer

Rachel is a mental health nurse employed as the Program Implementation Manager at Barwon Health Mental Health Drugs and Alcohol Services. She has clinical, research, project management and senior management expertise and is a strong advocate for lived experience participation at all levels of mental health service reform, design and delivery.