Don't be a flamingo: Why co-design matters and how to do it right

Co-design gives you the stability complex problems demand

We recently built a series of mobile application prototypes with one of the world’s largest pharma organizations and a team of brilliant behavioral scientists. From the very first moment — a full-day, all-in working session — the process was profoundly collaborative. Not the polite version of collaboration where everyone nods during a slideshow, but the real kind: sleeves rolled up, ideas challenged, metaphors sketched on whiteboards, data debated, and assumptions lovingly dismantled.

And something powerful happened.

We ended up with concepts that weren’t just beautiful from a UX perspective, or novel in their use of AI and personalization — they were grounded in evidence-based behavioral science. Early testing is already showing promise. But the real story isn’t the prototypes. It’s the way we made them.

In reflecting on the work, I’m reminded — again — that the more complex the domain, the more essential it is to design with people, not just design for them. In healthcare and pharma, where complexity and risk tower like twin mountains, co-design isn’t a nice-to-have method. It’s the only responsible path.

Because in a world increasingly shaped by AI, the future will belong to teams who know how to combine human insight, scientific rigor, and design craft into a single, coherent creative force.

What is co-design, really?

Co-design — sometimes called participatory design — emerged in Scandinavia in the 1960s and has always carried a democratic heartbeat. The idea is simple: invite all the relevant humans into the creation process, not as reviewers or approvers, but as co-creators.

Designers, clinicians, patients, data scientists, regulatory leaders, caregivers, behavioral scientists, and engineers — each one holds a piece of the truth. Co-design is the practice of assembling those fragments into a whole.

I still love this line from Doina Petrescu from Architecture & Participation, which feels even more prophetic in an age of generative AI:

Participatory design is a “collective bricolage”… the assemblage more important than the object.

In other words, the magic isn’t just the artifact. It’s the way we assemble it — the shared meaning, the shared risk, the shared discovery.

The keys to successful co-design:

1. Start early — way earlier than expected

Kickoffs shouldn’t be briefings. They should be creation events. We launch projects with half- or full-day sessions that blend problem framing, prioritization, rapid ideation, and vision alignment. Everyone participates. Everyone sketches. Everyone’s fingerprints are on the wall.

This early equity sets the tone: We are doing this together. And together is the only way this works.

2. Define clear domains of expertise. We call ours “Little e” and “Big E.”

On a recent pharma project, we developed a helpful distinction regarding areas of expertise:

• Little e: Engagement with the digital experience: UX, flow, visual design, interaction patterns.
• Big E: Engagement with the behavioral change mechanism: the underlying science, triggers, reinforcements, and cognitive models that enact the desired effect.

When you articulate domains clearly, you build trust quickly. You know when to lead and when to listen deeply. AI design adds two more dimensions: data fluency and model literacy — and the sooner you map expertise across these layers, the smoother the collaboration becomes.

3. Be vulnerable — show the work while it’s still wobbly

Gone are the days of disappearing into the studio and returning with a polished “ta-da” moment. Modern innovation demands transparency and iterative courage.

Showing incomplete work to domain experts can feel like standing on stage before the band is fully tuned. But the earlier we expose our thinking, the sooner the science, the lived experience, the regulatory realities, and the ethical nuances can shape it.

In AI-driven products, the user experience (UX) and the underlying model are inherently linked. Because of this, getting early feedback is absolutely vital.

4. Have fun

I’ve worked across enough teams and industries to know this: People do their bravest thinking when they feel safe enough to be playful.

Laughter accelerates trust. Play fuels imagination. Imagination fuels innovation.

Healthcare — for good reason — can be a risk-averse environment. But co-design creates a temporary greenhouse where bold ideas can germinate before the cold winds of compliance arrive. And when challenges inevitably hit (they always do), levity can even increase pain thresholds.

The real point: Don’t be a flamingo

Flamingos can stand on one leg for astonishing lengths of time — an impressive feat, but a terrible strategy for innovation.

When we rely on a single viewpoint, a single discipline, or a single moment of insight, we teeter.

But when we stand on all the legs available — human insight, scientific rigor, design craft, behavioral expertise, data, ethics, lived experience — we build products that don’t just function beautifully… they matter.

Co-design isn’t an efficiency hack. It’s a moral stance. A commitment to complexity. A belief that the future — especially the AI-enabled future — must be shaped with the people who will live in it.

And that’s how we create solutions that improve health, deepen trust, and make a meaningful difference.