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Co-Design as a Duty of Care: Accessibility in the Era of Psychosocial Risk

When I was a new graduate, I was given a small staff room to put my captioned telephone in.

It was the only phone I could use in the building. Everyone else could pick up any phone, anywhere. For them, communication was fluid, embedded, invisible — part of the rhythm of practice life.

For me, it was a logistical puzzle.

Every phone call meant leaving the treatment room, walking down the hall, hoping the staff room wasn’t full of people on lunch break, and trying to find a quiet moment in a space that was never designed for privacy.

I would talk about euthanasia, client distress, or financial consent while someone reheated curry in the microwave behind me, and others would come in, chatting about their weekend.

Later, I was moved to a quieter place — a euthanasia room.

It was private, yes. But it had no computer, no desk, no notes, and no way to access the information that made those calls possible. Just a sofa.

I learned to balance the captioned phone on my lap, making calls, then tell the caller: “Can you hold just a moment?” while I ran down the corridor to another room to check records, lab results or update an estimate. Frequently, I would do this multiple times in one phone call. It didn’t help with client rapport, and it added multiple hours to my working week.

Future workplaces had learned some lessons about privacy and workflow — but the system was still built around hot-desking. After a consult, when I needed to call a client before the next one, my only accessible workstation was often in use. Others could pick up the phone from any desk in the building; I had to wait for one specific desk to become free. Access was still conditional — still something to earn.

Each move solved a symptom. Each was well-intentioned. But it wasn’t access.

And that’s the difference between accommodation and co-design.

What Co-Design Really Is

Co-design isn’t a buzzword; it’s a redistribution of power.

It means designing with the people who will use, navigate, and be affected by a system — not just consulting them at the end. It’s grounded in the belief that the lived experience of the user is expertise in itself. It asks: “What does the person with lived experience know that we don’t?”

When a system is designed without the people it’s meant to include, the best we can ever achieve is retrofit inclusion — patching gaps that never needed to exist in the first place.

Had there been true co-design in that clinic:

• A captioned phone integrated into the main clinic communication system, not isolated in a separate room.

• The workstation would have been designed with both privacy and access to medical records.

• The same ability to move freely through the building and do my job as any other vet.

Instead, the design itself became the barrier.

Why It Matters for Veterinary Practice

This isn’t an isolated example to feel pity about. It’s replicated in many other ways for thousands more in our profession. In Australia alone, 38% of veterinarians report having a disability, chronic illness or neurodivergence - and the vast majority of it is invisible.

Veterinary work is built on communication — with clients, colleagues, and the animals we serve. When a system excludes someone’s way of communicating, it doesn’t just inconvenience them. It limits their professional contribution and silently tells others that difference is something to be worked around, not designed for.

And yet, most accessibility decisions in our profession still happen without co-design. Under Australia’s emerging psychosocial hazard frameworks, that’s not just inefficient — it’s risky. In other words: accessibility isn’t just good practice. It’s part of our duty of care.

Why Veterinary Systems Struggle with Co-Design

Veterinary medicine is a field of precision — clinical, procedural, scientific. We’re trained to problem-solve, to fix.

But co-design requires the opposite reflex: to listen first, design second.

That’s uncomfortable for a profession used to being experts.

We often fall into three patterns that unintentionally block co-design:

1. Expert dominance — believing that policy makers, architects, or managers already know what “good access” looks like.

2. Efficiency culture — moving too fast to ask the people most affected.

3. Token consultation — asking for input once the design is already 90% finished.

Each of these leads to the same result: people being invited to participate only after the decisions have been made about them.

And when that happens, we don’t get co-design. We get compliance.

The Cost of Designing Without People

When my workplace gave me a separate phone room, it solved an immediate issue: “Alex needs a captioned phone.” But it created new problems: inefficiency, isolation, and subtle messages about difference.

In access work, every workaround has an emotional footprint.

That footprint looks like:

• colleagues assuming you’re “less available” because you’re always leaving the room to make calls;

• self-censoring to avoid drawing attention to your access needs;

• internalised exhaustion from constantly explaining or adapting to systems that were meant to include you.

Designs that isolate don’t just inconvenience — they quietly erode belonging.

Co-Design as a Cultural Practice

True co-design isn’t a single project; it’s a cultural shift. It changes who gets to make decisions, whose expertise counts, and how we measure success.

In practice, that means:

• Hiring people with lived experience of marginalisation — not just consulting them.

• Embedding their input early in planning stages (renovations, software rollouts, team workflows, policy reform).

• Resourcing their time and insight properly — not asking for “voluntary feedback.”

• Valuing accessibility as a design metric, not a legal checkbox.

The result isn’t just inclusion; it’s innovation. When you design with the edges of experience in mind — with those most likely to be excluded — you actually make systems smoother for everyone.

Quieter spaces, better workflows, clearer communication, and more psychological safety.

That’s the universal benefit of co-design.

• A deaf clinician’s insight into captioning can improve call-quality and confidentiality for the whole team.

• A neurodivergent nurse’s input into lighting and workflow can reduce sensory fatigue for everyone.

• A culturally diverse receptionist’s input on client scripts can improve communication across the board.

Inclusion designed for one group always expands usability for others.

The shift we need isn’t only about empathy — it’s about cultural infrastructure.

What Co-Design Sounds Like

It’s easy to imagine co-design as a big meeting with sticky notes and post-its. But at its core, it’s about language and attitude.

Here’s what it sounds like in a veterinary context:

• “Can you show us what’s working well for you right now, and what isn’t?”

• “If we changed this layout, would it affect how you access equipment or clients?”

• “We’re about to install a new software system — could you walk us through how you’d interact with it?”

• “How could we make this process easier, faster, or safer for you?”

These are small questions, but they signal something profound: You belong in the design conversation.

Beyond Physical Spaces

Co-design isn’t limited to physical architecture. It applies to:

• Digital systems (practice management software, telehealth, online learning platforms).

• Workplace policies (rostering, supervision, feedback loops, disclosure processes).

• Educational design (curricula, simulation labs, assessments).

In each of these, inclusion shouldn’t depend on goodwill. It should live in the structure.

When we involve the people affected by our systems — from deaf veterinarians to neurodivergent nurses, parents, and part-timers — we uncover inefficiencies, risks, and inequities that otherwise remain invisible.

That’s how co-design turns inclusion into infrastructure.

What It Feels Like to Be Excluded from Design

There’s an emotional reality here that data can’t quite capture. When you’re the person the system forgot, you learn to survive through workarounds. You become a logistics expert, a translator, a strategist of your own access. You absorb inefficiency to spare others from discomfort. That invisible labour has emotional cost.

You learn to say “it’s fine” when it isn’t, because the cost of explaining — again — outweighs the hope of change.

And yet, those same people carry the most valuable insight any organisation could hope for: firsthand understanding of how the system actually functions.

Co-design gives that expertise back its rightful place.

From Sympathy to Shared Power

There’s a difference between a workplace that says, “We care about inclusion,” and one that says, “We share the power to build it.”

The first centres compassion; the second centres agency. The first relies on goodwill; the second relies on design. It is not a courtesy; it is governance.

And when we build systems this way — whether a new clinic fit-out, an education program, or a wellbeing policy — we produce something that doesn’t just include difference; it depends on it.

And that’s where veterinary medicine needs to go.

When we embed co-design, we stop building systems that depend on someone’s courage to ask for help. We build systems that assume difference — and plan for it.

The Epistemic Advantage of Lived Experience

Philosopher Sandra Harding calls this epistemic advantage: the unique knowledge that comes from living at the margins of a system.

People who have to navigate barriers develop a form of insight that those at the centre rarely need. They understand the friction points — the invisible seams where systems fail — because they feel them every day.

That’s not deficit. That’s data.

When organisations treat lived experience as inconvenience rather than intelligence, they throw away one of the most sophisticated diagnostic tools they have.

In my case, I understood the clinic’s communication infrastructure more intimately than anyone else — not because I wanted to, but because I had to. I knew exactly where the system bottlenecked, where privacy collapsed, and how the lack of integration slowed care.

That’s epistemic advantage: the capacity to see the whole system from its points of failure.

Co-design recognises that advantage and turns it into innovation.

How Co-Design Ripples Across Inclusion

Although this story begins with disability access, co-design is equally transformative for other under-represented groups:

• Neurodivergent professionals: Co-designing supervision and feedback systems can reduce burnout and increase retention.

• Parents and carers: Involving them in rostering and scheduling design can reveal inefficiencies that benefit all staff.

• Culturally diverse teams: Co-designing communication norms and client-interaction scripts can prevent miscommunication and bias.

• LGBTQIA+ colleagues and clients: Co-designing forms, records, and policies with those communities builds safety and accuracy for everyone.

Each group brings a different epistemic advantage — an angle of vision that improves the system’s precision and humanity.

That’s the real power of co-design: it doesn’t fragment inclusion into categories. It unifies them under a single question — who knows this system best, and how can we let them lead?

The Future We Could Build

If veterinary education, hospitals, and practices adopted co-design principles, we would see ripple effects across the profession:

• Fewer attrition losses from professionals forced out by inaccessible systems.

• Better safety through clarity, predictability, and inclusive communication.

• Higher morale and retention, as team members feel seen, valued, and capable.

• Better client outcomes, because inclusion and empathy flow through every interaction.

That’s what epistemic advantage looks like when it’s honoured: A profession wise enough to learn from its margins. It isn’t soft reform; it’s structural.

Co-design is how we move from compliance to culture — from “accommodation” to architecture.

And maybe, one day, no new-graduate vet will have to balance a captioned phone on their lap just to do their job.