The scene is set through building a reflexive, design-centred collaboration space. Within this space, we co-designers follow a systems and foresight methodology to explore questions of equity in medical device development. The researcher’s extensive experience in medical device development is leveraged, and the collaboration space is arranged to mimic the power dynamic between expert and users, so central to the task of fitting a medical device to the market. Collaboratively, we explore origins of system behaviours and dynamics, by tracing real-life tragedies, and opportunities for equity imagined through outlier success stories. This paper examines the changes and challenges in outcome that are brought about when “designing the designing” is prioritized as well as critically examining how these findings might apply to the system of medical device development as a whole.
A collaboration-building branch of this project provides a case study in which co-design theory is moved into practice. A branch dedicated to systemic exploration of medical device development reflects critically and creatively on the researcher’s practice, with specific interest in the Flourishing Business Model Canvas as well as risk/benefit analyses essential to achieving safety and effectiveness. Findings from each branch are proposed as the nexus of departure from which an individual may press for increased awareness of systemic inequity in environments into which products will be launched.
This research makes the case that the choice to prioritize “designing the designing” is necessary but not sufficient. Without a wholesale change of values in these ecosystems, this may be a small step toward increasing awareness. Values must undergo transformation at the business strategy level or above, for equity practices to become embedded in the system.

Keywords: power, reflexivity, intersectionality, social determinants of health, equity, futures, participatory foresight, co-design, systems thinking, design thinking, values, medical device development, flourishing business model canvas, ecosystems.