Applying design thinking for collaborative strategic planning in global health partnerships: the Operation Smile experience

Power asymmetries between global health actors based in low and middle-income countries (LMICs) and those based in High-Income Countries persist. Often actors in low-resource settings are seen solely as implementers of projects designed in High-Income Countries and are often not involved in the decision-making. To tackle the problem of power imbalances, a human-centered framework of design thinking was used for inclusive strategy development. This paper discusses how design thinking was used as a framework for the co-creation of Operation Smile Malawi’s (OSM) long-term strategy in a collaborative environment with in-country and international partners. The strategic planning process included a situation analysis, priority setting workshop and participant feedback. A four-question design thinking framework was used to frame the three-day priority setting sessions; ‘what is’, ‘what if’, ‘what wows’, and ‘what works’. Design thinking tools that were used during the priority setting workshop included; visualization, journey mapping, mind mapping, brainstorming and concept development. At the end of the priority-setting sessions, an e-survey was used to assess the participants’ understanding and perception of the use of design thinking for strategic planning. The product of the process was a long-term strategy with goals, activities and strategies that were understood and agreed upon by all stakeholders. The post-workshop e-survey revealed that all participants responded that the design thinking process fostered team spirit during the entire process. The design thinking process also made the strategic planning workshop more productive and enabled participants to incorporate their own ideas into the five-year strategy. Furthermore, participants reported learning something outside their area of expertise. As global health organizations increasingly recognize the need for equitable partnerships in the design and implementation of global health programs, the human-centred approach of design thinking can be used to create open and collaborative program design.