Co‐design: Moving towards authenticity

If you ask a colleague about codesign, expect a vast array of responses. It is safe to say that collectively, experiences of codesign cover the gamut of ‘the good, the bad and the ugly’. This editorial accompanies a Virtual Issue of the Australasian Journal on Ageing which brings together a series of papers describing how codesign has been applied to Aged Care service delivery and practice in Australia. Whilst it is important to acknowledge that codesign can be used indiscriminately and with opaque or even nonexistent definition and application, the collection reinforces other encouraging signals indicating that there is reason for optimism in this field. A recent and comprehensive review of codesign and coproduction research by Masterson et al.1 traces the origins of the science as far back as 1972; however, the substantive volume of research effort has been in the last 15 years. This roughly parallels the establishment of key institutions amplifying patient voices in healthcare such as The James Lind Alliance, which was established in 2004, and the Patient Centered Outcomes Research Institute, launched in 2010. Tellingly, over onethird of the 979 articles in Masterson's review did not provide a definition of ‘codesign’ or ‘coproduction’. In highlighting this, the authors reflect on key concerns about how the concept of ‘codesign’ is misused in practice – specifically through “using the terms coproduction or codesign, but not involving (or reporting inclusion of) service users ... this finding suggests that the core values underpinning coproduction and codesign may be being diminished” (p. 9). This reflects many conversations I have had as a researcher in this space. Often, when codesign is used in a superficial way, the ‘codesign’ activity is a oneoff, didactically focused information session with little opportunity for meaningful feedback or inputs – in other words, little actual codesign. So, what is codesign? Like many ‘umbrella’ terms, there is no single, universally accepted definition. Masterson et al.'s mapping of the highly cited articles that explicitly defined codesign/coproduction highlights, instead, a series of key themes that have emerged as the science of codesign has grown: