Sharing power

Put simply, power is the ability to influence an outcome.

The definition of co-design refers to ‘partnering as equals’, and for this to occur power must be shared between members of the co-design team.

In health system, there are power imbalances due to differences in knowledge, education, position, networks and access to information. These exist between staff and patients/consumers, but also between different staff members.

There are a few ways that we can make sure we are sharing power when doing co-design:

• Introducing team members based on their expertise and contribution, rather than their role or position. This ensures that you are acknowledging the unique experience and value each team member brings, rather than their power.
• Using our Co-design Terms of Reference Template to decide on team roles and accountabilities. By giving each person a role and accountability, you are starting to share power and influence across the team.
• Being explicit about power imbalance through conversations with your team. These activities may be useful.
• Acknowledging that there is responsibility as a team to make decisions, not as an individual. While each person has a role and accountabilities, it is the team’s responsibility to do co-design, not an individual’s responsibility.
• Using commonly understood and simple language rather than acronyms, to avoid isolating people in the team.
• Ensure that all team members have equal access to project information and documents. If these are only available on internal networks or share-drives, this will reduce the power of those who cannot access these. Explore the functionality of Microsoft Teams or SharePoint as a file sharing platform, and test that all members can access these.
• Implementing equity strategies.
• In stage 1 of the co-design process, ‘Engage and Align‘, using opportunities to get to know your team members and develop a shared understanding of the context, motives, attitudes and values of those in your team through an open conversation. This builds common ground.
• Acknowledging that most people in the team will have lived, observed and professional experience that they are bringing, but are usually asked to ‘show up’ as one of those perspectives. Accept people as a whole and allow opportunities to share and acknowledge the perspectives people bring outside of the ‘hats’ they’re wearing.
• Providing opportunities for ‘community groups’ to come together and form shared understandings before introducing them into a context where there may be natural initial power imbalances. For example, convening a meeting only with people with lived experience to give them the opportunity to share and listen, so that they can participate in future “mixed” meetings with the power of their broader community
• If you are co-designing and feel that all perspectives are not being heard equally, consider bringing in an external facilitator.
• Providing honest feedback in the Peer Performance Review and using it to assess and discuss power. This may be uncomfortable, but reporting confidentially and having honest conversations about the results as a team can be constructive to the dynamic.