Stakeholders & Beneficiaries

Beneficiaries: Járókelő is the Hungarian translation for “passer-by”, it refers to any citizen who is walking by and can be able not only to see an urban problem or malfunction, but also to report it in an easy and efficient way. Other group of beneficiaries are the local governments and other service providers (e.g. public transport companies). Járókelő has now more than 40 volunteers, mainly from the younger generation. There are monthly meetings for the volunteer administrators/ case managers.The association developed a volunteer recruiting and selection process in 2018.

Co-creation process

Járókelő created a fully citizen-centric and community driven internet-based service to strengthen active citizenship, democratic participation, and improve urban management. Járókelő is a mediator between civilians and authorities, so basically it created a new process for collecting and sending complaints, which had an impact on the whole system of fixing street problems. The employees of local municipalities tend to use their map application on the jarokelo.hu website. There are some local governments that indicate jarokelo.hu for citizens as their official forum of reporting street problems.

Digital Transformation Process

The innovation Járókelő realized is complex and practice-based (bricolage). The solution included not only the internet platform, but a process design, knowledge base, marketing and organisational innovation. By its digital solution Járókelő partly substituted prior co-production practices as well as some of the functions of the public organisations. Technology can enable citizen engagement. Platforms like Járókelő and others are tools that can have a positive impact on strengthening democratic institutions, transparency, accountability and foster public participation in public life. Járókelő functions as a bridge between citizens and local authorities in the common need to solve immediate problems in the built environment. As most of the problems reported are easy to fix, local governments can easily give a positive response to citizens.

Results, Outcomes & Impacts

Járókelő has grown considerably over the years since it started, nowadays it has reached around 20.000 visitors per month and registers 30 to 50 complaints per day in Budapest alone. Jarokelo has more than 9.000 registered users and more than 25.000 cases solved (as May 2019, approx. 2/3 of the reported cases are sold). Járókelő is often a „speeding lane”, so problem reporters experience quicker response. The positive experience encourages citizens to make further reports. Citizens monitor each other’s report, transparency is growing. The whole venture has not only grown in terms of the number of visits and reports but also in terms of the number of locations in Hungary such as Debrecen, Kecskemét, Veszprém, Szeged and Szentendre, cities that have joined the system. When the platform was launched, municipalities were unprepared for such an engagement, did not fully understand the platform and how it could be beneficial for them. As many of the municipalities lack the capacity of innovation to make their services more efficient and user-friendly, Járókelő can provide a platform that helps their work. Therefore, similarly to many other civic tech platforms, Járókelő can create a win-win scenario, building up trust between local governments and citizens, and improving public spaces. Nowadays Járókelő is more and more accepted as a trusted partner by public service providers.

Challenges & Bottlenecks

Creating the financial background of the association is the biggest risk ever since Járókelő is functioning. Financial resources come from donor organisations (for-profit companies). The Association can plan their budget and operation only year after year. There is a slight risk that the government may introduce a one-stop notification system regarding public complaints, and this way Járókelő could lose its mediator role between civilians and authorities. There is also a little risk, that thanks to technological developments the local governments will have more and more user friendly ways of communication, so Járókelő’s platform may be superfluous. There is also a risk of emerging competitors e.g. a Swedish company trading with crowdsourced online streetmaps. Cooperation with most local governments and public service providers is well-functioning, but cooperation with local authorities has not always been easy. In many cases, municipal offices have been reluctant to cooperate with Járókelő. It really depends on the actual place and the people working in these offices.

Transferability & Replicability

The system can easily adapt to other Hungarian cities. Járókelő plans to develop its system to other Hungarian cities as well, for this they would need other paid coordinators, who could keep the contact with the volunteer case managers on the countryside. So the plan is to increase incomes in order to be able to finance new full-time employees.

Success Factors

Institutional factor: obligation for co-production on part of the public organisations is coded in Act CLXV of 2013 (dealing with complains and public interest disclosures). Even though in Hungary the Act CLXV 2013 deals with complaints and public interest, each city and district deals with them in a different way because the regulations of how to deal with those issues are actually made locally. Járókelő has now more than 40 volunteers, mainly from the younger generation (between 16 and 43 years). They work as web developer and case manager. The volunteers are typically students, free-lancers, have jobs with flexible schedule.  The Association has a well-developed volunteer recruiting and selection process. The IT system is constantly developed and the website is easy-to-use.

Lessons learned

Digital technologies can substitute traditional co-production practices (e.g. remote monitoring or predictive algorithms). The platform of Járókelő provides an easy-to-use technology for citizens, where the reporting users can track and monitor the problem solving process. Furthermore digital technologies can eliminate public sector organisations from co-production (e.g. self-serving communities). The citizens do not need to know which organisation (local authority or a public service provider) is competent to solve a given problem. This knowledge is provided by the Járókelő.hu.

Stakeholders & Beneficiaries

The main beneficiaries of BAGázs live in the segregated Roma settlements of Bag (400 people) and Dány (600 people) in Central Hungary. A survey conducted by the Association in 2017 showed that the local community is far from homogeneous and the households vary greatly from one another, but the fundamental characteristics of segregated areas still fundamentally define the lives of the communities. Less than half of the adults living in the slum have not finished primary school. Of these, one quarter are most likely illiterate, having failed to complete even the first two grades. It is presumably linked to the low level of education that despite nearly half of slum residents having regular work, the average net income is 227.54 EUR (72,000 HUF) per months, and in some families, due to the high number of children, per capita income is far below average. The most pressing problem in the Roma slums in Bag and Dány today is the spreading and pervasive use of designer drugs. The work of BAGázs extends beyond the segregated settlements to the local village communities and to the level of society. The Association build relationships and cooperation with local institutions: local governments in Bag and Dány, kindergarten and primary school in Bag, family and child welfare services, police. ‘Parent Group for Our Hometown’ (SzöSz: Szülői Összefogás Szülőfalunkért) is a citizens’ initiative in Bag. They work with BAGázs from Summer 2018, and they play an important role to getting to know and accept the Work of BAGázs in the village. One of the most important aspects of BAGázs method is the high number of committed volunteers supported the professional work. In the beginning (2011) yearly 20-30 volunteers supported the professional work, in 2018 they have more than 100 volunteers per year.

Co-creation process

BAGázs is working to eliminate socio-cultural disadvantages of Roma people living in these segregated settlements. This can only be achieved if they jointly set up changes in the community of the settlements and in the majority society. The Association seeks to make the Roma people more capable, while at the same time sensitising and making more accepting the people belonging to the majority society. The program structure consists of 8 programs: mentoring for children, free-time activities, summer camp, women’s club, legal clinic and debt management, job hunt, adult education program, mentoring for adults, family consultation. The programs are based on local needs, so they are constantly evolving and adapting to the community. Most of the programs are organised by volunteers, so they are directly involved in professional work. The development of the BAGázs method is the result of a multi-year learning process that resulted in a complex program structure based on holistic, multi-level approach. The learning process is very reflective and conscious based on continuous assessment of experiences and results. Some program elements were largely modified during the last years (e.g. mentoring), and some elements have been omitted (e.g. small garden program or sport program). During the planning and implementation of the different programs the BAGázs Association interact with many stakeholders (e.g. donors, local public institutions, local civil organisations). Many of them play a crucial role in the co-planning and co-production of the programs.

Digital Transformation Process

Not applicable.

Results, Outcomes & Impacts

BAGázs started a social enterprise in 2016, which can be a useful additional element to the core activity of the association. BAGázs Bazaar consits of a mobile and a regular charity shop and a community centre in Budapest.  In Bagázs Bazaar they do not only recycle used clothes but are also able to provide job opportunities to people from the settlements. This way they can gain experience and prepare for entering the labour market. BAGázs Bazaar is also a Community Centre. By opening a community space in Budapest, the Association is broadening the horizon of the volunteer work, while providing further programs for underprivileged children. Main results in numbers:
  • permanent presence in 2 Roma settlements (Bag, Dány);
  • a complex program structure consisting of 8 programs for children and adults, 75% of families in the slums participated in these programs;
  • 15 paid employees (9 full-time, 6 part-time employees);
  • in 2018 more than 100 volunteers are trained and involved in their programs to bring new patterns to the closed communities;
  • more than 200 Roma participants.

Challenges & Bottlenecks

The public social service system in Hungary is very fragmented, the colleagues of public institutions in this sector (e.g. case managers of the Guardianship Offices) are often overburdened, the prestige of social work is low, and therefore the lack of appropriate professionals is typical. The long-term finance is also a crucial question for the Association, they try to find more regular supporters. The relationship with local governments in Bag and Dány is not always supportive. Manifestations of antigypsyism, including hostility, prejudice and discrimination specifically directed at Roma combined with stereotypical portrayals of Roma constitute the predominant narrative in all majority society.

Transferability & Replicability

Together with the local social care system and municipalities, the BAGázs is working to solve problems together. As an independent NGO, the BAGázs feels responsible for addressing systemic issues and making changes in related professional areas. Presenting in the press and social media in order to gain more publicity and at the same time strengthen the potential for change within the Roma community.

Success Factors

The BAGázs supports entire families through individual and group programs. In the last years 75% of the families in the slums participated in these programs. There are also employees of BAGázs living in the segregated settlements. Their training and development demonstrates the potential and credibility of change not only for individuals but for the community as a whole. Communication between the non-Roma residents in the villages and the segregated Roma communities is being strengthened, with the aim of presenting everyone’s point of view and providing a basis for co-planning and co-operation. Volunteers participate in the on-site professional work on a weekly basis. The personal and ongoing contact with Roma people gives the volunteers a deeper understanding of the complex problem, and also the personal experience of obstacles makes volunteers more sensitive, receptive.

Lessons learned

The innovative approach of BAGázs method is based on voluntary and bottom-up processes. During the planning and implementation of the different programs the BAGázs Association interact with many stakeholders (e.g. donors, local public institutions, local civil organisations). Many of them play a crucial role in the co-planning and co-production of the programs. The development of the BAGázs method is the result of a multi-year learning process. This process is very reflective and conscious based on continuous assessment of experiences and results. The BAGázs method can be interpreted as an interactive process of innovation.

Stakeholders & Beneficiaries

Stakeholders and Beneficiaries include:
  • the Primary School of San José Obrero (SJO)
  • the Antropoloops group
  • the Carasso Foundation
  • the Instituto de la Cultura y las Artes (ICAS) of the Seville Municipality

Co-creation process

This AW project is an example of process innovation to promote cultural inclusion in a primary public school in the South of Spain (Seville). Its main aim is to transform the teaching and learning processes to prevent stigma, dropouts and exclusion right at the youngest possible age. This idea was put into a project by Antropoloops, a NGO focused on combining music, education and technology. It consists firstly of an exchange of musical life stories between students (ages 10-12) of the CEIP San José Obrero School (Seville, Spain). Secondly, the students leave the School and record sounds and later mix those sounds and musics with other students, even from foreign schools. This mode of collaboration between the CEIP San José Obrero and Antropoloops seems to fit well in the rapid application model as the planning, delivery and innovation processes are one. It is an unplanned innovation, that was originally designed to find funding, but then changed into this other loose, less formal structured and spontaneous process, given the nature and aims of the project.

Digital Transformation Process

No digital transformation process involved.

Results, Outcomes & Impacts

The specific objectives of the project are:
  • To promote the interest and knowledge of other cultures through music and personal stories;
  • To improve musical listening skills and an emotional and cultural interpretation of music;
  • To promote creativity and imagination through narratives and stories generated from music and images;
  • To improve English language skills through the translation into English of student-produced texts;
  • To improve the knowledge of students with examples of traditional music in different locations in the world.
A summary of the seven impacts and goals identified and achieved through the first year, fully described in the case, is:
  • To expand the musical knowledge of students and to awaken their curiosity for the diversity of traditional World music as a source of inspiration for new creations. Students understand this heritage is not something parked far away and fossilized, but it is something alive and reusable;
  • To develop new ways of composing music. Use of tradition from creativity and remixing, with an approach that combines electronic music with traditional music to foster student interest in the proposed repertoire.

Challenges & Bottlenecks

The main barrier outspoken by our interviewees is the level of flexibility required to get the most of the project. “Only in a school like ours, devoted to work by projects, that is not opposed to changes of class schedules, class contents, and with faculty that is willing to take the extra step to work and be available beyond expectations, is AW possible.” The project is extremely rewarding for teachers and motivating for students. “But it is a lot of hard work and dedication.” A second potential barrier comes from the perspective the project produces in kids. While at their early education stages they experience teaching and learning through integration, practice and playful experiences, later stages do not seem to follow and build over the same perspective. This breach and the abilities they receive to cope with it seems a matter of concern for the design team.

Transferability & Replicability

The AW project uses a pedagogical approach based on working by projects. As with any of this type of projects, it requires that the School adapts its teaching curriculum to the needs of students – in this case, more than 32 nationalities. The AWs are run in a public institution with a managerial team that has understood its potential as an integrating element of many of the programs and teaching currently being carried out. Also, and from this institutional perspective, the project might help deepen the position of the school in its district as a cultural and relational reference.

Success Factors

One of the major drivers for this AW project has been the support of the Carasso Foundation. Through their regular calls for projects to innovate in nutrition and feeding, and in education, they shaped the individual contributions of a group of seven friends and colleagues into a prototype to innovate the integration of school’s boys and girls. They put together an original design combining education, integration, music, experiences and remixes. But it was through the call from the Carasso Foundation that they formalized the prototype and were able to get the funding. A second driver is the commitment of the school management and faculty. “A project like this involves a lot of flexibility, changing schedules, topics, and it could not be successful in another environment where management and teachers are not fully committed to it.” It is through it, developed over time, with results, and evident in the sheer number of active projects being run in the school at any given time, that AW has received full support from all the agents. This commitment is seen beyond the participation of the teachers in the activities of AW. They are adapting their own classes according to the experiences they and the students are being exposed to in AW. Even non-participating teachers, being aware of these experiences, are expected to modify their own approaches and behaviors thanks to AW. Thirdly, the AW network is constantly evolving the original design. Not that this design is no longer valid. It holds as the centerpiece of the project: Music and remixes for integration. But the project now involves exposure to neighboring institutions (a chorus of elder people, the local mosque, the local stores), language and verbal expression in Spanish and English, body coordination, or teamwork. This evolution is the result of the constant interaction of the two operating and design teams.

Lessons learned

This is a case reflecting a top-down network with a social aim. The distinctiveness of this case is its initiation: The call for projects of the Carasso Foundation aiming for social innovation. The call is won by an informal group of musicians and IT technicians that put up a project that, through music, teaches inclusiveness and cultural emotions. The project found an immediate welcome in one of the most committed schools of Seville, and its management saw in it a transversal project to help kids aging 10-12 years. It has served not only as teaching tool. Teachers involved in the project use some of the techniques in less soft classes. And it has enacted the school as a means of generating community in the neighborhood. Out of the interviews, we perceived that the principal of the school, is the champion of the project. Her commitment to innovate socially is paramount; she is driven by inclusiveness and making an impact in the neighborhood through the kids and their engagement with their families. The rest of her team, and the willingness of the Antropoloops team has leveraged the school principal’s drive to motivate themselves and produce significant benefits for the kids and their families – that large that they are planning to expand the experience to other locations.

Stakeholders & Beneficiaries

The main beneficiaries are the service users that receive follow-up services from the employment and welfare services. Consultancies providing design and programming expertise are involved stakeholders.

Co-creation process

A service design approach was explicitly adopted for the preliminary part of the project. In the project document, it was stated that the project ‘uses service design as a method to ensure a holistic approach in the development of new concepts. Service design is used throughout all phases of the preliminary project, with a continuous focus on the user’. Hence, a ‘holistic approach’ and ‘continuous focus on the user’ underpinned the service design approach. The project is anchored in qualitative and quantitative user research, and designers worked closely with frontline employees responsible for follow-up work in the development process.

Digital Transformation Process

The simplified follow-up project is closely connected to digital transformations in the organization. It is specifically interlinked with the introduction of a new system, called Modia, supporting new work methods in frontline work and digital interactions with clients. Moreover, the project was taking place in parallel to a broader organizational shift towards more agile methods for system development and organizational learning.

Results, Outcomes & Impacts

The central results and outputs of the service design process in this case was the development of a digital activity plan with an integrated chat function for direct communication between councillors and users. The interactive functionality was enabled by broader system changes in the organization related to the introduction of the administrative system Modia, developed to support two-way interaction between users and councillors. There are indications that the new solutions are well received among frontline employees and users, and it seems generally perceived as an improvement to how service interactions and follow-up is being carried out. It is not possible to say whether these improvements have broader impacts regarding employment rates. Calculations of benefits realization were still ongoing at the time of the case study.

Challenges & Bottlenecks

The case highlights various potential dilemmas related to the use of service design for public service innovation. First, service design assumes open, creative innovation processes in which time is spent on deeply understanding the service and its ‘pain points’. At the same time, service design stresses the importance of iterations as central to the creative processes, which require a proposed solution that can be prototyped.  In this case, there was a concern that the main solution was launched too early, which somewhat closed the innovation process. It was reasoned that the result perhaps became less ‘revolutionizing’ than it could have been. Second, service design also underlines the importance of working both holistically and iteratively. The case shows how this can involve dilemmas in the sense that iterations may lead to a narrow focus on testing and improving specific solutions, in which the broader, holistic perspective of the services gets lost. Third, it was acknowledged that the insight work informing service design processes may run the risk of becoming detached from existing research knowledge.

Transferability & Replicability

The case can serve as inspiration for similar public service organizations seeking to digitalize service interactions, or to improve existing digital platforms for interaction with users. There are potential for learning from the service design approach underpinning the innovation process, and there are potential for learning and transferability when it comes to the concrete digital solutions that were developed and implemented.

Success Factors

Not relevant.

Lessons learned

There are valuable lessons to be learned from this project when it comes to efforts to rethink relations and interactions between public services and users in the context of labor and welfare services. These relations tend to be largely asymmetrical, and the users can feel inferior and alienated from the administrative processes of the public service organization. The outputs of this project (the digital activity plan and the chat for communication between users and frontline employees) challenge these asymmetries. The new solutions seem to provide platforms for improved interactions between employees in the welfare bureaucracy and users. The case shows that interactions through digital platforms can strengthen relations and interactions between service providers and users.

Stakeholders & Beneficiaries

The scheme covers and supports projects in a wide range of service areas, but included projects are somehow meant to lead to improved services, processes or systems. Hence, the broad objectives of the scheme is to support development of more holistic and improved public services for citizens, and to enhance efficiency and effectiveness in public administrations. All parts of the public sector can apply, and the applications are controlled and rated by the Stimulab actors. “Wicked” problems (tasks that are shared between several actors and where the actors do not see an easy way out), are seen as particularly important to support. The Government is a stakeholder, and all public agencies. They can also be the beneficiaries, together with the firms that win the contracts, and hopefully the citizens who can get improved services.

Co-creation process

Stimulab demands several co-creation processes. They support the first part of a process to improve public services. First, some projects (among the applications) are selected for a next step, a project pitch where Stimulab wants to make sure that the selected projects have an innovation potential and can have a benefits realization. The projects that will be given support are selected, and a contract is signed between the applicants and Difi. The demanded next step is a dialogue with the market, where the project owner should find private partners with competence both in service design and leading the process for change. The experience so far has been that specialists in service design have made alliances with consulting firms. But some actors now (such as PwC) have competence in both fields. When the private partner(s) are chosen, the cooperation between the public agency and the partner(s) can start, using methods of the triple diamond, where the intention is that the actors should use extra time in the beginning of the process. The triple diamond method used by Stimulab is an adaptation of the Double Diamond developed by the British Design Council. In the Stimulab version, the third diamond is included to highlight the need for taking time to properly understand the problem, coined as ‘setting the right diagnose’. It is also underlined that this process of understanding the problem needs to be carried out in collaboration with agencies/ consultancy firms with innovation and design expertise.  This is meant to ensure that the public service organisations and the external consultancies have a shared understanding of the problem, which in turn is expected to strengthen the likeliness that the developed solution will meet the actual problem and needs (thus, the third diamond adds an extra step in the start of the process).

Digital Transformation Process

There has not been any systematic digital transformation process in the projects.

Results, Outcomes & Impacts

Stimulab uses three different categories of projects in its discussion of results:
  • Projects with concrete ( and measurable gains) after the projects are finished
One project about renewing driver licences has a calculated saving of 940 m ill. N. kr. in ten years. In a project for the Archive Service they have no exact number, but state that they now can conduct more supervisions with the same resources, to take two examples.
  • Projects who have developed tools already in use, but where the results will come later
Improved air quality may be a case where they have to wait for the results.
  • Projects were gains are identified but further development of the project is needed before a take out is possible
These will be the more complex projects, and even if the gains are identified, they do not know if a gain will be realised. The impact of Stimulab can be seen in a wider context, because the establishing of Stimulab itself can be seen as a reminder of the need for innovation, using service design to be user-friendly. Positive feedback from those who have participated can stimulate other services both to apply for support and to start innovation program themselves. Stimulab has got to be a symbol for user-oriented innovations in public services.

Challenges & Bottlenecks

In the projects supported so far, Stimulab`s activities have mainly been in the initiating phase. Stimulab`s platform is to be an active facilitator, who stimulates co-creation between public services and private enterprises. What they offer and demand is the active use of service design and of spending time in the beginning of the process, to understand and diagnose the situation. Seen together we are left with the impression that the main attention has been given to the procedures, to conduct the service design process properly. No recipes were given for the implementation process, and the actors had to apply for additional financing for this stage. The floor was left to the project-owners and the private consultants. But the project owner could stop the implementation when the money ran out. Lack of money and extra funding can therefore be a barrier for the implementation of good and innovative ideas. Support money can be given (after application), but cannot be taken for granted, and they may not be sufficient. It may give non-stimulating signals to the rest of public sector, if several of the initiated projects crash before they have given any results. If the interest for service design driven innovations should grow fast, the economic support frame will need to be scaled up.

Transferability & Replicability

The models and principles of service design can easily be transferred and replicated in all other parts of the public sector.

Success Factors

The success factors were the needs among the applicants to find new solutions, the possibility of economic support, and the inclusion of dialogue processes in the initiation phase of the projects.

Lessons learned

Public services need assistance to start and implement innovation processes where service design is meant to be an important part of the project. To make sure that initiated project can be realised, a project leadership – that is responsible for the whole project, from initiation to implementation, and has a realistic plan for financing it – is necessary.

Stakeholders & Beneficiaries

The main stakeholders and beneficiaries include the ministry, and the 3,3 million Italian civil servants from all 10,500 public administrations.

Co-creation process

The MEF LL approach strives for mutually beneficial outcomes based on the different project objectives. Overall, co-creation is understood as a form of 1) needs investigation and 2) as a tool to enhance productivity and stakeholder buy-in. MEF DSII LL’s focus is to have a physical location to invite other stakeholders and to support co-creation innovation. Co-creation activities are undertaken at the exploratory stage, where it is important to identify the needs and the “current state” of stakeholder interest as well as the operational background context. A preferred option to understand user needs is to prepare co-creation activities based on established definitions and understanding of the users and what they represent. This exercise translates into the definition of personas. These are fictional characters that represent specific types of customers. For instance, a persona could be “Marc – IT supplier.” Marc has a background in IT software development, has certain predefined personal and professional needs, he is introverted but has strong analytical skills. Persona examples are created based on preliminary investigation of the themes and common characteristics of the people that will take part of the co-creation sessions. This involves research to produce an overview of the current habits and practices of the targeted users. After understanding the user characteristics, one then engages in the process of discovering the latent needs and wants of the user. A specific focus is placed on the current problems they routinely face, taking into account the specific situations in which these problems occur. Here, sensitizing techniques are used to delve deeper into the users’ levels of knowledge – uncovering tacit and inherent needs and wants. This leads to the development of opportunities for the improvement of the users’ ‘current state.’ These materialize in possible ‘future states’ and originate from collective brainstorming, ideation, and co-creation techniques. Co-creation at the MEF DSII is also understood in terms of productivity. Despite the perception that deliberate and open discussion among all stakeholders may be time consuming, the real productivity gains resulting from co-creation exercises validate these nuanced methodologies. During and after the co-creation sessions, there were positive outcomes from multi-stakeholder engagement. In fact, it became clear that the discussions organized inside the LL were settled faster and more smoothly simply by giving the opportunity to all the participants to work in a common space during a fix set of time. Co-creation is understood in terms of cost-efficiency. This is especially true in user-centric software design approach coupled with Agile and SCRUM methodologies. These spur the greatest benefits when they are undertaken in a conducive environment where cooperation between developer teams is facilitated. This is why Agile methodologies are synergetic with co-creation and participatory approaches, where developers can act preemptively by interacting with other teams and end users to step-by-step develop development IT systems – gradually building up the complexity of the solution over time and improving overall efficiency. The role of front-end employees/public service staff in co-creation The Living Lab is having an increasingly prominent role at the MEF DSII as Living Lab managers sponsor and promote its usage to external stakeholders. At the MEF DSII, front-end employees take over the role of coordinating the different groups of participants. They also establish and promote the emergence of close relationships between various participants. In this sense, MEF DSII Living Lab front-manager tasks and responsibilities go beyond the physical space of the Living Lab. Positive relationships outside of the lab preclude and guarantee successful co-creation sessions. For the MEF LL to be disruptive, strong alliances should be built with other stakeholders.The facilitation of co-creation sessions requires competences which are highly contextual, anticipate the designer/manager needs and capabilities in stakeholder interactions and adjust to local settings. Due to the novelty of the MEF LL, there is still a need to hire a number of practitioners that possess the right skillsets in order to get the most out of the co-creation sessions. Attracting and retaining a broader range of practitioners that are trained in a varied set of methodologies such as co-design, co-implementation and co-assessment activities should be prioritized. Further, the stockpiling of institutional knowledge on User Research, Usability Testing, Design Thinking Workshop, Business Model Design, Change Management and Service Design is likely to produce skillful judgments and facilitate meaningful interventions which are much needed. The role of users in co-creation The users that are invited to participate in activities at the MEF DSII LL have different profiles and demographic backgrounds. The answer to the question of “who” are the end-users in the co-creation session varies according to the session’s objectives. The users, or customers, with different qualifications are included in the innovation processes based on their suitability to achieve the expected output. The MEF DSII LL utilizes the personas approach to profile the main distinctive features of the LL session participants. Regulatory and compliance, contract law, and technical/IT experts combined with the end user groups are some of the categories which are commonly involved in test experiments. The role and involvement of the users at the MEF DSII Living Lab is understood both as reactive informants as well as active co-creators (Dell’Era & Landoni, 2014). The Living Lab of the Ministry of Economy and Finance (MEF) DSII In the first use case, the users were involved in the MEF LL for implementation of top-down experiments, which are centered on the users and place users as the object of study. The MEF DSII ran a series of usability tests where the objective was to understand how a system should be used in order to produce optimal results. Different end users were asked: “Can you make sense of the tool? Did you experience any issues? Are there improvements needed for a user-friendly designed solution”? The project workers observed use of the products, identified problems and solutions with the engineers, and thought of ways to utilize different functionalities and properties of the IT system being studied. This methodology at the MEF DSII has proved successful when a technology/service relying on user feedback and acceptance has been tested. In such an occurrence, the MEF Living Lab allows collection, filtration, and transfer of all valuable end user ideas to the developers. In other co-creation sessions stakeholders are called upon to participate in an interactive and empowering way, enabling them to become co-creators, and to go beyond user-centered approaches that only passively involve users. Partners are therefore identified with important consideration of active user involvement in order to determine who should be involved in the different innovation stages. Users, or customers, with different qualifications are included in the co-creation processes based on their suitability to achieve the expected output.

Digital Transformation Process

Distinct from other Living Labs, the MEF DSII LL is driven by the public sector. It is operated by the public sector for the public sector. Although users are invited to co-create solutions, ultimately and intentionally, the public sector remains the primary beneficiary. The strategic aims of the MEF LL are in alignment with the Institution’s key objectives. Therefore, the Living Lab does not abide to set operational The Living Lab of the Ministry of Economy and Finance (MEF) DSII rules and its administrators are keen to explore potentially disruptive applications. The MEF LL employs a multi-methodological approach that is output oriented. It has flexible objectives that evolve to meet its changing needs. Since its recent inception, the MEF LL has produced tangible results by acting as a platform and co-creation space to facilitate:
  • A co-creation space facilitating multi-stakeholders collaboration and knowledge sharing;
  • Used as experimentation and usability tests to bolster digital innovation;
  • To provide an example, in use case n° 1 we detail out the operations and outcomes of the Living Lab within the so-called “Cloudify NoiPA” project. The MEF DSII is undertaking a large project that, by 2020, aims to expand the number of public organisations it services to cover the entire Italian public administration staff. It is then paramount to involve the end users, which in this case are the other public organisations that currently depend on the payroll and HR services or are expected to do so in the near future, in the design process. The MEF DSII launched a series of multi-stakeholder co-creation sessions to collect their input. The involved participants were decision-makers from other public institutions (for example, representatives from the Italian police and the army). The goal was to collect their feedback on the functionality of the IT platform they use, including insight on what bugs, errors and other technological issues they would like to see improved and to better understand if their needs were being met. In this respect, the MEF DSII LL put into action a methodology for collecting user needs and produced a physical space that fostered different and varied forms of collaborative interaction to spur innovation. The overarching objective is to ensure that stakeholders from other public administrations buy into the programme. Ultimately, by strengthening their confidence in the process, stakeholders are more inclined to support the transformation programme throughout all phases of the “Cloudify NoiPA” project. Another example of the Experience centre functioning as a space that facilitates multi-stakeholder collaboration and innovation was the participatory re-design of the MEF DSII’s new organizational model –much needed initiative to support its service expansion. Rather than making the organizational re-design a purely top-down management decision, the process extensively used and prioritized a co-creation approach. As part of the project, the design team invited around 50 MEF and Sogei top figures to a co-design session at the Experience Centre (picture on the left). Each participant was asked to share their ‘Loves’ and ‘Loathes’ of several pre-identified critical processes and was tasked with proposing their own preferred to-be organizational model by drawing a diagram with the office responsibilities and target processes. The participants were clustered in 7 groups and asked to agree upon a common a to-be organizational model for the group. In this stage, the list of 50 organisational models was reduced to 7 potential options. Afterwards the 7 organisational diagrams were displayed at the living lab during an “Expo” day (picture below) and the employees that did not attend the co-design session were invited to visit the “Expo” to discuss the models with project owners, share ideas, and provide input. This two-way communication ensured implementation of both top-down and bottom-up decision-making. It eventually resulted in the final selection of the preferred to-be organizational model of the MEF DSII. The highly participatory approach enabled by the Experience Centre environment and related co-creation methodologies guaranteed an avenue for the entire Ministerial staff that would be affected by the organizational change to express their design preferences. Ultimately, this can ensure a higher adaptability and success rate in the subsequent phase of transition plan implementation. Additionally, the MEF DSII experiments in semi-real life context and tests its products to collect feedback about usability issues. To provide an example, the MEF DSII has forgone some usability tests in advance of the launch of its updated webpage portal. This portal, on top of sharing informative material to the constituents about the MEF DSII activities, has a specific webpage devoted to “self-provisioning” services. The ”self-provisioning” services are a type of delivery mode that allow the MEF DSII to enlarge the user base of its public administration “clients” in a cost efficient manner. The local and regional public administrations can select, configure, and start services themselves in a cloud environment where they have access to download software from the web portal. Self-provisioning allows users to have rapid access to a customized infrastructure through a self-service portal, thereby limiting installation and maintenance costs, and avoiding costly procedures for requesting and approving new software. Thus, seamless functionality of the portal is critical for incentivizing adoption of the services and the wider buy-in from targeted stakeholders. The MEF DSII carried out usability tests on the portal by inviting a representative set of users to surf the web portal in the “observation room” (pictured on the right). The test subjects were then provided with a personal computer and were requested to navigate the portal by performing a selection of given tasks. In doing so, the users interacted with the test moderator in a consistent and measureable manner. The front line staff employed the “speak aloud method,” advising the users to say out loud what he/she thought were the main obstacles when processing the tasks. This was intentionally used to prevent participants from taking a reflexive approach where they say what they think they are supposed to say rather than their first impression. In fact, by proctoring the usability test in the separate “observation room,” the MEF DSII designers were able to effectively record the natural feelings and reactions of the participants. The metrics used for the web-portal user navigation assessment were, 1) Efficiency, 2) Efficacy, 3) Satisfaction, 4) Learning ease, 5) Memorisation ease, and 6) Error management. Technical tinkering enabled users to diagnose and fix bugs and optimize the customer experience with assistance from engineers and frontline employees.

    Results, Outcomes & Impacts

    In 1995, Mark Moore, in his book Creating Public Value (Moore 1995), coined the term Public Value to encapsulate an essential difference between the public and the private sector. According to Moore, public value can be seen as the total societal value that cannot be monopolized by individuals, but is shared by all actors in society and is the outcome of all resource allocation decisions. This shift calls for a different understanding in how value is generated. At the MEF DSII LL, it was observed that value stems from cross-interactions and knowledge exchange produced in Living Lab sessions and what emerges as an outcome. In its role as a public IT and HR service provider the MEF DSII is expected to deliver services to other public organizations. In this context, when these organizations see themselves merely as a recipient of services, dissatisfaction and claims of non-usable services are more likely. The MEF LL bridges the divide between the provider and end users and helps circumvent issues by integrating the users (other public organizations) in the different product/service development stages. It promotes active user engagement and incorporates user-feedback in a variety of ways. In the above-mentioned example, it is the user-friendliness and intuitiveness of the portal that gives it value. The public value and overall satisfaction generated from the MEF LL co-creation methodology is understood as a continuous and iterative value creation of services and products oriented for end users and prioritizes customer satisfaction. Initially a private consultancy provided co-designed and co-created solutions to the MEF DSII. In a context of contamination of approaches, the value seen in these methodologies in fulfilling customer satisfaction made the MEF DSII interested in establishing its own Living Lab at its own premises. This exemplifies the effect of contamination of approaches between private and public service offerings and delivery models crossing and blurring the differences. This is even more apparent in light of the shift, described in the New Public Management scientific literature, in how public services are increasingly inspired and managed according to private sector models. Public service providers are focusing on customer service and understand the centrality of the users as recipients of the services and holders of its public value.

    Challenges & Bottlenecks

    Throughout the co-creation session, staff observed an initial resistance by the involved stakeholders when having to follow a certain structure and set of rules during discussions and negotiations. For some participants, embracing the discussion in a different way than conventional meeting styles made them hesitant, impatient, or dismissive. However, at the end of the co-creation session a collaborative behavior emerged and participants gradually acted more like themselves. Seemingly less tangible, but still documented by participants during the co-creation session, was a heightened closeness with the other stakeholders. During the co-creation sessions users were more prone to finding a common ground with others and improved relationships proved to be a critical success factor.

    Transferability & Replicability

    It is expected that such digital transformation practice could be replicated in other parts of the Italian public administration if the need and the will is there, since it is the same socio technical conditions that apply. Whether such digital transformation can be replicated in public organizations located in other national contexts depends on the way public administration is organized in such contexts as well as the level of digitalization of both businesses and society.

    Success Factors

    The MEF living lab is an avenue that promotes innovation – which is understood in two ways. Firstly, as what stands between the ‘current state’ and how things will be done (i.e. the ‘future state’) – encompassing a whole series of drivers such as technology, nuanced business models, and organisational restructuring in line with the Open Innovation paradigm. Secondly, as a disruption to the current way of thinking and acting through the exploration and usage of innovative technologies. The MEF DSII Living Lab innovation approach mirrors the principles of Open Innovation, which is the concept that in addition to its own internal research and development, the unit’s innovation is based on external ideas, resources, and competencies. Openness is crucial for the innovation processes of Living Labs due to the valuable role in the collecting of a multitude of perspectives which allows development of the most competitive and productive innovations possible. This paradigm is based on the belief that knowledge today is diffuse and distributed among various stakeholders and no organization, no matter it size and influence, can afford to innovate effectively on its own. It is critical for the MEF DSII to open its innovation procedures to the critical sources of knowledge that are the potential beneficiaries of their services. Open innovation facilitated by a certain usage of Living Labs, such as the MEF LL, is a step toward an innovation process that is increasingly shifting away from top-down approaches and promoting user-driven ecosystems. The second approach to innovation at the MEF DSII LL can be labelled as ‘experimentation.’ In the stage where a certain solution or ‘future state’ materializes into a proven concept, the building stages of developing and experimenting technology applications are validated. For instance the MEF DSII organized a Design Sprint workshop in its Living Lab to select a cost-efficient and valuable blockchain solution for the redesigning of MEF’s internal processes. The workshop methodology combined divergent and convergent thinking in order to address the business problem/s from different perspectives. This problem solving session led to the prototyping phase of a blockchain application to re-invent and innovate MEF DSII processes. This is only an example on how the MEF DSII Living Lab acts as an innovation method.

    Lessons learned

    Observation of the ongoing activities and results from the initial studies of the MEF DSII LL are encouraging. Several psychological and general considerations have been realized for the correct assessment of its service experience. Ultimately, involvement and motivation in the process were both a pre-conditions to the co-creation session as well as a succeeding outcomes. Although involving users is only one factor among many that promotes co-creation in a LL, it is considered indispensable. Users at the MEF DSII LL were considered involved to the extent where their ideas were helping influence and develop others’ point of views. The success of such real-life collaboration, which aims to promote learning between different stakeholders, hinges on how the co-design process was orchestrated, facilitated, and managed.

    Stakeholders & Beneficiaries

    The Team is in charge of supervising and providing support for the Agency for Digital Italy (AgID), the operation branch of the Council of Ministers. Since the creation of the Team, two Ministries have played a key role in this setup: the Ministry of Economy and Finance and the Department of Public Administration. The Ministry of Economy and Finance is responsible for the allocation of financial resources for digital transformation. Whereas the Department of Public Administration is in charge of all public sector needs and governs the process of modernisation and reform of the public administration. Lato sensu, the immediate beneficiary is the public sector, including public agencies, the Court of Auditors etc. However, its activities aim at creating a digital transformation impact for businesses and citizenry while making Italy more attractive from a digital perspective.

    Co-creation process

    The Team took a completely new approach to creating value by supporting public administrations in their digital transformation processes. This approach consists of three main pillars: (1) embracing existing and standstill projects necessary to build up the backbone of the digital architecture in the Italian public sector; (2) creating mechanisms, tools and processes to facilitate the Italian government’s pathway to digital change; (3) rolling out a model of active and open collaboration with all public actors. To explain the process of co-creation we provide examples about one project in particular that is underway. In the case of Data and Analytics Framework, at the co-commissioning stage, a public task force has been in charge with collecting requirements and setting jointly the priorities of the project. DAF’s goal is to create a platform for collecting, processing and sharing of public data, which will ultimately lead to improved public services based on the exchange and use of big data. During the co-design phase, extensively the experience of services users – especially internal ones – has driven the creation, prototyping and testing of the first version of the platform. Co-implementation is foreseen later, at the release stage, where service users will manage jointly public assets in the form of open data.

    Digital Transformation Process

    To support and advance the process of digital transformation, as mentioned earlier, the Digital Team has conceived a strategy built around three main pillars, working on them concomitantly. In the first one, the Team continues to implement a set of existing and ongoing projects designed to generate value through digital transformation, while contributing further by establishing new ones. By and large, these projects regard infrastructure and interoperability, services and tools championing a human-centric model. In the second pillar, to support the above-mentioned projects, the actions of the Team has focused on empowering the capacity of public administration in terms of assessing needs and finding proper solutions for developing and designing services fit for specific purposes. Finally, the third pillar is about engaging openly with the public sector through a staged approach, involving first enthusiastic adopters, and eventually get laggers on board.

    Results, Outcomes & Impacts

    Given the nature of change, the Digital Team is contributing to implementing, the timeframe for seeing results matters. Most visible achievements are still measurable in terms of outputs, whereas impact and long-term value creation will have to be assessed at a later stage. In terms of outputs, we can refer to cost savings, time savings and productivity, the introduction of new services and creation of support tools for the public administration. In parallel, the Team focused on creating value in terms of skills and competencies, and a proper culture for digital transformation in the public sector; simplification and usability of public services for citizens and crucial from a societal perspective, the value of transparency.

    Challenges & Bottlenecks

    Among the challenges emphasized by the interviewed members of the Team can be mentioned: (1) cultural resistance to change; (2) lack of skills and digital awareness among public managers and policymakers, which leads to reluctance towards ambitious projects; (3) fragmentation of databases, power and plurality of suppliers, which slows down the process of adaptation, (4) lack of communication.

    Transferability & Replicability

    At the outset or in a more advanced phase, all the projects follow a user- or human-centred approach and design thinking methodology applied in developing services, directly targeting users (internal or external). At the same time, the Team adopts a management style that is agile, collaborative and efficient.

    Success Factors

    The radical approach adopted by the Team meant a departure from focusing exclusively on strategies and instead support planned actions with structured mechanisms and processes that lacked in the public sector. This required also a redesign of the process management, introducing an agile approach for: budget and staff recruitment, procurement process, software development process etc.  

    Lessons learned

    To ensure sustainability and support for such a complex process of transformation, the Team did not start from scratch; rather it has relied and acted upon already existing programmes that could work while launching new ones considering successful models developed elsewhere. With this in mind, the focus has been on both the definition of a long-term roadmap and, most importantly, the provision of means to make projects operational (tools, communication, etc.). Finally, the Team has engaged with other stakeholders to exponentially increase inputs and achieve greater outputs.

    Stakeholders & Beneficiaries

    NEMO exists to take care of patients with neuromuscular diseases and their families. They are frequently grouped in family associations. The team of doctors, specialists, nurses and the management are all devoted to putting the patients at the centre of the treatment / care. The city of Messina is talso an important community for Nemo in terms of local support, because the city is small, so the Centre is more representative within that context and all the community is involved in the project. When patients die, the family raise donations for the Centre, and all of the persons involved participating in all the stages, even in the death moment. Professionals also mention ASL – the local public healthcare institution, but maybe even more important are the suppliers/home care providers, that understand the functioning and the bureaucracy to which they are subject to and are flexible in efficiently providing Nemo with necessary supplies.

    Co-creation process

    Co-creation is taking place in all three phases: planning, structuring and service delivery. Not yet in the part when patients go home (domicile phase), as the Centre is not completely well structured for that yet. According to patients, value is created in both the design and the delivery of services, as Nemo works, in co-creation, co-production with them, on innovation, listening to their needs and treating them with dignity. The importance of the families’ integral participation in the process is highlighted in the professionals’ testimonial as well. All stakeholders also agree on the evaluation of services, as it allows the professionals to redesign and adapt their service, which do not exist separately, but it is a result of all phases in which the patient is present.

    Results, Outcomes & Impacts

    The patients and families are all very satisfied with the non-standardised, or individualised, care model applied in Nemo. They rate each professional they meet during their treatment on a scale from 1 to 7 as follows: nurse coach: 6,71; physiotherapist: 6,65; nurse: 6,76; speech therapist: 6,69; doctor: 6,75. According to page 21 of the CSS report, their perception of the treatment received from their arrival through their stay in Nemo’s facilities is as follows: possibility of accessing Nemo 24/7: 6,69; respect to their privacy: 6,67; their perception of being treated as a person, and not just as a patient: 6,60; respect and approach regarding their religious beliefs: 6,59; dedicated spaces to leisure time (recreation, tv, games): 6,56.

    Challenges & Bottlenecks

    In spite of the unarguable evidence collected in the different fieldwork approaches regarding value creation, the question of value destruction was also brought up by some of the involved parts. Nurse coach brought up the risk from the part of healthcare professionals of being too involved in their jobs and ultimately “loosing” their sense of personal life. Also, the “excess” of care can highlight a consequence of value destruction for the patients as they could expect too much care and forget that they have a brute, degenerative pathology that needs an active role from them too to be fought. Political relations must be carefully managed too, otherwise a wrong move can lead to value destruction, like in the nonprofit world, where egoism of its actors can sometimes lead to conflicts and disruption, or in the social media world, with the propagation of various news, which can generate conflicts and disruption in the value creation process. Finally, the risk of creating excessively high expectations and not delivering what patients expect, i.e. the cure, because it has not yet been found for neuromuscular diseases, also represents a big challenge.

    Transferability & Replicability

    The model of the nurse coach is already inspired from something that is well-known in the U.S. Model. Also, the methodologies is applied in four different clinical facilities throughout Italy. So, the clinical medical concept it not related to any very specific, local context and can be replicated or transferred.

    Success Factors

    Creating a symbiosis among all the stakeholders is what makes the individualised care system work: patients must be aware and feel confident towards the multidisciplinary team; healthcare professionals must carry certain types of value (respect, dignity, etc.) not only in their professional life but also in their personal one to be able to use them with the patients; family associations play a crucial supporting role (financially, emotionally, in research); the supplier/home care providers, that understand the functioning and the bureaucracy to which they are subject to and are flexible in efficiently providing Nemo with necessary supplies, are facilitators; the local health public institutions need to be involved as well; and the citizens and communities are key too. All stakeholders work hand in hand towards the same goal, i.e. allowing people with neuromuscular diseases to not only survive but actually live quality lives.

    Lessons learned

    Evaluations are critical to constantly improve the services and keep as close as possible to the patients’ needs. Through constant monitoring of how much they offer to every patient, they can improve the answers to treatment needs. Based on this principle, they have developed a system for evaluating the satisfaction of patients accessing the services, based on their perception of the care/operating model. In concrete, Nemo has developed a customer satisfaction survey which is the result of a multidisciplinary work, through which the professionals of Nemo have expressed their point of view on the issues to be evaluated. For the first time, topics such as the respect for the individual and his/her choices, the perception of being ‘at the center of care’, welcoming to the patient’s family nucleus, were studied. This system also allows for the healthcare professional to redesign their role based on the indicators that are measured not only by the patients, but also by the public healthcare system.

    Stakeholders & Beneficiaries

    Policymakers define the strategy. Front-line employees implement the physical training and relationship building courses (in their own words, they “make an offer” to the benefiairies – the seniors) and senior participate in the activities. Sometimes, external actors are involved too, as with the Cycling Without Age, a voluntary programme initiated by one citizen (to take elderly citizens on bicycle trips in the city), where the municipality responded positively, by purchasing some bikes to scale up the initiative. Finally, private funds and private firms play a role in research projects in the municipality (via living labs activities), as well as in the development of welfare technology.

    Co-creation process

    Policymakers define the strategy for healthcare policy for the elderly. Based on this framework, the front-line employees of the Activity Centre design training sessions with the elderly who take part. After a long period of time, the elderly can take charge and interact with each other on their own.

    Digital Transformation Process

    The municipality further participates in several living lab activities, where welfare technology developed by private firms are tested by citizens.

    Results, Outcomes & Impacts

    The main success criteria of the project is that it is perceived as meaningful for the elderly and that the municipality ensures that the findings and the learning of the project are applied prospectively. The success of the Activity Centre is mainly measured by its occupancy rate and members receive a phone call on a yearly basis as part of a satisfaction survey. In both cases the Centre gets high scores, but there is a caveat: the evaluators do not visit the centre and don’t see how the activities and the daily life unfold. Also, the employees think there is a lack of focus on what they perceive to be main objective of their work; i.e. the measurement of parameters that can embrace relationship building, life quality, degree of loneliness, the excitement of the elderly in the daily activities, etc. They propose to measure the amount of readmissions among the elderly that use the centre, testing of functional ability and to use the start-up dialogue with the elderly and the subsequent evaluation dialogues (each year) to see if they have experienced a change in life perspective.

    Challenges & Bottlenecks

    1) There is a disconnect between the policymaking level and the operational level on value co-creation: when reacting to what the role of staff is in value creation, policymakers emphasize strongly both the need for political structures and for development work at the strategic level as a basis for public service staff in creating value, but, at the level of the projects, there is much more emphasis on the competencies, enthusiasm and the mood of the front-line staff in co-creating value in direct interaction with the elderly users. 2) Policymakers state that, at the strategic level, there is strong interest in user involvement. Yet the potential of user involvement is not realised in a systematic way in practice. There is a lot of rhetoric rather real user involvement. Whilst the municipality is making an effort to listen to the users, the impact of this approach is still weak. 3) Projects like this one are meant to become driven by the users/citizens over time. Citizens should create the value and take responsibility for it. But here, the elderly citizens do not see themselves as having a key role creating value for others. And it takes time for the front-line employees to build trust with the seniors (1.5 year, according to the log-books), so that, later on, they can slowly withdraw as main actors and let the elderly themselves be drivers – based on their new social relations.

    Transferability & Replicability

    The objective of the project is to foster the ability of the elderly to stay as long as possible in their own home and to be self-sufficient as long as possible thanks to a good mental and physical health – which are stimulated by physical training and relationship building. This very general objective is replicable in other municipalities.

    Success Factors

    1) To let the surrounding community (associations, evening schools) use the facilities of the Activity Centre, outside opening hours. 2) A condition for creating value to the elderly, is to work network-oriented in the municipality and to open up between the different institutions at an individual level. 3) Create platforms where it is possible as an individual to be something for the elderly – e.g. supported by digitalisation. 4) To counteract the practice of the public sector that classifies people and puts them into boxes (e.g. the box of an elderly that starts at 65+) more flexible housing areas for people across generations could be developed – also to support the changing family structures. 5) If there were resources to support the relationships outside of the Centre, improvements could be greater 6) Invite other Activity Centres and their events to our place or to do activities together with groups of elderly that have the same challenges/oppurtunities. 7) To increase the visibility of the Activity Centre – and to create opportunities for being or becoming e.g. a visitor. 8) To make sure the local environment is designed for the needs of the Centre’s participants (e.g. having a hairdresser, a grocery shop, a church, in the whereabouts).

    Lessons learned

    1) It seems as if the lingo of public services and value co-creation, as part of the policy terminology of the welfare state, is mainly mirrored at a tactical and strategic level, but less at the operational level. The danger is that policies might become detached from practice, which is why it seems pertinent to contextualize what is meant by value and to whom. Or to discuss whether the term value are analytically suitable if it becomes a straitjacket to understand the logic of public services from an employee perspective. 2) There is a change that has taken lace from a partial patronizing approach towards a more responsive approach to care. However, to provide care must still first of all correspond to professional standards, and then next be responsive to users’ expectations and experiences. It’s less advanced than in the MAIA approach, where the senior’s need are placed above the professional’s diagnostic. 3) There is a generational effect: the elderly of today come from a frugal generation. They do not expect the public sector to solve their problems and are therefore quite thankful for all initiatives they perceive to be beyond their rights as citizens e.g. medical care and hospitalisation. An offer such at the Activity Centre and being part of the BIN-project falls within these not-expected-categories.

    Stakeholders & Beneficiaries

    MAIA aims to ensure the decision-making process (interaction, collaboration) between stakeholders at two levels: at a strategic level – in order to develop a collaborative and decision-making space between decisionmakers and funders of gerontological policies (ARS, departmental councils, and others); at a tactic level – in order to create a collaborative and decision-making space between the operators responsible for the healthcare and support services that help seniors to stay at home. For seniors in complex situations, an intensive and long-term follow-up (including during hospitalisation periods) is implemented by a case manager (a new professional skill). This professional is the direct contact with the senior, with the general practitioner, with the professionals working at the senior’s home, and becomes the referent of complex situations.

    Co-creation process

    At the institutional level, there is a top-down approach to co-creation, designed to better fit the realities of the territories: the Regional Health Agency selects, via a call for application, an infra-departmental institution (non-profit organisation) which can mobilise local actors. This non-profit will be in charge of implementing the MAIA pilot on its territory, by connecting the professionals in healthcare to fit the territorial reality. At the user level, the co-creation materialises through the dialogue between the senior (the user) and the case manager, who becomes the spokesperson for the user and translates the user’s needs and wishes to the healthcare professionals (sometimes against the advices of the health professionals).

    Results, Outcomes & Impacts

    In its interactions with the users and professionals, the care manager helps to improve the organisation of the care system by identifying any dysfunctions observed on the territory.

    Challenges & Bottlenecks

    According to Policy maker, MAIA activity reports are done by the MAIAs but require a thorough understanding. Starting to introduce indicators for measuring value creation raises problems relating to the instrumentalisation of such indicators. Ideally, a territorial roadmap used by all the operational actors would be interesting to develop, but given the fact that data would be analysed on a very small territorial scale and then structured at a regional and national level, it requires money and tools. This is not done today. Monitoring indicators have been developed and used during the implementation stage of the MAIA method (e.g. number of contacts a senior must have established to access to the right resource). Currently at the local level, the impact in terms of organisation is measured (participation rate of partners at the tactical table, or for the case management, the territory distribution of seniors being managed). It has been noted that the participants to the tactical tables are always the same volunteers, actors who encounter difficulties in their daily practice do not often wish to participate (as this could be viewed as failure) and general practitioners are rarely part of the table. According to the pilot at the local level, a tool has been evaluated, but there is no local evaluation of the value creation of the MAIA for the territory. It would be interesting to know for example the impact of MAIA on the reduction of hospitalisation in emergencies, the reduction of user orientation towards wrong services. The partners should be involved to create these indicators. For the case management, the value creation is evaluate via the decreasing needs of the senior that the case manager has to fulfill. The creation of value can be measured via satisfaction surveys but this is not a global value creation, that is, the medico-social system as a whole. Care Pathways Operational Committees are currently working on impact indicators (non-use of emergency, scheduled hospitalisation). The current problem is that the databases are currently partitioned between the medico-social, social and sanitary field, so there are difficulties to measure the impacts on a pathway of a user. Finally, MAIA is on a voluntary basis, so there is no incentive (legal, financial), for professionals who are solicitated to take part in brainstorming sessions and one can find always the same people involved.

    Transferability & Replicability

    This initiative is applicable to the various sub-territories of the French regions, because of its very locally-oriented – and even user-oriented approach. The concept is therefore replicable to other territories. Also, the MAIA project was already copied from a similar initiative in Quebec, Canada.

    Success Factors

    An integrated, one-stop service provides, at any place of the territory, a harmonised answer adapted to the needs of the users, by directing them towards the adequate resource. It integrates all the reception and orientation counters of the territory. The MAIA method includes the development of common information-sharing tools and action-steering tools (a shared multi-dimensional analysis form, a standardised multidimensional needs assessment tool, and individualised service plan). If the MAIA method is originally top-down, once the project holder chosen by the network, the deployment is left to the initiative of the Maia pilot. Thus, this method is deployed on territories in very different even innovative ways, depending on the diversity of actors and networks already existing on the territory. Thus, the approach is considered as “help-it happen” by the policymakers. Various forms of MAIA multi-stakeholder networks have emerged at a territorial level.

    Lessons learned

    All respondents have stressed that it is difficult to determine the moment of value creation. National and regional public manager, partners, pilots agree on the fact that the creation of value of the MAIA method is mostly upstream, as a back-office function, during the constitution of the network, when the pilot and the partners discuss together to facilitate the articulation between services (creation of a professional dynamic). The users here are the partners. Thus, the value creation takes place before the services are delivered. However, the respondents point at that the value creation is also continuous, throughout the accompaniment of seniors all over the care process (according to the national and regional public manager and partners). When a single patient joins the healthcare system, this is value creation. According to the case manager, the value is created once the professional chain around the senior is stable and complete. Thus, mostly once the service is delivered, even if the senior monitoring continues to be provided.