Using co-design for improvement

A diagram that outlines parts of the co-design process, how it feels and flows

In response to teaching Safer Care Victoria’s Co-design NOW our co-design crew devised a diagram called Spirals and Squiggles to explains the co-design process connects to improvement science.
We use Squiggles and Spirals to share out:

  • how the co-design process feels and flows
  • outline key stages and activities
  • identify points we can share decision making to be successful.

Key stages

Using linework the diagram shows how an uncertain start is common, but as you make and learn together, this leads to clarity and purpose, and controlled growth.
The diagram lines are color coded to respond to parts of the co-design and PDSA (Plan-do-study-act) process from Improvement science.

Visual description linked in article. Line drawing with annotations. Phases and text correspond to sections of the lines and showcase parts of the co-design process.

Build the conditions

In the ALIGN phase you:

  • Create conditions for success: governance, sponsorship, time and money, safe spaces, policies and processes.
  • Build your community and staff networks.  

Here three different lines come together to create a squiggle.

Immerse and align

In the PLAN phase you:

  • Build a shared understanding of the project and how the team will work.
  • Set up goals and metrics for success and evaluation.
  • Connect, share stories, begin to explore the topic.
  • Identify skills and strengths.

It is the most tangled, complex, busy side of the squiggle. You don’t know where one thing starts and the other ends. This is when you PLAN in Improvement science PDSA cycles.

Discover and design

In the DOING phase you:

  • Learn together using generative tools, rich data to identify themes and trends.
  • Map and make sense of different perspectives.
  • Start making prototypes to test your thinking.
  • Bring in others as critical friends.

Visually the Discover lines are green and Design is purple. Here the wobbly lines start coming together, reduced amplitude and oscillation. The line finds focus.

Design, test and refine

This is the STUDY phase in improvement science. Actions in this phase:

  • Rapidly prototype multiple ideas and concepts to test them with others.
  • Measure improvements and gather feedback.
  • Refine your design with what you learn.

This section is purple and blue shades emerge as one spiral  grows outwardly from the centre. You design, test and refine.

Implement and learn

In the ACT phase you:

  • Determine next steps together.
  • Select the most promising prototype to refine, implement or scale.
  • Evaluate the process and progress.
  • Celebrate and share results.

Visual description: The line continues to loops outward increasing in scale, the light blue line is complemented with phase title “Implement and learn”. In improvement science this is when you act. 

Listen to the diagram here or get a copy or read the alt text (Google slide)

What is it based on?

We started our conceptualising by reviewing a variety of visual approaches:

  • Scales and tiers seen in IAP2 Spectrum of Public Participation (IAP2, 2018), Ladder of Participation (Sherry Arnstein, 1969) and Partnering in healthcare framework (Horvat, 2019)
  • Metaphors of the future (Kauffman, 1984)
  • Design models (Dubberly, 2011) including the Double diamond (British Design Council, 2005)
  • Matrices comparing levels of partnership vs. mindset or tools
  • Journey maps with ‘sentiment lines’


Arnstein, S. (1969). A ladder of citizen participation. Journal of the American Planning Association, 35(4), 216–224.

British Design Council. (2005). The double diamond: A universally accepted depiction of the design process. Design Council. Retrieved March 31, 2022, from

Dubbely, H. (2011). Design models. Dubberly Design Office. Retrieved March 31, 2022, from

Horvat, L 2019. Partnering in healthcare for better care and outcomes, Safer Care Victoria, State Government of Victoria, Melbourne

IAP2 International Federation. (2018). IAP2 spectrum of public participation – IAP2 Australasia. IAP2 Spectrum of Public Participation. Retrieved March 31, 2022, from

Kauffman, D. L. (1984). Futurism and future studies. National Education Association.

Mckercher, KA (2020). Beyond sticky notes : co-design for real. Sydney, N.S.W.: Reed.

Newman, D. (2019). The Design Squiggle. [online] The Design Squiggle. Available at: