Introduction

In 2019, Policy Press journal ‘Evidence & Policy’ called for Special Issue proposals. I was aware of a previous special issue in this journal (Metz et al., 2019) exploring “Co-creative approaches to knowledge production” that concluded by suggesting “a greater focus on the topic of creativity”. It therefore felt natural to propose a special issue exploring the theme of Creativity in Co-production. Yet given the topic it also felt appropriate to do this with others. I called some friends. Given deadlines, these were people I knew and I knew were interested in this topic. They also brought design, arts, sciences and lived experience (long term illness and caring for people with long term illness).

Background

I apply, facilitate and support co-design in health research and innovation. I have been super interested for some time, in variations of the way co-design is viewed, written about and practiced by people from Design/Arts backgrounds and people from Health Sciences backgrounds.

Read more: Joe Langley NIHR Knowledge Mobilisation Research Fellowship

Background to Experienced-Based Co-design (EBCD) in health

To fit with the needs of Health Professionals, a process of co-design was formularised into Experienced-Based Co-design (EBCD), developing a repeatable method that would fit with reporting requirements and perceptions of what counted as valid or rigorous. I sometimes think of it as a ‘scientified’ co-design process. Even in the literature justifying the use of design, the creators of this process refer to Design Science rather than Design or Co-design practice. EBCD also reduced the complexity of the design process, and limited the variety of approaches, picking methods that were perhaps more familiar within the Social Sciences. For example in the earliest phases of the process (perhaps aligned to the Discover phase of the Design Council’s Double Diamond model), they specified video recorded interviews. The simplification and selection of methods that might be more familiar social science research methods, was purposeful with a view that the people applying this formularised co-design would be clinicians who would be unfamiliar with the paradigm of Design. As time has moved on, EBCD has evolved from this original purpose (frontline clinical settings for participatory service improvement) to be applied as a research approach or even method by health (science) researchers.

There is a lot to unpack with EBCD from the perspective of those in the academic discipline of design, not least the very name itself. Adding the prefix ‘Experience-Based’ implies that all other co-design processes are not based on experiences when in fact one could argue that all co-design are inherently based on the experiences of the co-design partners involved. And in fact, the practice of co-design always has been based on the experiences of co-design partners, throughout its history of evolution from participatory design to co-design, within the discipline of design itself, long before health scientists ever heard of it. So, adding that prefix doesn’t suddenly make EBCD the one-and-only form of co-design that is based on Experience and could be interpreted as bit of a ‘land-grab’ by Health Science Researchers for something that already existed within the discipline of Design.

Creative practices in co-design

Setting that, and many other points of contention, aside for some other blog, I have always been struck by a contrast in styles in the way co-design was conducted in the field of health research. If I facilitate co-design and when I observe or participate in other co-design work facilitated by other designers, we always used/use a variety of creative practices to engage partners more deeply in the actual activities of design. Yet such creative activities aren’t generally applied in more formularised approaches. This begs a question of how do I define these creative practices – which I will come on to later – but I am categorically excluding the use of sticky notes as a form of creative practice. So I was left with questions; Why was this? What value did the creative practices offer? How did they enhance a co-design process? These are the questions I have been asking myself for a long time. And I have chewed many people’s ears off about this over the years. I think there is a fascinating tension between the democratisation of design as a process that anyone can do, and design as a practice that requires skills, training, expertise in design – and ultimately how these come together in co-design. I myself believe it is both and I have been involved in work that has applied design in both ways. But again, I think this is the subject of another post.

Questions for a special issue

So in this proposal for a special issue, I was wanting to focus on:

• How is creativity applied within co-production?
• How does such creativity influence the incorporation of evidence into policy or practice?
• What impact(s) or effect(s) does creativity have in these applications?
• What are the implications of this, and for whom?

Creative Practices

---

The special issue process

Time wise, the start point for this was summer 2020. The UK had experienced its first pandemic ‘lockdown’ from March to July, so this felt like a summer of relative freedom, although with the burden of a short life span looming with all the signs of a second lock down rapidly approach. Eventually this transpired in mid-September.

The proposal

After convincing some friends to join me on this venture, we drafted the proposition to the journal editorial panel including details of the whole editorial group of six of us (see the end of this post for their details). In their response, Evidence & Policy asked us to reduce the editorial group to two at most, as this was their norm. We argued back, suggesting that the diversity of the topics (creativity, applied within co-production, applied to research) needed different people and perspectives. The proposal was subsequently accepted.

Submission and review of abstracts

We went through a fairly standard process of issuing a call, inviting abstracts, reviewing these within our guest editorial team and then inviting a subset for full paper submissions. Throughout this time, our group of editors had been meeting via zoom (time zonally challenging with Canadians and Kiwis in the group). For me, these had been late evening chats with friends. A mug of tea in hand, children already in bed, and an air of peacefulness with some gently thought-provoking conversation.

Full submissions and review

As full submissions began to trickle in, they were processed first by the journal editors-in-chief before being handed to us for the blind review process. As we sent articles out for blind review, we began to encounter the wider impacts of the pandemic. Reviewers were struggling to be able to take up invitations. People we knew as good, thoughtful reviewers, that had been responsive for previous invitations, were declining and citing pressure of health, wellbeing, family and work.

We tried hard to keep a balance of reviewers from Design/Arts, Science and people with lived experience of long-term illness. Yet this seemed to compound our challenges and made our task of securing reviewers all the harder.  

The effort was rewarding though. Our reviewers engaged in a dialogue with the authors, us editors and (through successive rounds) with each other. With often very divided views, the role of editing often took on a steering dimension, encouraging the authors to respond to conflicting comments but suggesting to authors which comments or perspectives they might hold in priority given their specific disciplinary root or perhaps how to reframe something from one domain to be palatable to readers from another.

This process continually reminded us that interdisciplinary work is both hard and rewarding.

Online workshop

As the first full drafts began to come in, we set up a Miro board (a collaborative online whiteboard) and gave authors access, dropping in some background, context, interesting references, emerging themes, questions posed by reviewers or editors. We then organised an online workshop for as many authors and co-authors as possible. In this we shared some early emerging themes and questions inviting authors into a dialogue and to give them insight into the neighbouring articles they would be bound with in this special issue. The opportunity to meet people screen-to-screen, put faces to names and hear the timbre of their voices, enhanced a feeling of connection. The themes are described in more detail on the project page.

Editorial team tasks

From this point onwards, the editorial work came in ebbs and flows, articles arrived for review in handfuls rather than all at once, I was able to take time in evenings to read articles, seek reviewers and pass them on. The emails back and forth with authors became an opportunity to check-in, get updates about their circumstances and ask after their wellbeing. Occasional online check-ins with fellow guest editors, catching up on the reviews, questions and topics of the special issue as well as personal wellbeing. There was a necessary component of relationship building between all of us – and for mutual benefit. I valued these connections as much as I hope others got value from it.

Second online workshop

As second and even third rounds of reviewing and revising ensued, we arranged a second online workshop with the authors. By this stage we have much firmer draft manuscripts, some almost final. With permission from the authors we shared them all amongst the authors before this second workshop. They got to read or scan them, identify common themes and distinctive contributions. Many of us met again in that second event and discussed the emerging themes. This led to the main points within our covering editorial. After this workshop, authors worked on getting their final papers to us, while the editors worked on the editorial.

Working in the midst of a pandemic

Wellbeing, family and work challenges faced by our pool of potential reviewers where also experienced by our authors. Pressures of work, bereavement, overwhelmed healthcare systems impacting the working lives of co-authors in countries all over the world. As much as possible (and supported by the editors-in-chief), we flexed deadlines and submission dates, being as compassionate as possible.

While all the authors, reviewers and editors were separated by vast distances and facing difficult personal circumstances and challenging professionals’ scenarios, I personally felt more connected to the wider world through intermittent phases of work and communication than I did through the media or any other work I was involved in. Although the work associated with this had no resources, budget or time allocation in my official work plan, it was some of the most rewarding work for me throughout the pandemic. Whenever I came to do any work associated with this, it made me feel calmer, more present, more empathetic and connected. I found it a fulfilling and beneficial experience. This process worked as a wellbeing support for me through the pandemic in a way some other projects did not.

Final selection and publication

The final papers were selected and reviewed by at least 2 members of the editorial group after the peer review stage, and then submitted to the production team. Meanwhile, we were in discussions with the publisher and were supported financially by Sheffield Hallam University to ensure that the whole issue was available Open Access.

Personal reflections

I would have loved to have had more resources and the opportunity to do more with authors and editors. Yet on balance, perhaps this may have prompted us into trying to do too much and would have applied more time pressure to people who were already time poor. Maybe it was just enough…

I certainly wouldn’t rush to do another special issue editorial job. This was the right opportunity, the right people, the right time. But having heard many scare stories of people scarred by guest editorial experiences, I cannot say this was what I experienced.

If there is one thing I would recommend to others – give yourself plenty of time. We started our process in July 2020. We’re publishing May 2022, partly due to shifting the planned publication issue (in discussion with editors in chief) and ‘buying’ ourselves a much needed 3-month window. This time frame was just sufficient. And has felt a little close to the mark in these final stages.

Throughout the process of pulling this together, some key sources of inspiration kept coming into the conversation between reviewers, editors and authors that didn’t make it into the references lists of any of the articles. These are described in more detail in another blog post. 

The learning from the content of the special issue is already informing my existing work in small ways, such as practice development, but I am also applying for funding to explore these topics further – watch this space! But before closing this blog I just want to share some concluding thoughts with you now.

Read Joe’s next blog post: Sources of inspiration for creative practices in co-production

Concluding thoughts

My concluding thought is that diversity of genes, genres, culture, ideas and knowledge makes humans and our societies stronger and richer in multiple ways. For this reason co-production is an essential tool to help address the biggest challenges we face.

Research, and the evidence from research, shouldn’t seek to dominate dialogue and decision making, but to act in services to dialogue and decision making. We suggest that creative practices provide an approach to facilitate the dialogue and decision making; to do the blending of perspectives, in a way that puts research, and research evidence, equally alongside others.

We don’t feel that this diminishes the research perspective at all. In fact, it allows researchers to see themselves and their own knowledge in completely different ways and so catalyses, multiples or amplifies the potential ways in which their knowledge can be useful and can be used.

Creative practices in coproduction liberates research evidence and enables it to be more useful and usable for society.

References

• Gauntlett, D. (2011). Making is Connecting; The social meaning of creativity from DIY and knitting to YouTube and Web 2.0, 2011, Polity Press
• Kuruvilla, S., Dorstewitz, P. (2010). There is no “point” in decision-making: a model of transactive rationality for public policy and administration. Policy Sci 43, 263–287. https://doi.org/10.1007/s11077-009-9098-y
• Metz, A., Boaz, A. and Robert, G. (2019). Co-creative approaches to knowledge production: what next for bridging the research to practice gap? Evidence & Policy, vol xx, no x, 1–7, DOI: 10.1332/174426419X15623193264226
• Sousanis, N. (2015). Unflattening Harvard University Press. ISBN: 978-0-674-74443-1
• Syed, M. (2019). Rebel Ideas: The Power of Diverse Thinking. John Murray Press. ISBN 978-1-529-34840-8

Author details

Joe Langley is a Design Engineer and Academic Researcher at Sheffield Hallam University in the UK, working in the Lab4Living research centre. He explores various forms of participatory research and innovation using design practices and co-design approaches, with a focus on Knowledge Mobilisation and the use of evidence in shaping and informing innovations.

You can get in touch with Joe via email (j.langley@shu.ac.uk) and Twitter (@JoeLangley_).

The Evidence & Policy Special Issue Editorial team

Joe Langley. You can get in touch with Joe via email (j.langley@shu.ac.uk) and Twitter (@JoeLangley_).

Nicola Kayes has a background in health psychology and is based in the Centre for Person Centred Research at Auckland University of Technology in New Zealand. Her work aims to challenge conventional rehabilitation practice through rethinking ways of working to improve outcomes that matter to people. This has led to collaborative work with design colleagues exploring the potential of creative and participatory practices in rethinking rehabilitation.

You can get in touch with Nicola via email (nicola.kayes@aut.ac.nz) and Twitter (@nickayes4.)

Ian Gwilt is a design academic at University of South Australia in a unit called UniSA:Creative. His current areas of research include practice and theory in visual communication design in the context of healthcare and wellbeing, and in how we can incorporate visual communication design practices into interdisciplinary research teams.

You can get in touch with Ian via email (ian.gwilt@unisa.edu.au) and Twitter (@iangwilt).

Erna Snelgrove-Clarke is a Nurse specialising in maternal and new-born health with career in both clinical work and research. She is based in Queen’s University, Faculty of Health Sciences, Canada. Her research and clinical work focuses on implementing evidence for compassionate, person-centre care.

Sarah Smith is a local Councillor for the people of Ardwick and Carcroft ward of Doncaster. She is also an international renowned Artist, a Radiographer and researcher with Lab4Living. She has won innovation awards for her patient centred and co-designed resources to better support patients in her Radiography clinic. She using drawing as method in her research work.

You can get in touch with Sarah via email (Sarah.Smith3@doncaster.gov.uk) and Twitter (@smizz)

Claire Craig is a Historian, Occupational Therapist and Design Researcher at Sheffield Hallam University in the UK, working in the Lab4Living research centre. She focuses on end-of-life and on Dementia.

You can get in touch with Claire via email (c.craig@shu.ac.uk).

Follow us on Twitter: @Lab4Living @EvidencePolicy