Squiggles and spirals: a model linking co-design and improvement science

Jo Szczepanska
3 min readJun 9, 2022


In a busy and time-poor world, our team wanted to find a way to quickly and effectively explain how co-design and improvement science connect.

Our objectives

  • Communicate what a project might feel like from start to finish
  • Present a conversation starter for teams for planning, iteration and navigating uncertainty
  • Frame the project using the co-design process from Beyond Sticky Notes: co-design for real (McKercher, 2020)
  • Leverage visual metaphors that describe the Process of Design (Newman, 2019).

Our best draft (for now)

We landed on a visual model that describes co-design and improvement science in action.

An uncertain start is common, but as you make and learn together, this leads to clarity and purpose, and controlled growth.

Long alt text available for this infographic linked below. ALT TEXT
This graphic centres around a line drawing. Phases and text correspond to sections of the lines and showcase parts of the co-design process.
Starting on the left you have a tangled series of lines “a squiggle” that loops, bends and overlaps. Eventually the lines refine down to a central point. The diagram finds focus. Is still. Then continues by spiralling out, larger and larger anti-clockwise.

Listen to the diagram here or get a copy or read the alt text (Google slide)

What we learnt

  1. Linear, rigid models limited the nuance and connection of co-design and improvement science
  2. Using lines to describe certainty and process flows is a promising communication tool
  3. Linking sentiment to stages, intentions and tools could assist teams to explain and begin planning their partnering in healthcare.

How we did it

We started our conceptualising by reviewing a variety of visual approaches:

  • Scales and tiers seen in IAP2 Spectrum of Public Participation (IAP2, 2018), Ladder of Participation (Sherry Arnstein, 1969) and Partnering in healthcare framework (Horvat, 2019)
  • Metaphors of the future (Kauffman, 1984)
  • Design models (Dubberly, 2011) including the Double diamond (British Design Council, 2005)
  • Matrices comparing levels of partnership vs. mindset or tools
  • Journey maps with ‘sentiment lines’ (below)
Sentiment line, one dividing central horizontal line Smiley face above, angry face below and a squiggly line moving between the emotions chronologically

Special thanks to my co-authors

Barry Baulch, Caitlyn Brennan, Peta Fawcett, Lidia Horvat, Nina Mulvey, Nami Nelson, Nora Refahi, Kristiina Siiankoski, Dan Ussher. And hosts Safer Care Victoria, Department of Premier and Cabinet Australia


Arnstein, S. (1969). A ladder of citizen participation. Journal of the American Planning Association, 35(4), 216–224.

British Design Council. (2005). The double diamond: A universally accepted depiction of the design process. Design Council. Retrieved March 31, 2022, from https://www.designcouncil.org.uk/news-opinion/double-diamond-universally-accepted-depiction-design-process

Dubbely, H. (2011). Design models. Dubberly Design Office. Retrieved March 31, 2022, from http://www.dubberly.com/category/topics/design/

Horvat, L 2019. Partnering in healthcare for better care and outcomes, Safer Care Victoria, State Government of Victoria, Melbourne

IAP2 International Federation. (2018). IAP2 spectrum of public participation — IAP2 Australasia. IAP2 Spectrum of Public Participation. Retrieved March 31, 2022, from https://iap2.org.au/wp-content/uploads/2020/01/2018_IAP2_Spectrum.pdf

Kauffman, D. L. (1984). Futurism and future studies. National Education Association.

Mckercher, KA (2020). Beyond sticky notes : co-design for real. Sydney, N.S.W.: Reed.

Newman, D. (2019). The Design Squiggle. [online] The Design Squiggle. Available at: https://thedesignsquiggle.com



Jo Szczepanska

Jo wants to live in a fair and healthy world, where services are co-designed with communities. She's multidisciplinary designer with a background in research.