Purpose: This paper sets out a framework for planning co-design processes for complex sys-tems-based projects typical in healthcare settings. Background: Healthcare systems and environments are complex. Innovation often requires the redesign of physical spaces or objects, social processes, and the complex associated layers of ser-vice systems. Co-design is an established methodology for catalysing innovation in products and services because the scope is often well-defined but can be more challenging when working in sys-tems where complexity impacts boundary definition. Co-design uses interdisciplinary and mul-ti-level engagement with diverse stakeholders to catalyse innovation at the intersection between disciplines, experiences, and knowledge sets. The evaluation of these processes often utilises con-trol over decision-making as a defacto measure of participation quality, reflecting potential for stakeholders to influence key outcomes. Yet there are also practical and theoretical reasons to val-ue well-designed participatory processes in their own right. Methods: The framework presented in this paper combines the evaluation of participation in co-design processes and in decision-making as two distinctive activities, applied to real-world and hypothetical case studies that demonstrate the potential of this framework as a transparent plan-ning and evaluation tool. Results: The framework allows participation to be planned and valued independently without defaulting to control over decision-making processes as the (only) valued option. The case studies demonstrate its potential in structuring a range of collaborative processes that suit different types of system innovation. Conclusions: The formalisation of a framework for planning co-design activities that values participation in co-design processes in parallel with participation in decision-making provides a more transparent and beneficial way to structure co-design for complex systems-based challenges that recognises the humans at the heart of co-design.

Day surgery is an expanding service, yet in many cases the current built environment is based on the general surgical department, with access to day bed wards and has changed very little since 1950s in the UK. In Dec 2019 a one-day workshop was organised to investigate the future concept for day surgery services and to explore the spatial provi-sions. The event consisted of a range of stakeholders from government, practice and aca-demia involved in healthcare environments. A design dialogue methodology was imple-mented, exploring the ‘ideal model of care’ through a series of activities using word, image and free association from user experiences. A design game, using tangible materials, let the participants develop and build visual proposals of new surgical environments. The workshop outcome was further processed through identification, sorting and coding of key themes for improvement, such as; user experience, logistics, adaptable design, after-care and recovery. By defining high and low parameters of patient experiences, a number of topics were discussed, including social community systems, information awareness, safety and wellbeing, continuity of patient pathways as well as efficiency and effectiveness of staff. The final design game combined the themes and topics and further deepened the in-sights. The use of a variety of design dialogue methods combined perspectives and knowledge and the workshop clearly identified the value and impact of interdisciplinary collabora-tion to deliberate and explore ideas for future healthcare facilities.