Facilitating Democracy: Concerns from Participatory Design with Asymmetric Stakeholder Relations in Health Care

This paper addresses how facilitation can implicate what, whose and how perspectives and values become embedded in the results from participatory design activities. Inspired by Donald Schön's reflection-on-action theory, an analysis of our facilitator performances in three design activities involving health care stakeholder groups with asymmetric relations has been performed. The analysis highlights the often subtle and unforeseen ways by which facilitator actions influence who "has a say". The results emphasize how continuous introspective analyses and reflections may improve the facilitator's attentiveness to actions that may inadvertently impede the disfavored party. In the long-term, neglect may threaten the integrity of participatory design as a democratic and empowering design approach. The shift towards a practice-perspective on facilitation goes beyond the efforts of the individual practitioner. The cultivation of the reflective facilitator, a concern of relevance for the Human?Computer Interaction and Participatory Design community as a whole, is considered.