Health Service Co-Design



A prototype is a rough draft of an improvement.

Many kinds of prototypes are used throughout improvement work (ranging from a simple verbal description of the improvement through to a full mock-up).

Prototypes can even be made just to help you learn. The key with all prototypes is to be clear about what you need to learn and who from.

Prototyping simply means using a 'rough draft' of an improvement or a touchpoint to learn more about it. Prototyping for services can seem difficult because they rely on intangible processes, such as relationships with people. For example, patients want to experience intangible touchpoints such as warm smiles, informative conversations and helpful actions. But in fact processes typically involve many tangible touchpoints, such as letters, gowns, signage and information booklets.

There are two broad types of prototyping, the first for intangible elements and the second for tangible ones.

Why use it

Prototyping can be used to test new processes, products or services to see if they will work.

When to use it

Prototyping is used throughout the design process. Early prototypes (such as concepts, descriptions, sketches and diagrams) are very useful for learning more about ideas and how best to develop them further. Later prototypes (such as drafts, role plays or physical mock-ups) are critical for making sure improvements are working as they should to improve patient experiences. Prototyping is a very useful way of engaging in learning with stakeholders and stimulating creativity. 

In co-design work it is important not to spend a lot of time and money on individual prototypes. When working with stakeholders, a prototype only needs to be good enough for everyone to learn from.

1. Specify whom the improvement idea is for and what you want to learn

Always start prototyping by clarifying who exactly the improvement idea is for. Be as specific as you can. For example, when developing a patient brochure, your key patient might be a person who knows very little and is confused. The next step is to specify what you want to learn, Even if you have a lot of questions, focus on one ir two at a time. For example, if you have a draft brochure for patients who know very little, find an appropriate patient and ask them to help you with one element such as the pictures and diagrams.

2. Select and develop the simplest prototype

  • Use the prototype selection template below to help you with the simplest possible prototype. Note: the earlier you start prototyping the better your later prototypes are likely to be.
  • You can develop tangible prototypes using materials such as paper, cardboard, cloth, plastic, lego, polystyrene and so on
  • You can develop tangible prototypes using diagrams and role-plays.

3. Develop the prototype as quickly and cheaply as possible

4. Test the prototype

  • Test the prototype as many times as you need until you notice a pattern in the ways people respond to it. You can adapt tools such as SWIFT ideas and the biggest difference to assess the prototypes.
  • Use the prototype evaluation template below to help you document your findings.

5. While you are fresh from your findings with this prototype, brainstorm ideas for the next one


  • Prototyping is best when the exercise itself is very focused. The more focused the exercise, the faster and easier learning is.
  • Prototyping is best when people can play with and easily alter the prototype to reflect their findings and allow them to try out new ideas. The result might be an improvement or an idea for a new and better prototype.

Example: Mammography gown design

Waitemata DHB needed new mammography gowns. The project team organised a workshop with staff, patients and design students to help develop new ones.

The workshop started by exploring problems with existing gowns. Then eight teams of patients, staff and students identified what an improved gown might be like and brainstormed ideas. These eight 'ideas of an improved gown' were the first prototypes. Each team evolved theirs simply by reflecting on it and refining the idea.

A second set of prototypes was developed by sketching the gowns. This was repeated until the look and features of the gown seemed optimal to patients and staff.

A third set of prototypes was developed by mocking up gowns using lightweight material, cut to shape and held together with staples and Sellotape. Patients in the teams acted as both models and advisors to help evolve gowns that could both look and work well.

A fourth set of prototypes was developed by students as a coursework assignment. This version used materials and sewing appropriate for a real gown. A fashion show was held, in which patients and staff modelled the eight prototypes. The gowns were judged and three chosen on style, functionality and overall popularity.

A fifth set of prototypes was developed to pilot four different possible gowns in mammography scan clinics. Patients selected one of the four and used them during their scan. They then filled in a simple survey rating the gown on key features and checking for any final refinements. Results showed one gown (with minor refinements) was strongly preferred by patients and, as it happened, staff preferred this version as well.

The final gown is the result of five different prototypes and about 36 different versions of a simple mammography gown.