People close to the work should be engaged, not merely as recipients of change, but as co‑designers of viable solutions.
Mandated change meets the workflow it never saw coming. Co‑designed change is built inside that workflow from day one. The cycle below shows how leaders move from announcing change to building it, and each step opens with the leader moves that make it real.
The Co-Design Cycle
Four Steps, One Continuous Loop
Select any step in the cycle to explore it. Use the Next button to walk the loop in order.
1Step 1 of 4
Observe the Work
Go where the work actually happens and watch the workflow as it is, not as the policy manual describes it. The gap between work‑as‑imagined and work‑as‑done is where most change initiatives quietly fail.
Leader Moves
Schedule recurring rounds at the point of care or point of service, not just when something breaks.
Ask “show me” instead of “tell me.” Watching one scan get scheduled beats ten meetings about scheduling.
Treat workarounds as signals of design failure, never as staff violations to correct.
Watch OutObservation that feels like inspection shuts people down. Announce why you are there and what you will do with what you see.
The Reframe
From Recipients of Change to Co-Designers of Solutions
The shift is not a communication style. It is a redistribution of design authority. Watch what changes when the same organization moves from the left column to the right.
Recipients of Change
➞
Co-Designers of Solutions
Change is announced to the team
➞
Change is built with the team
Compliance is the finish line
➞
Ownership is the finish line
Feedback is collected after decisions
➞
Input shapes decisions before they are made
Workarounds are hidden from leadership
➞
Workarounds are treated as design data
Sustainability depends on enforcement
➞
Sustainability comes from fit with real work
Self-Assessment
How Co-Designed Is Your Organization?
Rate each statement from 1 (rarely true) to 5 (consistently true). Your score maps your organization onto the co‑design maturity spectrum. Two statements test each step of the cycle.
Observe the Work
Leaders regularly watch the work where it actually happens, not just in reports.
RarelyConsistently
Observe the Work
We map real workflows, including workarounds, not just the process on paper.
RarelyConsistently
Surface Constraints
Frontline staff can name barriers openly without fear of being blamed.
RarelyConsistently
Surface Constraints
Constraints raised by staff are documented and visibly acted on.
RarelyConsistently
Design Together
People who do the work sit at the table when solutions are designed.
RarelyConsistently
Design Together
Teams choose between viable options rather than receiving a single directive.
RarelyConsistently
Test and Refine
Changes are piloted small, with success criteria defined before launch.
RarelyConsistently
Test and Refine
We refine or retire changes based on evidence, not sunk cost.
RarelyConsistently
–0 of 8 answered
Answer all eight to see your profile
The ring fills as you answer. Your final score places your organization in one of four maturity bands, from Directive to Embedded Co‑Design, with a next move for each.
KEY INSIGHT
Better solutions emerge when the people doing the work help design the change.
From On the Road to Excellence · Kelly Emrick, DHSc, PhD, MBA, BSRT(ARRT)R