Designing With, Not For: Rethinking Co-Design in Complex Systems

It usually involves people with different priorities, different incentives and – more often than we care to admit – different definitions of the problem. Which is where most well-intentioned co-design efforts begin to drift.

At Pivot, we’ve learned that co-design doesn’t fail because people don’t care. It fails because we skip the hard part.

Alignment.

Dr. Wina Smeenk, Professor of Societal Impact Design at Inholland University of Applied Sciences and a leading thinker in the field, once observed, “There is a reason… a problematic situation why you want to work together.” And that observation gets right to the heart of it. Before the Post-its, before the journey maps, before the frameworks, there has to be a shared understanding of why you want to work together; of why the work matters.

Without it, collaboration becomes performative. Everyone participates. No one agrees.

Start With the System, Not the Output

Co-design is often treated as a method; a workshop; a phase in a project plan. It’s more useful to think of it as a practice framework. A framework that helps teams navigate complex systems rather than rush toward solutions. Because the real work isn’t in generating ideas. It’s understanding the system those ideas need to live in. 

That means looking beyond users to focus on stakeholders in the full sense of the word: communities, organizations, policymakers, and frontline staff. Each brings a different view of the system and a different stake in how it needs to change.

Applied to Pivot’s healthcare-focused work, that means hospital officials might bring policy insight. Patients bring lived experience. Businesses bring operational expertise. Healthcare systems bring research. Each perspective reveals something different about the system being examined.

And each brings something else we don’t always want to name, much less face.

Power.

Everybody has power. Not just formal authority. But influence, expertise, relationships and critically, the ability to move things forward or quietly stall them. Ignoring power doesn’t make it go away. It just shows up later, usually when timelines tighten, and decisions become more substantive.

Good co-design surfaces those dynamics early. It makes them part of the conversation. Not to resolve them completely – because that rarely happens – but to understand the terrain and dynamic.

Design the Process Like It’s Real

If co-design is to work, the process must reflect reality. Which means letting go of the idea that will unfold neatly.

The strongest co-design efforts move back and forth; between defining the problem and redefining it; between imagining the future and recalibrating what’s possible; between individual perspectives and shared direction. It’s less a linear path and more of a working system.

Sometimes that system includes sketching. Sometimes it includes structured dialogue. And occasionally, it includes something even more hands-on. Sometimes there’s nothing better than tangible objects – think Lego, clay, blocks or other random stimuli – to spark people to externalize thinking in ways conversation alone can’t; to kickstart lateral thinking; to express a shift in perspective.

The Designer Role Has Changed

In complex systems work, as we see in our healthcare clients, we are no longer just shaping outputs. We’re shaping the conditions that make our design better.

As designers, that means we ask better questions. We make complexity visible. And we help people see the connections they might otherwise miss. 

That doesn’t necessarily make our work easier. If anything, it makes it more demanding. But – and this is a big but – co-design makes our work more impactful. Because when co-design works, it doesn’t just produce better ideas, it produces shared ownership. And that’s what allows change to stick.

Let’s Close the Loop

If co-design still feels like a workshop, it’s probably not doing enough. Used properly, it’s a way to align people, navigate complexity, value decision making and design systems that reflect how the world actually works. Which is to say, messy, interconnected and human.

The goal is not perfect alignment. The goal is enough alignment to move forward together. And occasionally, when the conversation stalls, knowing when to reach for something unexpected to get it moving again.

AUTHOR’S NOTE: Co-Design as a Practice Framework was the subject of a recent DesignMeets event sponsored by Pivot Design Group. DesignMeets is a series of social events where the design community can connect, collaborate, and share ideas.