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www.ijdesign.org 15 International Journal of Design Vol. 12 No. 2 2018
Introduction
Recently, an increasing number of design and innovation projects
apply co-creation as a process, agenda or tool. Beyond the
eld of design, these projects often include multiple disciplines
such as marketing, service development and innovation, and
management and organization studies. In marketing, Ramaswamy
and Gouillart (2010) describe a co-creation approach to process
design as involving several different stakeholders, exploring their
experiences, organizing participatory workshops for improving
interactions and building platforms for new interactions and
continuous dialogue. In design, while different institutions
dene the term slightly differently (Mattelmäki & Sleeswijk
Visser, 2011), co-creation is widely understood as practices
where a design practice and one or more communities of practice
participate in creating new desired futures (Holmlid, Mattelmäki,
Sleeswijk Visser, & Vaajakallio, 2015).
In this paper, co-creation refers to the entire process of a
design or innovation project, which involves different stakeholders
in various phases of the project, aiming to create desired futures
together from the planning and research phase, a “pre-design” phase
according to Sanders and Stappers (2014), to the implementation
phase, a “post-design” phase (Sanders & Stappers, 2014). The
term co-creation has also been widely used outside the design
eld. Service innovation and marketing research, for example,
use the term co-creation to explain the shifting role of customers
who become co-creators of value (Prahalad & Ramasway, 2004)
with the rising notion of Service Dominant Logic (Vargo & Lusch,
2008). In these domains, co-creation rather refers to co-creation of
values in the use context where service is co-produced (Grönroos
& Ravald, 2011). In our paper, however, the term co-creation
focuses on creative activities and co-creation of knowledge of
various stakeholders in a design or innovation project.
The origin of co-creation in design goes back to 1980s when
the participatory design (PD) movement emerged in Scandinavian
countries. Research projects on PD were conducted to involve
workers in the development of new systems for the workplace
(Ehn & Kyng, 1987). Scandinavian PD carried a political agenda,
asserting that people who are affected by a decision should have
an opportunity to inuence it (Schuler & Namioka, 1993). Since
then, as Halskov and Hansen (2015) review the current PD
research practices, the main concern of many current PD research
projects is to clarify tensions among stakeholders and make sure
that voices from different people are heard in the design process
(e.g., see Buur & Larsen, 2010; Simonsen & Robertson, 2012).
In 1990s in the U.S., Elizabeth Sanders introduced a notion
of “collective creativity”, believing that everybody is the expert
in regards to their life and can contribute to the design process.
ORIGINAL ARTICLE
Design Choices Framework for Co-creation Projects
Jung-Joo Lee 1,*, Miia Jaatinen 2, Anna Salmi 2, Tuuli Mattelmäki 2, Riitta Smeds 2,
and Mari Holopainen 2
1 National University of Singapore, Singapore
2 Aalto University, Helsinki, Finland
Co-creation has been adopted in many recent design and innovation projects, bringing different stakeholders together and creating a shared
understanding and new ideas through creative and participative approaches. Despite this increasing popularity, there is still a lack of a
systematic understanding of key dimensions and design choices in co-creation projects due to contextual complexity and contingencies. In
this paper, we develop the design choices framework for co-creation projects as a result of analyzing 13 co-creation projects from multiple
elds, including design research, process innovation and service innovation. The design choices framework provides us with vocabularies
that help to explain what kinds of dimensions co-creation projects are built on, what inuences the formulation of co-creation projects and
what informs the selection and development of methods. The framework also helps to assess and plan co-creation projects. We introduce
ten design choices identied from the cross-case analysis and discuss their dynamic interrelations.
Keywords – Co-creation, Design Choices, Design for Service.
Relevance to Design Practice – The design choices for co-creation projects provide a framework for researchers and practitioners
to plan and evaluate their co-creation projects. The design choices can also function as shared vocabularies and a framework for a
multi-disciplinary team.
Citation: Lee, J-J., Jaatinen, M., Salmi, A., Mattelmäki, T., Smeds, R., & Holopainen, M. (2018). Design choices framework for co-creation projects. International Journal of
Design, 12(2), 15-31.
Received Oct. 8, 2016; Accepted Sep. 5, 2017; Published Aug. 31, 2018.
Copyright: © 2018 Lee, Jaatinen, Salmi, Mattelmäki, Smeds & Holopainen.
Copyright for this article is retained by the authors, with rst publication rights
granted to the International Journal of Design. All journal content, except
where otherwise noted, is licensed under a Creative Commons Attribution-
NonCommercial-NoDerivs 2.5 License. By virtue of their appearance in this open-
access journal, articles are free to use, with proper attribution, in educational and
other non-commercial settings.
*Corresponding Author: jjlee@nus.edu.sg
www.ijdesign.org 16 International Journal of Design Vol. 12 No. 2 2018
Design Choices Framework for Co-creation Projects
For collective creativity, a designer plays a role as a facilitator
who scaffolds a process where users are invited to the design
process, envision desired futures and generate ideas (Sanders,
2000; Sanders & Stappers, 2008). Sanders introduced a set of
generative tools with which users—non-designers—can express
their experiences and generate new ideas.
Designers and researchers in current co-creation projects
are confronted with two main challenges: rstly, whom to
involve and how to open the process for those who are affected
and secondly, how to scaffold the setting for fostering people’s
collective creativity. These are crucial challenges for designers
and researchers as current co-creation projects deal with more
complex problems and stakeholder relations. Current practices to
cope with these challenges are often situated (Suchman, 1987);
designers and researchers plan and conduct the co-creation
project by responding to the very local context of the project and
contingencies that emerge at any points of the project. They choose,
develop and modify methods for co-creation as situated practices
within the project. There is then a lack of shared, systematic
understanding of what kinds of dimensions co-creation projects
are built on. What kinds of contingencies should the project
consider? What information could support the selection and
development of methods? This lack of systematic understanding
also makes it hard to evaluate the co-creation projects.
In this paper, we introduce a framework of key dimensions
and consideration areas for co-creation projects, which we call
the “design choices framework.” Through this term, we mean an
opportunity or an act of selecting from a variety of alternatives in
designing a project. The term is in debt to Cockton’s (2013) work,
which talks about “types of design choices” as frameworks that
cut across different vocabularies in different design paradigms,
for example, engineering design’s problems versus the briefs
in applied arts. Cockton identies four types of design choices:
artefact features and qualities, intended beneciaries, intended
purpose and evaluation practices.
In having the design choice framework as a conceptual
lens, designers and researchers can take a more holistic and
exible view when planning, making decisions in and evaluating
a project beyond the mere reliance on methods. As Cockton
(2013) emphasizes, design choice as a concept can also be shared
between different approaches to design and thus provides a useful
starting point for integrating them. We believe that the design
choices framework can especially benet co-creation projects
in a multi-disciplinary setting. Without shared frameworks and
vocabularies for co-creation projects, a team may face difculties
when carrying out a project.
In this paper, we identify ten types of design choices for
co-creation projects, based on our research in the multi-disciplinary
consortium project ATLAS at Aalto University, Finland. The
objective of ATLAS (2012-2014) was to create a cross-disciplinary
map for future service co-development, based on cross-case
analysis of a total of 13 earlier co-creation projects which had
been conducted by the research groups of the ATLAS consortium.
The research groups represent three different domains—design
research, process innovation and service innovation. Each group
had many years of experience in co-creation research and brought
the data from their past co-creation projects into ATLAS for the
cross-case analyses. In the following sections, we rst introduce
the theoretical perspectives to co-creation brought by the three
research groups to explain the kind of theoretical lenses used in
respect of co-creation in this paper. We then move on to explain
the analysis process and the resulting ten types of design choices
for co-creation projects.
Theoretical Perspectives
The three research groups in the ATLAS project brought their
theoretical perspectives to co-creation, which formed the theoretical
background for the cross-case analysis and the development of
the design choices framework. At the center of the theoretical
backgrounds are empathic co-design, knowledge co-creation and
process innovation, and service innovation.
Firstly, the design research group carries theories and
approaches from empathic design and co-design. Empathic
design stems from interaction design to enable designers to have
an access to felt-experiences and emotions of users (Mattelmäki
& Battarbee, 2002). The theories of and approaches to empathic
design are currently applied in a co-design setting in terms of
building empathy among various stakeholders beyond between
just designers and users (Holmlid et al., 2015; Mattelmäki,
Jung-Joo Lee is an Assistant Professor in the Division of Industrial Design,
National University of Singapore, where she leads service design education
and research. Since 2014, she has headed the Service Design Lab Singapore.
Her recent research focuses on designing with and for government for human-
centered innovation in public services and policy. She has collaborated with
various government agencies in Singapore and Finland, aiming at growing
design capabilities within these organizations.
Miia Jaatinen, Dr.Soc.Sc., is a senior university lecturer in the Department
of Industrial Engineering and Management at Aalto University, Finland.
Her research interests focus on communication, knowledge creation and
innovation in inter-organizational settings. She has taught university courses
on communication, management and development in business networks. She
is adjunct professor on public relations and organizational communication
at the University of Jyväskylä, Finland. She received a Doctoral degree in
communication from the Department of Social Sciences, University of Helsinki.
Anna Salmi, MA (New Media), is a doctoral student at Aalto University. Her
research interests focus on the role of co-design in developing organizations.
She works in the crossroads of design and organization studies and aims to bring
together knowledge in these two elds.
Tuuli Mattelmäki is an Associate Professor at Aalto University Department
of Design. Her starting point for design research is in empathic design and
explorative methods in human-centered and collaborative design. Currently, her
work focuses on service design related questions.
Riitta Smeds, D. Sc. (Tech.) is Full Professor in the Department of Industrial
Engineering and Management at Aalto University School of Science where
she leads the SimLab research group that she founded in 1998. The eld of
her professorship is Business and Service Processes in Digital Networks. Her
current research focuses on the management of digital transformation in inter-
organizational networks and emerging business ecosystems. In SimLab research
projects, which include participative developmental interventions, she studies
collaborative knowledge creation and facilitative management that support
innovation in networked processes and business. She is co-chair of the IFIP WG
5.7 Special Interest Group on Experimental Interactive Learning in Industrial
Management and a member of the European Academy of Industrial Management.
Mari Holopainen, M.Sc. (Econ.), is a doctoral candidate in the Department of
Engineering and Management, Aalto University School of Science. Her research
interests focus on temporality, user-based innovation in services and future
orientation in the innovation context.
www.ijdesign.org 17 International Journal of Design Vol. 12 No. 2 2018
J-J. Lee, M. Jaatinen, A. Salmi, T. Mattelmäki, R. Smeds, and M. Holopainen
Vaajakallio & Koskinen, 2014). A variety of empathic, generative
and participatory approaches such as design games, design probes,
acting-out, storytelling and prototyping are applied in co-creation
projects (e.g., Hyvärinen, Lee & Mattelmäki, 2015; Sanders &
Stappers, 2014; Vaajakallio & Mattelmäki, 2014). Instead of
explaining the existing, these approaches focus on developing
future visions of the human world (Cross, 2006) and are typically
context tied, democratic and practice driven (Keinonen, 2009).
By contrast to traditions in human research science or marketing,
these co-creation approaches are built on designers’ genuine
competences in respect of the visual, empathic and generative
(Hanington, 2003; Lee, 2014).
These approaches have now been adopted in emerging elds
like service design and innovation for making sense of complexity,
articulating experiences and creating and supporting collaboration
among different stakeholders (Hakio & Mattelmäki, 2011;
Holmlid et al., 2015; Steen, Manschot, & De Koning, 2011). Tools
like service blueprints, stakeholder maps or customer journeys
are adopted in co-creation workshops. For service professionals
and researchers, these methodologies provide rich co-creation
instruments for making use of users’ and other stakeholders’
creativity, collecting tangible artifacts built by them and leveraging
their engagement as full participants to the design of services.
The process innovation group carries theories and
approaches from organization and management theory, educational
sciences and design. They apply a developmental action research
approach to inter-organizational participative processes and
service development, focusing on the co-creation of knowledge
embedded in the processes and their social practices and through
that, the design of process innovation to produce added value
to all actors (Smeds & Alvesalo, 2003). In its action research
projects, the group prepares co-creative process development
workshops, so called process simulations, and realizes them as
a facilitated group dialogue in a virtual learning environment,
including through tools for visualizing and modelling the objects
of knowledge creation and innovation (Smeds, Lavikka, Jaatinen,
& Hirvensalo, 2015). These shared objects, often referred to as
boundary objects (Star 1989), include models and visualizations
of the present or future processes. They help to create a
shared understanding across organizational borders between
collaborators and this shared understanding supports the creation
of new knowledge (Bechky, 2003; Carlile, 2002).
Discussion and joint elaboration of the boundary objects
help to perceive the viewpoints of the customers, the collaborating
companies and other stakeholders. This joint process enables the
co-creation of mutually benecial solutions for shared problems
(Valkeapää, Lavikka, Jaatinen, & Smeds, 2007). According to
Bushe and Marshak (2009), social construction of new meanings
through the facilitated group dialogue in a co-creative setting may
encourage change in actions and new patterns of organization.
A process simulation helps change management which involves
empowerment of process actors, knowledge sharing and
co-creation as well as creation of a shared vision for process
innovation (e.g., Feller, Parhankangas, Smeds, & Jaatinen, 2013;
Smeds, Haho, & Alvesalo, 2003).
Service innovation research is built on service studies,
organization theories and innovation research. In this eld, the
challenge in services is to identify innovative ideas and manage
them through the whole cycle until they are implemented in
the marketplace. Current studies show that consumers’ service
ideas tend to be more innovative in terms of originality and user
value than those of professional service developers (Matthing,
Sandén, & Edvardsson, 2004) and that co-creation techniques are
much more efcient than traditional market research techniques
for creating protable service offerings (Witell, Kristensson,
Gustafsson, & Löfgren, 2011). This brings innovative service
development traditions towards the design eld, particularly
as the visualization techniques and deep user engagement are
established strengths of professional designers (Holopainen,
2010). Based on this idea, the service innovation group studies
innovation in services, recognizing the spreading role and
importance of customer involvement. In projects, they apply
storytelling and participatory methods in working directly with
customer groups.
Cross-Case Analysis
To identify common dimensions of co-creation projects, the
three research groups analyzed 13 co-creation projects. Of the
13 projects, six were conducted by the design research group,
three by the process innovation group and four by the service
innovation group. The 13 projects were conducted from 2004
to 2014 and were considered successful in the sense that they
produced a wealth of deliverables and outcomes that supported
the participating organizations’ co-creation and innovation as well
as producing new scientic knowledge. In most of the projects,
the main arena for co-creation was workshop-type events
gathering various professional actors and end-users together.
In the workshops, the researchers applied different co-creation
approaches, including design games, design probes, storytelling,
customer journey mapping, prototyping, personas, process
simulation, scenarios and future recall. Table 1 summarizes the
aims, participants and types of co-creation events and tools across
the 13 projects.
We organized six data analysis workshops to analyze the
empirical data from the 13 case projects. From each research
group, the responsible researchers who had participated in
the case projects took part in the analysis workshops. We used
a stimulated recall method to examine the decision-making
processes of the researchers who had planned and conducted
the projects. Stimulated recall usually involves playing back an
event to those involved to help them remember the thoughts and
feelings they had during the event, often with the help of empirical
data (Hodgson, 2008). The empirical data included the printed
reports of the processes and results of the case projects, project
plan documents, tools used in co-creative practices and co-created
artefacts, pictures and videos of the co-creative workshops and
simulations, publications from the case projects and so on. In the
workshops, the researchers from the case projects explained the
data and the details of each project (see Figure 1).
www.ijdesign.org 18 International Journal of Design Vol. 12 No. 2 2018
Design Choices Framework for Co-creation Projects
The ATLAS project had an external advisory board
consisting of academic experts and practitioners. The practitioners
were mostly from the organizations that had been involved in
the case projects, so they had knowledge about the case projects
and their impact afterwards. The practitioners were invited to
the second workshop. Later, the whole external advisory board
was invited to the fourth workshop to ensure scientic validity
and practical relevance of the analysis results. Each analysis
workshop took a half to a full day and involved small meetings
before and after for preparation and debrieng. The size of each
Table 1. The 13 co-creation projects for cross-case analysis.
Project name Research group Project aim Participants Co-creation events and tools
TULE
(2011-2012)
Design
research
Design a new cancer center based on
patients’ needs
Hospital staff, patients,
architects
Co-design workshops with patient
journey mapping and a real-scale
paper prototyping technique
Wellbeing365
(2011-2012)
Design
research
Design for public services
focusing on citizen’s wellbeing Citizens, municipal ofcers Pre-interviews, co-design workshops
with storytelling and design games
Palvelupolku
(2009-2011)
Design
research
Develop cross-sector service networks
within a municipality
Citizens, service business
partners, NGOs, municipal
ofcers
Design probes, personas, co-design
workshops with stakeholder mapping,
service blueprinting and make tools
Spice
(2009-2011)
Design
research
Design for metro experiences based on
storytelling
Multi-disciplinary research
groups, partnering companies
Design probes, co-design workshops
with role playing, make tools and
storytelling techniques
Active@work
(2004-2006)
Design
research
Design for wellbeing and work conditions
for ageing workers
Ageing workers, managers,
various experts
Design probes, personas, make-tools,
video observation
Extreme Design
(2008-2010)
Design
research
Help various companies from building,
banking and social media to co-design
services for customers
Company representatives,
customers
Co-design workshops with design
games, exhibitions
VisciTools
(2010-2012)
Process
innovation
Develop a company’s internal
innovation process and related
innovation practices
Company managers,
employees
Process simulations, co-design
exercises with personas, scenarios
and idea cards
INNOSchool
(2007-2010)
Process
innovation
Develop educational services in a public-
private network
School teachers, principals,
students, parents, municipal
ofcers
Process simulations with future recall
and scenarios in a workshop setting
PRO2ACT
(2010-2013)
Process
innovation
Develop a proactive contracting
process and software
Procurement ofcers,
associations, companies Process simulations
Inno-Wellness
(2010-2013)
Service
innovation
Develop employee-driven
innovation management models
Company employees,
managers Visualizations of management models
LEAPS
(2012-2014)
Service
innovation
Develop user-driven productization of
KIBS (knowledge-intensive business
services)
Employees, managers Storytelling, co-development of
leadership models
Innopex
(2010-2012)
Service
innovation
Improve user experience by comparing
users’ and the rm’s perspective
Users, company managers,
employees Storytelling
ISO
(2007-2010)
Service
innovation
Develop user-driven service innovation
processes and methods
Customers, company
managers, employees Co-development of methods
Figure 1. Data analysis workshops involving the three research groups.
www.ijdesign.org 19 International Journal of Design Vol. 12 No. 2 2018
J-J. Lee, M. Jaatinen, A. Salmi, T. Mattelmäki, R. Smeds, and M. Holopainen
workshop varied according to the aims, substance matters and
cases. The researchers’ workshops (1st, 3rd, 5th and 6th workshop)
were smaller in varying from 10 to 17 participants. In other
workshops with external partners, there were an additional 5
to 10 participants. Figure 2 encapsulates the overall process of
the cross-case analysis, participants, activities and results of
each workshop.
The goal of the rst data analysis workshop was to map
the different co-creation methods used in the 13 case projects and
to classify them according to their characteristics and purpose.
17 researchers representing the 13 case projects participated in
the workshop. They were divided into three multi-disciplinary
teams to classify the methods. During the analysis, the researchers
discovered a difculty in classifying the methods into a xed
framework because the same method could be applied in a variety
of ways and for different purposes. Instead of classication of the
methods, the rst workshop resulted in various dimensions that
serve as criteria for choosing methods, such as purpose of phases,
power distribution, mind-sets of participants, types of knowledge,
concreteness of outcomes, time scale of change and so on.
In the second workshop, the researchers tested and
elaborated the initial dimensions with the external practitioners.
Four case projects were chosen for deep analysis with the invited
practitioners and researchers discussing in groups what role these
dimensions played in the four case projects and elaborating the
attributes of each dimension. The practitioners also discussed
the concerns and challenges when taking such dimensions
into account. Soon after the second workshop, the researchers
conducted the third analysis workshop to synthesize the results
from the previous workshops. This third workshop resulted
in a rened version of seven dimensions, including purpose of
intervention, time scale of change, mind-sets of the participants,
types of knowledge and so on. This list served as a very preliminary
framework of design choices.
The fourth data analysis workshop served as an important
milestone in improving the scientic rigor and practical relevance
of the design choices. The external academic experts and
practitioners were invited for this purpose. The project researchers
presented each design choice in a card format with a design choice
name and a short description. The workshop participants were
divided into two groups, one with the academic experts to clarify
the concepts and connect the design choices with theories; the
group with the practitioners sought to validate practical relevance
and priorities of the design choices. As a result, some design
choices merged, a few new design choices were proposed and
relations between the design choices were identied.
Mapping co-creation
methods
Testing & elaborating
the dimensions
Synthesizing the
preliminary results
Improving rigor &
relevance
Synthesizing &
elaborating
Improving theoretical
explanation
Participants Activities Results
Project researchers
Project researchers,
external practitioners
Project researchers,
external practitioners,
external academic experts
Project researchers
Project researchers
Project researchers
Mapping methods
Analyzing dimensions
from the case projects
Refining the dimensions
Developing theoretical
explanation & validating
practical relevance of DCs
Elaborating DCs
through case analysis
Theoretical explanation of DCs
& identifying the relations
Dimensions for
method-mapping
An elaborated set of
the dimensions
A preliminary set of
design choices (DCs)
Theoretical explanations
& inter-relations of DCs
A modified set of 10 DCs
& 4 upper level categories
A final set of 10 DCs
1
st
workshop
2
nd
workshop
3
rd
workshop
4
th
workshop
5
th
workshop
6
th
workshop
Figure 2. Overall process of the cross-analysis of the 13 case projects.
www.ijdesign.org 20 International Journal of Design Vol. 12 No. 2 2018
Design Choices Framework for Co-creation Projects
The project researchers conducted a fth analysis workshop
to synthesize the results from the fourth workshop and to rene
the relations of the design choices. That workshop resulted in
the modied version of ten design choices and four upper level
categories, such as purpose of the change, participants dynamics,
methodological choices and outcomes; later modied into project
preconditions, participants, co-creation events and project results.
Finally, the sixth analysis workshop was conducted by the
project researchers to improve the theoretical explanation of each
design choice and clarify the interrelations between the design
choices. The nal list of ten design choices was generated from
this workshop.
Design Choices Framework
As result of the elaborate stepwise cross-case analysis process, we
developed the Design Choices Framework of ten design choices,
grouped into four categories: project preconditions, participants,
co-creation events and results (see Figure 3).
In the following sections, we describe each design choice
under its respective category. We use two case projects to illustrate
the problem dimensions and contingencies that could exist in co-
creation projects and how each design choice can be made in
response to the contingencies and problem dimensions in real
project contexts.
Two Cases for Illustration
To illustrate the design choices, two case projects out of the
13 were selected as examples, based on the following criteria;
the case projects had a comparable scope but applied different
types of co-creation approaches according to different aims
and participants of the projects. The comparable scope helps to
illustrate how different decisions can be made concerning the
same design choice according to different project contingencies.
Case 1. TULE Project:
Co-creation for a New Cancer Center of the Hospital
TULE project (2011-2012) was conducted by the design research
group. The initiative for the project came from a regional
hospital in Finland that planned to design a new cancer center
as part of a two-year long program to develop a patient-centered
care management model for sarcoma-type cancers. The project
management team from the hospital wanted to include patients’
needs and ideas in the development process so engaged the design
research group to plan and facilitate the co-creation process. Three
rounds of co-design workshops were conducted to bring different
stakeholders’ views and create ideas together.
Case 2. VisciTools Project:
Co-creation of a Process for a Digitally Supported
Collaborative Innovation in the Company
VisciTools project (2010-2012) was conducted by the process
innovation group. The project set out to develop the innovation
process of a global manufacturing and service company that
has R&D units in different countries. The company wanted to
develop a new innovation process and practices with a digital
tool, especially for collaborative innovation across geographically
distributed units. Altogether, the project held ve co-creation
workshops over a year and a half time span.
Project preconditions
•Openness of the brief
•Purpose of change
•Scope of design
Participants
•Diversity in knowledge
•Differences in interests
•Distribution of power
Project results
•Outputs of the project
•Outcomes of the project
Co-creation events
•Types of activities
•Setting for co-creation
Figure 3. Ten design choices grouped into four categories.
www.ijdesign.org 21 International Journal of Design Vol. 12 No. 2 2018
J-J. Lee, M. Jaatinen, A. Salmi, T. Mattelmäki, R. Smeds, and M. Holopainen
The attributes of Case 1 and Case 2 overlap with the case
projects conducted by the service innovation group in terms of
participant dynamics and methods used, although the service
innovation group does not use co-creation tools and visualization
as extensively as the other groups. We could thus select Case 1
and Case 2 as examples.
Design Choices Related to Project Preconditions
Design choices related to “project preconditions” set the ground
for the project to start and for framing the overall scope, purpose
and mode of the project.
1. Openness of the Brief
This design choice describes the mode of inquiry with which
the project approaches the goals of co-creation. A project team
could start a project with a pre-dened brief that leads to a project
process with a problem-solving mode, or an open-ended brief that
leads to a process with a more exploratory mode. Projects with a
pre-dened brief focus on analyzing pre-identied problems and
developing solutions for them. Projects with an open-ended brief
focus on identifying and framing relevant problem areas, which
then lead to the formulation of relevant design areas.
According to our analysis, many co-creation projects tend
to have an open-ended approach as their aims are often to frame
key problem areas in complex service systems. Burns, Cottam,
Vanstone, and Winhall (2006) explain that “complex challenges”
in current society are messy and more difcult to solve with a
straightforward planning process (for “wicked problems”,
see also Rittel & Webber, 1973). We found that although a
co-creation project is launched with a pre-dened brief, the brief
can be re-framed to be more open-ended along the way as various
stakeholders collaboratively frame and reframe objectives.
Lanzara (1983) long ago suggested that a large part of the design
process, especially in large-scale projects and organizations
involving several actions, is not dedicated to analytical work to
achieve a solution. Rather, much work of the designer is concerned
with collective denition of the relevant problem and how to see
it. The following cases demonstrate this nding.
Case 1
The hospital management team’s initial brief proposed an
architecture project focusing on the physical space solutions based
on patients’ needs. In early project meeting, the design researchers
and management team realized that the brief should be more open-
ended in order to identify real problems and create solutions for
these beyond the physical space. The management team also wanted
to develop effective approaches for patient engagement and co-
creation. The brief was revised to be more open-ended, which led
to a more exploratory process, encouraging the design researchers
to create and experiment new types of co-creation methods.
Case 2
The original brief was concerned with designing an improved
front-end for a global company’s innovation process, starting
from the existing innovation process model and aiming to
promote the quality of ideas and the efciency of the innovation
process. This focus was dened in the project planning phase and
arose from the company’s internal needs. After the rst process
simulation workshop, the researchers and participants realized
jointly that the initial focus neglected many of the undocumented
and messy practices within innovation. Hence, the project team
collaboratively reformulated the brief into a more open-ended
form, i.e., the creation of new co-design tools and concepts to
support the organization in changing its innovation practices. In
the course of the project, the company shifted from a technology
and results oriented view of innovation to a more human-centered
orientation. For example, they began rethinking the roles of
champions and the competencies needed to facilitate innovation.
2. Purpose of Change
Our analysis shows that the purpose for changes in a co-creation
project can vary from customer experiences (customer level)
to organizational practices and culture (organizational level)
to an entire service system and a collaboration network
(cross-organizational level). This nding is in line with the
multiple levels of service design identied by Patricio, Fisk,
Cunha, and Constantine (2011). Beyond these, an added purpose
for change can be at the level of society in promoting new values
and culture (Meroni & Sangiorgi, 2011).
We found these purposes for change involve a change in
employees’ mind-sets and practices, and in organizational culture.
In addition, the different levels of change inuence each other.
Designers and researchers of a co-creation project will need to
identify a main purpose of change on the map on different levels
to determine the design scope and participant dynamics.
Case 1
With the open-ended brief, the project team altered the purpose
of change from designing a new cancer center space based on
patients’ needs to the creation of new service experiences for
patients and embedding patient-centered innovation approaches
in the hospital.
Case 2
The project initially aimed to improve the employee’s experience
of using the new digital tool. The introduction of the tool, however,
created a need to establish new roles, responsibilities and a
tutoring system, including information about the new innovative
working culture. Furthermore, it was realized that setting up a
new service system was not enough; a simultaneous wide-scale
change in organizational practices, employees’ roles and attitudes
towards collaboration was required.
3. Scope of Design
Although the design choice for “purpose of change” considers
fundamental agenda and impacts of the project in a broader and
long-term sense, “scope of design” is concerned with what is
to be designed during co-creation activities. The most concrete
scope of design focuses on service touchpoints and interactions
where a customer has direct interactions with physical, digital
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Design Choices Framework for Co-creation Projects
or human touch points. Beyond what customers can see and
experience, the scope of design can also be on the operational and
organizational level, including organizational processes and tools
or cross-organizational collaboration models. As Patricio et al.
(2011) explain in their analysis, the scope of design broadens for
co-creation projects which aim to design a new service concept,
new types of value co-creation platforms or business models.
From more current projects, we found that the scope of design
expands from designing products or services to that of conditions
or platforms for future actions as Manzini (2011) puts it.
Case 1
As the main purpose of change was to design new service
experiences for patients, the scope of design focused on new
types of services and processes at the cancer center, including a
new patient journey, spatial layout, environment and atmosphere,
touchpoints like furniture, equipment and communications and
so on.
Case 2
The initial scope was on improving the interactions of employees
in the digital tool, including the roles and responsibilities in
each phase of the innovation process and improvements to the
user interface. However, as the work proceeded, developing new
approaches to innovation in the company raised wider questions
concerning, for example, multiculturality, work processes and the
technological ecosystem in the organization. Thus, the scope of
design widened to developing the whole service system around
the IT-tools that can support new innovation processes.
Design Choices Related to Participants
The design choices included in the “participants” category
concern who has relevant knowledge, what types of interests are
involved and consideration of the power dynamics in the project.
4. Diversity in Knowledge
Co-creation takes place when involving various stakeholders
who hold relevant knowledge and in seeking to achieve a
polyvocal perspective in the design process (Muller & Druin,
2012). The 13 case projects required knowledge from different
areas of expertise and scopes to solve complex social and
business challenges.
In selecting the participants for the co-creation group
according to knowledge diversity, we found two requirements
for successful co-creation, these being holistic knowledge and
hologram structure in line with Smeds’ (1994) framework on
knowledge sharing and management. The participants of a
co-creation group should: 1) together possess all the requisite
knowledge of a product, service, or process that they develop
(holistic knowledge); 2) bring together into co-creation effort
the practice-based knowledge of all identied stakeholders
(organizations, functions, business areas, hierarchical levels,
customers, etc.) whose practices will be affected by the
co-created product, service or process (hologram structure).
Holistic knowledge and hologram structure of a co-creative group
are needed for developing viable ideas that can be successfully
implemented into innovations (Smeds et al., 2003). A co-creation
project can thus be analyzed according to the diversity of
knowledge it encompasses and according to the inuence of this
knowledge diversity on the success of the project.
Case 1
The participants represented healthcare staff, patients, architects
and design researchers. The group presented a high knowledge
diversity: the healthcare staff had extensive knowledge of the care
processes; the patients could bring in their felt-experiences related
to the hospital and the care processes; the architects needed to
understand those stakeholders’ knowledge and at the same time
provide architectural knowledge to the project; lastly, the design
researchers brought their expertise for design of the co-creation
process and tools and facilitation of the collaboration among
different stakeholders.
Case 2
Case 2 involved a group of stakeholders who together possessed
diverse practice-based knowledge according to their elds of
expertise, these ranging from R&D managers and engineers to
marketing and service experts, from different hierarchical levels
within the company and also from different geographic locations.
To involve the knowledge of employees outside the geographical
location where the project took place, the employees from six
different countries were interviewed and the data was introduced
as persona descriptions in the co-design workshops.
5. Differences in Interests
When there are several stakeholder groups in a project, interests
can be varied and complex. We found that taking different
stakeholder interests into account can inuence the success of the
co-creation project as also observed by Ramaswamy and Guillart
(2010). The project team needs to carefully design the way
different interests can be taken into account and the way in which
stakeholders can be involved by considering the complexity of
their relationships and possible conicts. Stakeholders’ different
interests also inuence their roles in co-creation activities and the
way the project outcomes are created.
Case 1
The stakeholders had different interests in their participation.
Hence, the project team needed to design the entire process
to support the different interests. The project management
team was keen to collect good ideas for new design and learn
new approaches for patient involvement; hospital staff wanted
to contribute their professional knowledge for the process
optimization and more effective and friendly interactions with
patients; patients were keen to express their needs and inuence
the design of the hospital; architects’ interest was to gain an
understanding of all those needs and ideas expressed by the
hospital staff and patients. In addition, the design researchers
had an interest to develop and experiment new types of co-
creation methods. As a result, the co-design workshops were
developed using patient journey mapping and a full-scale
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J-J. Lee, M. Jaatinen, A. Salmi, T. Mattelmäki, R. Smeds, and M. Holopainen
participatory prototyping technique to enable hospital staff and
patients to bring their experiences and knowledge, for the project
management team and the architects to learn about the needs and
new ideas, and for the design researchers to experiment with
new tools.
Case 2
The R&D management who initiated the project aimed to
renew the innovation practices and digital tools. While some
employees saw the introduction of the digital innovation tool as
an opportunity to create a collaboration platform among experts,
some others saw it as a threat to the existing system that supports
professional merit for individual work. The design researchers had
an interest in experimenting with different co-creation methods
and learning about their use in organizational development. In
the ve workshops, the design researchers employed various
kinds of visual objects and facilitation techniques, for example,
process simulation, personas, scenarios, process concepts with
metaphorical design and storytelling with idea cards to help
the participants negotiate their different interests (for details of
the tools, see Salmi, Pöyry-Lassila, & Kronqvist, 2012). Those
exercises helped the participants explore each other’s motivations
and concerns as well as build an empathic understanding of each
other’s experiences and the meaning of the whole co-creation
process. In the last co-creation workshop, the managers and the
employees were able to co-create a roadmap for future innovation
practices where the differences in interests had been resolved.
6. Distribution of Power
Participants in co-creation projects have different degrees of
power due to their different knowledge levels, interests, roles,
societal and organizational backgrounds and so on. Considering
the power asymmetries, designers and researchers who facilitate
co-creation events apply tools and settings that aim to empower
participants with less power to express their views and provide
equal chances to all participants.
We found from our analysis that the diversity in power also
exists between designers who facilitate the co-creation event and
participants who have less ex pertise in creative activities. The
level of power given to the designers as facilitators can also vary
depending on the goal of the co-creation event and the complexity
of stakeholder relationships. The facilitators can choose to take
either a neutral position or an active collaborator position as
Schein (1988) puts it. The neutral facilitator focuses more on
supporting the participants to solve the problems on their own,
minimizing their inputs for idea generation and decision-making,
while the active collaborator-facilitator both facilitates the process
and participates in idea generation and decision-making. When
the participants lack ideas and cannot think out-of-box, designers
could play the latter role in the co-creation, using their expertise
of making creative inputs. Kankainen, Vaajakallio, Kantola, and
Mattelmäki (2012) call this role of designers in the co-creation
creative secretary. In order for users to take an equal role, they
need to be given the necessary equipment for idea generation
and visualization.
Case 1
In the early phase of the project, the design researchers noticed
a power distance especially between the hospital staff and the
patients due to their different knowledge levels of the care process
and social roles in a hospital. This might hinder the patients
from condently presenting their ideas. The design researchers
thus paid special attention to the power distance when designing
co-creation activities to empower the patients regardless of
knowledge backgrounds and to develop a full-scale participatory
prototyping technique. With that technique used in a workshop
setting, all participants move around and work in a visual and
making mode, regardless of their expertise backgrounds. During
the co-design workshops, the design researchers tended to play
a neutral facilitator role, focusing on helping the participants
perform the co-creation tasks rather than making creative inputs
as the architects were in charge to make new design proposals.
Case 2
The workshops in Case 2 aimed at levelling out the power
difference between managers and employees by requiring
an equal hands-on participation from both and by using the
difference in experiences as a source of new ideas. In the process
simulation workshops, the researchers—as facilitators—used
their expertise in process modelling and simulation. They
guided the company representatives in their innovation process
modelling and facilitated the subsequent process discussion but
refrained from taking a stand on substance related matters as the
company representatives were the experts who possessed the
knowledge of what their work entails. In the co-design workshops,
the participants were required to explore the process from the
viewpoint of the others and to work curiously on an unfamiliar
ground by using visual and storytelling methods such as personas,
scenarios and idea cards (Salmi et al., 2012). This way of working
resulted in a ne-grained understanding of the requirements of
collaborative innovation.
Design Choices Related to Co-creation Events
The design choices related to “co-creation events” concern what
types of co-creation activities are chosen and developed according
to project preconditions and participants and what the setting
should be like in order to achieve desired outcomes.
7. Types of Co-creation Activities
The activities in co-creation projects aim at eliciting knowledge
from stakeholders and creating new ideas, which can be achieved
through a step-by-step procedure that moves from articulating
experiences and building mutual understanding to generating
future ideas together. These phases are often structured as a
multi-stage process within one co-creation event or a series of
co-creation events during a project, as observed in previous
design literatures (e.g., see Binder & Brandt, 2008; Sanders &
Stappers, 2014; Vaajakallio & Mattelmäki, 2014). The best-
known practices include Future Workshop in participatory design
(e.g., Kensing & Madsen, 1991), the overall framework for which
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Design Choices Framework for Co-creation Projects
proceeds through critiquing the present, envisioning the future
and implementing, and generative tools (Sanders, 2000) under an
overall conceptual strategy that combines market research (what
people say), ethnography (what people do) and participatory
design (what people make).
From the knowledge co-creation perspective, these steps
can be explained as knowledge dissemination, knowledge sharing
and knowledge creation according to the knowledge boundaries
that need to be crossed (Carlile, 2004) and the type of learning
occurring (Paavola, Hakkarainen, & Lipponen, 2004). In
disseminating activities, knowledge is transmitted by a sender to a
recipient when participants express their experiences and different
perspectives through visual and narrative tools. In knowledge
sharing activities, knowledge is shared between participants
through dialogue. These activities include plenary discussions and
workshops which aim to visualize different views, build empathic
understanding and create a shared meaning and a collaborative
relationship among the participants. In knowledge creating
activities, knowledge is co-created by the participants in the form
of ideas, concepts and solutions. The focus of co-creation often
takes the form of developing shared artefacts. The following cases
illustrate how this occurs in practice.
Case 1
Co-creation activities in Case 1 were designed by considering
the purpose of change and the scope of design in the project as
well as different knowledge, interests and power distribution
among the participants. The full-scale participatory prototyping
technique was applied in the workshop so the participants could
model the spatial arrangement and the interactions together and
physically experience how the future services would be (see
Figure 4). Before actual prototyping, however, the workshop
consisted of gradual steps of knowledge dissemination, sharing
and creation to help build ideas on a shared understanding of the
different stakeholders.
Firstly, all participants were asked to bring pictures to
the workshop of places that were inspirational and pleasant for
them. The workshop started with the participants’ telling stories
about the pictures to other participants, followed by discussion
of the kinds of experiences a new hospital might provide.
The participants then built a journey map about patient care
processes. Visualizing each step of a patient journey through
discussions helped the participants negotiate their ideas and
build a shared goal for participatory prototyping. After this, the
participants started participatory prototyping with the real-size
cardboard furniture.
Tools for visualization and physical modelling provided a
shared means of communication for participants from different
knowledge domains, helping to avoid situations where the doctors
might use medical-specic terms or the architects might use
architecture-specic terms, which could create a power distance
and hinder equal participation. Further details of the co-design
process and participatory prototyping techniques can be found in
Kronqvist, Erving, and Leinonen (2013).
Case 2
The project included a series of altogether ve co-creation
workshops, out of which one was process simulation with the case
company participants and four were co-design workshops. The
process simulation workshop started with a presentation by the
manager on the status of the innovation tool and the development
of the innovation process in the company. This was to facilitate
a shared understanding of the project background and motivate
the employees to participate in the workshops as there were
knowledge boundaries arising from differences in professional
backgrounds and roles in the innovation system. In the workshop,
discussions concerning the participants’ different experiences
of innovation and their expectations regarding the innovation
process supported the creation of shared meanings that provided
the basis for development.
Knowledge sharing about the process in the workshops was
followed by co-design exercises in which the groups developed
shared artefacts. The researchers believed that such concretization
helps participants to negotiate the key aspects of ideas or concepts,
embodied participation or the use of different materials help the
participants engage in knowledge co-creation while recording
ideas in the form of words and pictures helps participants recall
the ideas and develop them over time. Further details of the
co-creation activities in Case 2 can be found in Salmi et al. (2012).
8. Setting for Co-creation
In addition to a co-creation activity’s type, a project team also
needs to pay attention to the physical setting of the activity. We
found that the physical location of the activity and the design of
different materials inuence the success of a co-creation event.
Figure 4. Co-creation activities in Case 1: Storytelling with pictures (left), building a shared goal by mapping a patient journey (middle),
participatory prototyping with real-size cardboard furniture (right).
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J-J. Lee, M. Jaatinen, A. Salmi, T. Mattelmäki, R. Smeds, and M. Holopainen
In participatory design, siting and setting of co-creation
has been recognized as one of the important parameters. Muller
(2003) emphasized that the selection of site can be a deliberate
strategy to introduce new experiences and perspectives to one
or more practices in the design process—a de-centering move
that can bring people into positions of ambiguity, renegotiation
of assumptions and increase exposure to heterogeneity. The
designer’s role is important in creating “the third space” beyond
the participants’ domain boundaries. The third space contains an
unpredictable and changing combination of attributes of each of
the bordering spaces (Bhabha, 1994; Muller, 2003). Recently, the
importance of the material settings of co-design has been as also
emphasized by Eriksen (2012).
In organization sciences, there has been an upsurge of
interest in the material side of knowledge creation, on objects
and artefacts that support knowledge creation and on spaces
that support creative group processes. The material setting can
motivate action, facilitate collaboration and provide infrastructures
for work (Nicolini, Mengis, & Swan, 2012). The following cases
illustrate how designers and researchers then considered the
setting for co-creation.
Case 1
The design researchers paid careful attention to the physical
setting, materials and atmosphere of the workshop to encourage
the participants to be motivated and generative. They rst piloted
the workshop in the hospital building. It was found that the
existing power distance between the hospital staff and the patients
inuenced their collaboration, the familiar environment hindering
them from thinking out-of-the-box. The design researchers,
therefore, set up the workshop in a TV production studio with
full scale, simplied cardboard models of furniture that resembled
hospital beds and equipment—“the third space” according to
Muller (2003). This decision was to freshen the participants’
existing perception of a hospital but still give them a symbolic
association with the hospital.
Case 2
The researchers paid attention to the ways in which the
participants’ knowledge creation could be enabled through spatial
arrangements and various artefacts. In the process simulation
room, the seats were organized in a comfortable cafeteria layout to
diffuse the division between a stage and audience and to encourage
discussion and participation. To facilitate the process discussion,
a visual process model, enhanced with persona descriptions, was
projected on a 10-meter white board. Being able to view the
process as a whole and to perceive it in all its complexity was
eye-opening to the participants. For the co-design workshops the
researchers chose to invite the participants to a site different from
their ordinary working environment, a university working space
designed for creative collaboration. The choice of space for the
co-design workshops was to inspire the participants by providing
a new experience of an innovative place for collaboration.
Design Choices Related to Project Results
The “project results” category includes two levels, from
immediate results and deliverables as “outputs” of the project
to further implementations and impacts as “outcomes” of
the project.
9. Outputs of the Project
Various kinds of outputs are produced from the co-creation
activities during the project. Some are immediate outputs from
the activities created by the participants. Some are consolidated
reports and proposals by the researchers or designers. The outputs
of the project can vary in a range from ideas about concrete
changes and their visualizations (e.g., improvement ideas, touch
points, customer journey maps) to new service concepts (often
presented as scenarios, videos, service blueprints and process
models) to future strategies (e.g., a set of experience goals and
future road-maps). At the end of the project, the outputs are
handed to the project owners as deliverables.
The scope and content of the outputs are inuenced by the
preconditions for the project, i.e., purpose of change and scope of
design. In addition, the medium of the outputs, whether documents,
visualizations or prototypes, are decided for efcacious delivery
of the content. Already dening the outputs of the project at the
beginning of the project informs how to collect ndings and ideas
during the project as well as who will do this.
Figure 5. Co-creation activities in Case 2: Discussion about the innovation process (left) and co-design of new ideas (right)
(pictures redrawn due to non-disclosure agreement).
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Design Choices Framework for Co-creation Projects
Case 1
After the co-design workshops, the design researchers created
a report that compiled key stakeholder insights and new design
ideas for the hospital with visualizations. The report also included
the descriptions about the methods, including the participatory
prototyping and patient journey mapping. The reports were
to full the interests of the project management team and the
architects in collecting patient experiences and new ideas
as well as learning new methods for involving patients in the
innovation process.
Case 2
The results of the rst process simulation were compiled into a
written report, whereas the results of the latter co-design workshops
were summarized in slide sets that included visualizations of
the company’s future innovation process and the concept of the
digital tool as well as digitized material for shaping tomorrow’s
innovation workshops. The co-design process produced grounded
recommendations about the new front-end innovation practices
and about the related digital tools. It also produced strategies
for developing the roles in the innovation system in the form of
user prole posters, process concepts, scenarios about future uses
of the tool and a ve-year roadmap for the future development
of innovation practices in the organization. The outputs of the
co-design process took advantage of various visual formats
whereas the process simulation report employed a textual manner
of presentation.
10. Outcomes of the Project
The co-creation projects in our analysis created impacts and
further implementations beyond the project outputs. They include
new mind-sets, processes and culture, future project ideas and
so on. The outcomes of the project usually refer to the direct
effect on target population, which could result from outputs of
the project as well as other changes gained in the participants
or the project context (Munns & Bjeirmi, 1996; Wardale, 2013;
Sangiorgi, 2011). Whether the goals of the project are achieved
depends on many different factors in the project and its context.
The implementation of the outputs of the project also plays a
role. The analysis of the outcomes of the project gives important
information about its success. Poor outcomes can be a signal of a
problem in the planning and execution of the project. Sometimes
the projects can also have unintended consequences or a wider
impact than initially expected.
Case 1
As the proposed ideas for the hospital are now in implementation,
the effect on patients’ experiences cannot yet be evaluated. However,
there has been evidence on changes in hospital management towards
adopting more active patient-centered, co-creation approaches in
their innovation, for example, planning a series of future projects
on patient-centered services by working together with patients. In
addition, the co-creation workshops and participatory prototyping
techniques applied in the project have gained strong attention from
service design communities and the healthcare sector inside and
outside Finland.
Case 2
The service system stabilized its position in the company’s “tool
ecosystem” to a point that the managers decided to continue the
expansion of the user base. The novel front end of the innovation
process, supported by the ecosystem of tools, should enable
non-linear work processes and collaboration through time
and space. Simultaneously, an organizational transformation
process was set in motion in the R&D function of the company.
This change concerned a rethinking of role assignments, the
integration of work processes and tools to the innovation process,
company policies as well as adopting a human-centered mind-set
and methods to develop organizational practices. Due to the wide
scope of changes to be made, the complexity of the network of
actors involved and the multinational nature of the organization,
not all the changes could be implemented during the two-year
project, but a ve-year road-map was drafted to support the
continuing of the development process.
In Table 2, we overview the ten design choices and
summarize the case illustrations on how the attributes of each
design choice have been considered and the decisions have been
made in the co-creation projects.
Discussion
The design choices framework helps us understand what kinds of
dimensions a co-creation project consists of and which attributes
and alternatives can be considered and chosen between when
planning and conducting the project. In addition, we identied
inuential relations among the different design choices.
Inuential Relations among Design Choices
In the previous section, we explained how one design choice
inuences decision-making for another, consequently shaping the
co-creation project as it proceeds. From the illustrations of the
design choices in Case 1 and Case 2, we identied a few inuential
relationships, especially (a) between participants’ knowledge,
openness of the brief and purpose of change, (b) between scope
of design and participants and types and settings of co-creation
activities and (c) between interests and power of the participants
and outcomes of the project (see Figure 6).
Between Participants’ Knowledge, Openness of the
Brief and Purpose of Change
In both Case 1 and Case 2, we observed that the involvement of
diverse knowledge of participants widens the openness of the
brief, which in turn leads to reframing the purpose of change.
In Case 1, for example, the involvement of design researchers
at the early phase of the project made the project brief more
exploratory in order to identify real needs of the patients and
develop new methods for patient-centered innovation at the
hospital. This widened brief reframed the purpose of change
from the design of the space to designing for new patient
experiences and embedding a patient-centered innovation
approach in the hospital.
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J-J. Lee, M. Jaatinen, A. Salmi, T. Mattelmäki, R. Smeds, and M. Holopainen
Table 2. Overview of the ten design choices and design choice illustrations in the case projects.
Design Choices Case 1: TULE project Case 2: VisciTools project
Category 1: Project preconditions
Openness of the brief
is often required in co-creation projects as
various stakeholders frame key problem areas
during the projects.
Widened to identication of real problems and
co-creation of new ideas
Widened to co-creation of new ways of innovation
with the employees
Purpose of change
varies among the levels of;
- customer experiences
- organizational practices and culture
- collaboration networks
- new values and culture in the society
- Creating new service experiences for patients
- Embedding a patient-centered innovation
approach
- Effective use of a digital tool
- Re-designing innovation practices
- Transforming organizational culture to innovation,
from tech-oriented to human-oriented
Scope of design
varies;
- service touchpoints and interactions
- organizational processes and tools
- cross-organizational work models
- service concepts and business models
- Spatial arrangement and touch points in a future
hospital
- Service interactions and patient journey
- New ways of utilizing the tool
- New processes & tools that support innovation
- Service system that supports the front end of the
innovation process
Category 2: Participants
Diversity in knowledge
for successful co-creation can be achieved when
the participants;
- together possess all the requisite knowledge of
what to design
- bring together into co-creation effort the
practice-based knowledge of all identied
stakeholders
- Hospital staff: medical and care process
knowledge
- Patients: patient experiences
- Architects: architectural knowledge
- Design researchers: co-design knowledge
- Company R&D management: management
agenda
- Company employees in different elds, positions
and geographic locations
- University researchers: knowledge on process
innovation and co-design
Differences in interests
by different stakeholders are often complex. It
is important to identify the possible conicts and
complexity and take them into account when
designing the co-creation activities
- Hospital staff: designing an effective work
environment
- Patients: expressing their needs
- Architects: understanding client needs &
design ideas
- Design researchers: experimenting new co-
design methods
- R&D management: renewing innovation
processes
- Employees who see the project intent as an
opportunity or a threat
- University researchers: experimenting new
co-creation method
Distribution of power
could result from different organizational and
knowledge levels, interests and roles.
Power differences between hospital staff and
patients, and between architects and other
participants, inuencing the choice of methods:
pictures for sensitizing and expressing; full-scale
prototyping as a shared language
Power differences between managers and
employees, inuencing the choice of methods:
visual and storytelling methods (personas,
scenarios and idea cards) for articulating
employees’ needs and roles
Category 3: Co-creation events
Types of co-creation activities
consist of step-by-step activities for:
- articulating experiences
- building a mutual understanding
- generating future ideas together
- Storytelling with pictures
- Collaborative mapping of a patient journey
- Full-scale prototyping of a future hospital and
care models
- Process simulation workshops for a shared under-
standing of the current status and the project aims
- Co-design exercises with hands-on materials
(persona building and idea cards)
Setting for co-creation
should be a deliberate strategy for effective
power distribution and idea co-creation.
Full-scale cardboard prototyping in a TV produc-
tion studio to provide a fresh environment yet with
hospital metaphors
- Cafeteria-like seat arrangement to diffuse division
- Visual process model on a large screen for a
holistic view
- Setting up workshops to an environment inspiring
for creativity and collaboration
Category 4: Project results
Outputs of the project
are immediate results and deliverables;
- new ideas about concrete changes
- new service concepts
- future strategies
- Compilation of insights and new design ideas
with visualizations
- Method descriptions
- Improvement ideas for the tool and the innovation
system
- Strategies for the system
- 5-year future roadmap
Outcomes of the project
can be analyzed for important information about
project success.
Planting patient-centered culture in the hospital Wider-scale organizational transformation process
www.ijdesign.org 28 International Journal of Design Vol. 12 No. 2 2018
Design Choices Framework for Co-creation Projects
A similar inter-relationship was found in Case 2. The
original purpose of change was to improve the innovation process
by using a new digital tool based on the formal innovation model.
In the early phase of the project, the research group interviewed
the employees and recognized limitations in the formal innovation
model. This nding drastically widened the brief of the project in
order to co-create new ways of innovation with the employees and
to transform the organizational culture to innovation from tech-
oriented to human-oriented.
Scope of Design and Participants Inuencing
Co-creation Events
The design of co-creation activities and settings was importantly
inuenced by the scope of design and the dynamics of the
participants. In Case 1, the scope of design was about new space
and touch points as well as service interactions and patient
journey in a new cancer center. This led to the use of full-scale
participatory prototyping techniques to simultaneously model the
space, the equipment and interactions. In addition, the differences
in knowledge, interests and power among the participants
had an important effect on the decision regarding co-creation
activities and settings. Hands-on creation and bodily experiences
with visual and tangible materials were chosen to encourage
the hospital staff, patients and architects to collaborate beyond
their own professional domain and societal roles. Realizing the
prototyping workshop in a TV production studio was the design
researchers’ experiment to diffuse power distance and help the
participants think out of the box.
In Case 2, the researchers chose to combine hands-on
co-design workshops with process simulation when the scope
of design widened from innovation in the formal process to
new ideas for the whole digitally supported innovation system.
Because the workshop participants were from different levels of
the company, including managers and subordinate employees,
power distribution was also an important dimension in choosing
the activities and settings for co-creation. Visual and storytelling
methods such as personas, scenarios and idea cards helped to
articulate both managers’ and employees’ needs and to build
a shared understanding of the roles innovation entailed in
the company.
Participants’ Interests and Power Inuencing
Outcomes of the Project
Another nding from analyzing Case 1 and Case 2 using the design
choices framework is that the participant’s interests inuence
the implementation and impacts of the project results, i.e., the
Purpose of change
Scope of design
Diversity in
knowledge
Differences in
interests
Distribution of
power
Openness of the brief
Types of co-creation
activities
Setting of
co-creation
Outputs of the
project
Outcomes of the
project
(a) Involving stakeholders with diverse knowledge leads to a more open-ended brief
and reframes the purpose of change of the project.
(b) The scope of design and the diversity in participants’
knowledge, interests and power influence
the types and settings of co-creation activities.
(c) Participants’ interests and power
influence outcomes of the project
Figure 6. Inuential relations of the design choices.
www.ijdesign.org 29 International Journal of Design Vol. 12 No. 2 2018
J-J. Lee, M. Jaatinen, A. Salmi, T. Mattelmäki, R. Smeds, and M. Holopainen
outcomes of the project. In Case 1, the project management team
from the hospital had an interest in new approaches to involving
the patients’ experiences in innovation in addition to new ideas
for hospital design. After the project, they were very active in
promoting the co-design methods used in the project inside
and outside the hospital, seeing the hospital become known as
progressive in co-creation approaches involving patients. In Case
2, the company’s R&D team initiated a wide-scale organizational
transformation process following the end of the project. This was
possible because they had enough power to implement the outputs
of the project and leverage them.
We would like to note that it is not our aim to generalize
these ndings into some kind of formula of relationships among
design choices. Our aim, instead, is to demonstrate how the
design choices framework enables us to understand the dynamic
and progressive formation of co-creation projects in particular
project contexts. In doing so, the design choices also provide
us with a framework and vocabularies to compare different co-
creation projects and to understand their underlying similarities
and differences.
Design Choices Framework beyond
Methods Matrix
As explained earlier, co-creation projects are often built with a
project brief that is open-ended and exploratory. This means that
procedures and participating stakeholders might change along
the way due to various contingencies that emerge. Problem areas
and stakeholder relationships in recent co-creation projects are
more complex than those in traditional product development. The
impact of changes is also interrelated in a complex network. These
characteristics inherent in co-creation projects make it challenging
to plan and systematically analyze co-creation projects.
Traditional product development or user-centered design
projects have been formalized and executed on types of methods
that are used in different phases (e.g., see Laurel, 2003). During
the cross-case analysis in this paper, however, we realized that
creating a method-phase matrix for a co-creation project is fairly
difcult and sometimes invalid. Instead of suggesting which
methods to choose in certain phases, the design choices framework
was developed to inform what variables and alternatives to
consider in order to choose and apply more relevant methods. In
this way, decision-making about the approaches can respond to
various and changing contingencies around the projects.
As we demonstrated earlier, each design choice is not an
independent entity, but relates dynamically to other choices. By
“dynamically”, we mean that the way different design choices are
interrelated is not predened but depends on the contingencies
that emerge as the project unfolds. The design choices framework
helps us plan a co-creation project so that it can adjust to changes
and contingencies more exibly. In other words, not only can
the design choices framework help the designers and researchers
systematically plan, understand and evaluate a co-creation project,
it can also help them respond exibly to the dynamic context of
the project.
Conclusion and Future Research
The design choices framework can be used in practice when
planning and evaluating co-creation projects. The framework
gives the various dimensions that need to be considered, from
setting the project preconditions and identifying relevant
stakeholders to designing co-design activities and expecting
the project results. In addition, by understanding the dynamic
relations of different design choices, the designers and researchers
of the co-creation projects can form a more exible strategy to
cope with project contingencies.
This study is the rst step towards integrating knowledge
and practices from different disciplines to create a holistic
understanding of co-creation projects. The resulting design
choices framework is based on the multi-disciplinary research
from 13 co-creation projects. In this paper, we provide detailed
analysis of only two of the cases. In future research, we will
analyze the design choices and their dynamics in the remaining
cases more deeply to further validate our framework. Future
research can continue by looking closer at each design choice to
identify the variety of alternatives within each choice situation
and the dynamic relationships between the design choices in
changing project contexts.
Acknowledgments
This research was conducted at Aalto University by the
multidisciplinary research team of the ATLAS project. ATLAS was
funded by the Finnish Funding Agency for Innovation Tekes and
Aalto University, which are gratefully acknowledged. We would
like to thank our researcher colleagues in the ATLAS project,
Kirsikka Vaajakallio, Juha Kronqvist, Olivier Irrmann and Otso
Hannula, for their signicant contribution to the development of the
framework. We also warmly thank the committed representatives of
the companies and public organizations in the ATLAS Consortium
as well as the distinguished members of the international ATLAS
Scientic Advisory Board for their active participation and valuable
input to the research. Jung-Joo Lee gratefully acknowledges the
Singaporean Ministry of Education’s Start-Up Grant funding support
for the publication process, Grant number: R-298-000-007-133.
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