Spark Series: Community Design Thinking
Equity Design Thinking Program DesignSpark was a healthcare design-thinking events series facilitated by Island Health's Innovation Lab that took place in communities around Vancouver Island.
Design Thinking in Community
Real problems don't fit inside an organization's walls.
The SPARK Series launched in 2023 as a portable, community-facing extension of the Innovation Lab's design-thinking methodology. The concept was simple: rather than inviting communities to come to the health system, I brought the Lab's tools and facilitation capacity to the places where the problems lived. Two events ran in Nanaimo. A third was fully planned and ready to run when it was cancelled. Each step in that arc offered insights that I carried forward.
The format was built for complexity. Each SPARK ran across structured sessions using a design-thinking framework anchored in the "What? So What? Now What?" reflective model. Shared context first, then ideation, then prototyping, and presentations with named next steps. The design sprints were intended to be inclusive and diverse with clinicians alongside community workers, researchers alongside peers with lived experience, post-secondary partners, municipal voices, and frontline service organizations all at the same tables.
“Rather than tackling problems in the Innovation Lab or at Code Hack, we’re bringing the Lab’s design-thinking process into communities to explore opportunities with the people who are affected by, and who can most benefit from, potential solutions.” Matthew Miller, Island Health News, 2024
Source: Spark Nanaimo Report
Spark 1.0: Nanaimo and the Toxic Drug Supply Crisis
Statistics from the Spark Nanaimo Report
Call to actionIn spring 2023, a senior colleague raised concern that the health authority's innovation response to the toxic drug supply crisis lacked the same urgency it had brought to COVID-19.
At that time, BC was recording approximately seven overdose deaths per day. Nanaimo's rate of increase was 1.7 times the provincial baseline. Nanaimo's Medical Health Officer (MHO) position was vacant. BC's Chief Coroner had resigned.
Spark Nanaimo was one of at least 6 interventions
Crisis ResponseThe SPARK series was my immediate response to the call to action. Within months, SPARK Nanaimo was designed alongside people with lived and living experience (PWLLE), funded from my budget, and scheduled in partnership with researchers at Vancouver Island University (VIU).
Partners for Spark 1.0 included the Mental Health & Substance Use (MHSU) department
Three crisis areas across Nanaimo
Bringing Diverse Minds Together
Spark Nanaimo was a collaborative initiative dedicated to designing a future that is caring, kind, and responsive to the needs of all community members. Thirty participants gathered at Vancouver Island University over two days: Island Health staff, community organizations, researchers, a city councillor, a post-secondary partner, and people with lived and living experience (PWLLE) of the toxic drug crisis.
Gathering those participants and planners around the same tables quickly, and structuring the environment so the sessions were psychologically safe, culturally safe, and physically safe, required more planning than most events expect, especially considering the stigma around the topic and the animosity that existed between some of the groups that were attending.
There were also at least three internal work cultures involved on the planning side: my Innovation Lab team with domain expertise in design thinking, design, and building; a Research team with domain expertise in a different set of principles and methodologies; and a Mental Health and Substance Use team with relationships in the local community. As a result, the planning process was too fast for some and not fast enough for others.
Participants at the Spark Series, Nanaimo.
Learning Out Loud
To ensure a good pace and to respond in the spirit of the call to action, I contracted the Pivot Group, co-design facilitation experts, to plan and run the event alongside our planners. And because my team was not yet at full capacity, this provided me with an opportunity to train them in real time and prepare them to run future Sparks as more team members onboarded.
During the planning phase we asked participants what they were expecting:
- Facilitate open, transparent communication
- Engage in brainstorming where creative and feasible ideas are encouraged
- Acknowledge diversity of expressed thoughts
- Feel heard and valued
- Don’t reinvent the wheel
- Cultivate humility to change who we are and do
- Appreciate and foster culture of questioning and fierce curiosity
- Share results
Prototypes included a mobile peer support bus bringing services directly into the three communities based on priority needs.
Rapid Design Prototype Results
At the end of two days, three groups presented their prototypes which were framed by the How Might We question format for design thinking sessions:
- Mobile Peer Services, wondered: How might we create Island Health Initiatives with emergency departments to provide safe and effective overdose care? Their answer was a low-barrier mobile care unit designed around the three highest-concentration areas in Nanaimo.
- PUNK (Peer United Network of Knowledge) asked: How might we provide a safe and accessible drug supply and increase access and capacity to current resources? The result was a peer-led support and consulting model.
- Bridge the Influencers explored: How might we arm influencers and decision makers with peer connections, stories, and data to create a cohesive community message for top priorities for change? This led to prototyping a strategy to connect and draw community members into their mission.
Ninety-three per cent of respondents said they would attend a future SPARK event. Spark Supplemental Report
Spark 2.0: Nanaimo
Invitation to Spark Nanaimo 2.0
Spark returned to Nanaimo in September 2024 with sixty participants, approximately double the size of the first event. My team had grown and no external consultants were required this time. Based on survey feedback and further consultations, we shifted the format to a single day with a World Café structure: participants upvoted topics over lunch, rotated through discussion tables, and reported out at the end. The agenda included updates from the new Medical Health Officer, addiction and mental health services leadership, and the teams who had carried the three concepts forward since the first event.
It was clear to all at the outset that a Spark event, on its own, could not end a provincial health emergency. However, I witnessed firsthand that the participatory nature of the event reduced noticeable barriers and tensions between community members and groups, and in particular how certain Island Health departments were seen by the community. As one participant remarked, they "came in with some rage and frustration at the situation – and now I feel a little more optimistic after going through the process. It's been helpful."
The event was featured on page 53 of Island Health's 2024 Annual Report.
Spark ALC: Alternate Levels of Care
By spring 2025, SPARK had attracted interest beyond Island Health. The BC Ministry of Health Innovation Branch approached the Innovation Lab to host a SPARK event at Royal Jubilee Hospital focused on Alternate Levels of Care.
Invitation to Spark ALC
Call to actionALC, as it is known, marks the moment when a patient no longer needs the intensity of hospital care, but the next step in their journey has yet to begin. In these in-between spaces, people wait, often in beds needed by others, while families and the system carries the strain. Every hospital system in the world faces this situation.
The Ministry approached me because they had difficulty finding a hospital to work with directly. Like the toxic drug supply, the purpose wasn't necessarily about fixing this intractable problem, but in designing a way into possibilities that could be tested and potentially carried forward into real world settings. Since both of our teams were based on Vancouver Island, we agreed to host the event in the Innovation Lab at the Royal Jubilee Hospital.
Spark ALC was fully sketched out in a matter of weeks thanks to several design thinking sessions held with the Ministry over Teams. Unlike the first two in-person events held over one or two days, we scheduled six days of structured design sessions across two weeks, with in-person and hybrid participation options for anyone wishing to join remotely from anywhere in the province.
Spark ALC invitation details
Crisis ResponseWith dates confirmed and invitations drafted, approved, and ready to send out, the event was shut down before it could begin. As you might imagine, strategies for providing alternate levels of care vary from region to region. And it's a hot topic, which is why my Ministry colleagues faced difficulty finding partners willing to co-design possibilities. But that is what made the Innovation Lab and the Spark series work. They existed and provided value in the gaps. While I was unable to access the table where the shut down decision was made, I had watched healthcare dynamics long enough to read what was happening.
The topic of this event could have been brought to Code Hack without a second thought. Code Hack tackled complex problems from inside the system. Spark ALC was designed to work from the outside in. Spark ALC had a singular intended outcome, and a genuine partner in the BC Ministry of Health to pursue it: co-designing with patients, families, and front-line staff living inside the ALC problem, not just managing it from the outside. In a large system, that distinction doesn't always travel cleanly up the chain. Decisions got made about the program without the program in the room.
Spark 1.0 ran in Nanaimo with thirty people. Spark 2.0 doubled. Spark ALC was cancelled before the invitations went out. That arc is not a record of failure. It's a record of a program that grew until it mattered.
What Wicked Problems Teach
Design thinking doesn't solve wicked problems. Done well, it changes how a community holds them.
What Worked
- Co-design is a powerful force. The last Spark event was cancelled internally. Some might see this as a failure. It proved to me that co-design is powerful because even when the intended outcome is benign and actually helpful to patients and customers, it challenges traditional structures that aren't set up to change.
- Broken communities can grow stronger. Spark 1.0 in Nanaimo, turned feelings of rage, experienced by some, into feelings of hope. By the second Spark, I saw that animosity disappear.
- Living our values. Our team embraced the organization's core brand values of courage, aspire, respect, and empathy. All of those values were required from each of us.
What It Taught
- Stigma is also a powerful force. The initial call to action included many leaders from many departments. After experiencing a pandemic and an ongoing drug crisis together, few readily responded.
- It's not always about the big problems. While tackling big issues, it's often the many smaller issues you encounter along the way that make the big issues appear much bigger than they need to be. Don't skip over those. Your future self will thank you.
- The system can change. At the first Spark, it was onerous to obtain cash honoraria for peers. For those without bank accounts, cash is the only way they can accept payment. Why make the process more difficult by default? Before the second event, I worked with the Finance department to ensure cash payments for peers would be the default going forward.