Stakeholders & Beneficiaries

The main beneficiaries of Esélykör are: people with disabilities living in Székesfehérvár, non-governmental organizations dealing with disability issues, non-governmental development organizations, Székesfehérvár City (local government). The member organizations of Esélykör have significant expertise among deaf and hard of hearing people, people with reduced mobility, people with visual impairments and citizens with mental disabilities.

Co-creation process

Esélykör’s main activities are:
  • Sensitizing society to the problems of their disabled peers.
  • Providing services to citizens with disabilities in Székesfehérvár.
  • Contributing to the employment opportunities of the disabled people in Székesfehérvár through organizing joint programs and operating information channels.
  • The members of the network work together to promote their interests through Esélykör.
The main innovation of Esélykör is that it has orchestrated strong cooperation among NGOs supporting people with disabilities in Székesfehérvár, and because of this bond it is able to facilitate a prosperous collaboration with the local government, to represent and act for the interests of the citizens it represents. Esélykör has an effect on the involved non-governmental organizations as well through the Civil Centre Foundation’s (CiCE’s) development activities. The municipality, although being an informal network, mentions Esélykör in its strategic documents and its funding has a separate line in the city budget. Esélykör is a bottom-up, voluntary and spontaneous innovation network, operating as an informal network at the moment. Esélykör can be interpreted as a centralized network with CiCE at its core as a NAO (Νetwork Αdministration Οrganization).

Digital Transformation Process

This case study is not about a digital transformation process, but about social innovation.

Results, Outcomes & Impacts

As a result of the activities of Esélykör, disabled citizens of Szekesfehervar are able to defend their interests more effectively, and organizations working for people with different disabilities have a cooperative attitude instead of their previous competitive approach. Not only can their services deliver greater coverage, but also the organizations’ tasks and operations become more efficient and transparent. Communication with non-professional organizations (municipalities, companies, the general public) has improved as well. The network is able to use municipal resources more efficiently along the designated goals (e.g. social sensitization). NGOs are able to respond more flexibly to social needs by working in a network. The network can utilize the capacities of all organizations in a synergic way, so it can respond better to unexpected situations. The network has greater social embeddedness than the individual organizations themselves, so they can act more effectively to assert their interests.

Challenges & Bottlenecks

The general management knowledge and the legal knowledge of small NGOs are insufficient, their objectives are not coherent and consistent. Their internal communication is ineffective, it is often full of conflict. Due to lack of management knowledge and internal conflicts, the civil sector is not credible to other actors of the economy. If they are not able to articulate their goals (social impact), then it is not worth working with them. There is no consensus-based social vision, this way there is no strategy. While NGOs compete for scarce resources, which may be good in certain cases, they do not develop a culture of cooperation. The barrier to municipal and civil cooperation is that the municipality can only cooperate with a non-governmental organization that is legally registered. However, this entails significant costs and time, meaning that the transaction costs of cooperation for many civilians outweigh the benefits. These self-organized civil groups are not enter collaboration with the municipality in a network system.

Transferability & Replicability

Based on the effective operation of Esélykör, the municipality would like to initiate similar processes among NGOs of other professional areas to establish networks and to take over complex social services from the municipality. It also shows that the Municipality wants to launch a planned, top-down innovation process, based on the experiences with the bottom-up innovation process of Esélykör.

Success Factors

The city (local government) saw the value of working with NGOs in the delivery of public services, but also realized that communicating with them separately would create an inefficient system and therefore supported the establishment of the network. The city administration visits Esélykör’s event regularly. They also support the communication of the network, which is beneficial to both actors, as of course this also serves political purposes. The administration listens to Esélykör’s suggestions, integrates them into its strategies in so far it is possible, and contributes to their implementation as well. European Union grants and funds also support network based operation models, as these organizations alone do not have the capacity to prepare, submit and implement large and complex projects. Non-governmental organizations cannot take over complex public services from the local government, while a network of NGOs is able to do so. Everyone can put their best knowledge, experience and resources into this network, and build a comprehensive, complex service portfolio.

Lessons learned

The success of the network is largely due to the activity and coordination capabilities of the network administration organization (NAO), the CiCE. The structure of the network, the presence of a NAO, contributes significantly to the efficient and effective functioning of the network, which is why we consider innovation primarily as structural innovation. The professional work of neither the local government nor the individual NGOs has changed radically, but they have become more efficient and effective.

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

There are several examples where PwC Experience Centers engaged multi-stakeholders and served as platforms where users/citizens could express their needs and wants of certain products/services. In the Lombardy case, for instance, in addition to the co-creation session PwC helped organize a call-for-feedback session, where Lombardy citizens were able to submit their opinions on the new public portal. Through this process, the Regione Lombardia could collect responses and better understand the fundamental issues of the application based on the user experiences. Another example, the Meet Sweden project pioneered by the PwC Stockholm Experience Center in partnership Swedish Industrial Design Foundation (SVID) and Swedish public agencies, highlights how the public sector is growing increasingly interested in the role of users/citizens in service model development. Asylum seekers in Sweden often struggle with long and arduous processes when trying to resettle and legally immigrate to Sweden. Information is lost between multiple visits to disjointed public organizations and refugees does not feel in control of their own asylum journey. To remedy some of these issues, PwC Stockholm brought together private and public actors as well as the migrants themselves at the Experience Center to participate in co-creation sessions and generate human-centric solutions. Assessing the needs of the migrants was essential when developing the layout and in-app design features in the Meet Sweden mobile application. As a result, the participants jointly created a new mobile application that streamlines the asylum process and saves time, money, and energy of all involved actors. This is just one project where livelihoods were improved based on co-creation design thinking and it exposes the potentialities of Experience Centers in enhancing public service delivery models.

Co-creation process

Through iterative activities at the Centers, including group brainstorming in the Sandbox rooms, usability tests of company products and design thinking exercises, PwC works jointly with the public sector, its providers and the citizens to develop approaches that align with the above pillars. PwC intentionally outfits each Experience Center with adjustable, client-friendly workspaces and focuses on developing efficient and agile solutions. While Centers in every country belonging to the PwC network abide to a shared set of methodologies and approaches, each has its own focus and peculiarities. PwC structures each physical space differently to match regional and cultural characteristics. One example is the PwC Rome Experience Center. Inside the Center, there are flexible spaces with adjustable walls and moveable tables to accommodate activities organized for and with clients. It has a work café with objects of Italian design to create a familiar environment conducive to make people unwind and spur a positive ideation and reflection process. Additionally, the interactive technology and writeable walls incorporated in the central Sandbox meeting room offer clients unique spaces for meetings, workshops, and trainings with PwC UX design and technology professionals. The Testing Lab and Observatory Room include a unidirectional mirror so clients can carry out usability tests and observe real time client reactions to services/products. The Rome Experience Center also has AI technology, 3D printing, and contemporary digital programming to collaborate with clients in the development of prototypes.

Digital Transformation Process

Scholars envision Living Labs as the generators of concrete, tangible innovations based on contributions from users and communities, rather than just simply functioning as brainstorming spaces. The PwC Experience Centers propel forward several iterations of innovation by recruiting diverse job profiles, applying co-creation methodologies, and prioritizing the human experience in all project designs. Dynamism and functionality are consistent features across all PwC Experience Centers and this allows innovation to manifest in a variety of ways at different stages in the development process. Namely, we will detail out how the Experience Centers incite business model innovation for its public sector clients, and how they understand service/product and touch point innovation throughout the design process. Innovation is transient across levels and, at PwC Experience Centers; it is contingent on the end goals of the client.

Results, Outcomes & Impacts

PwC Experience Centers’ principal objective is to bring together customers and businesses in dynamic spaces to establish business models that incorporate user feedback at all design stages. In occupying this intermediary role, Experience Centers help identify user needs and the root causes of customer dissatisfaction through co-creation processes so the resulting business model used by the client satisfies needs of end-users. This open-innovation environment attracts private companies and public organizations looking to modernize and transform the business-consumer service delivery relationship. Their human-centric nature makes these spaces distinct and helps concentrate varied perspectives and problem solving tactics in a central meeting location. In joint collaboration with other stakeholders, PwC helps clients rethink their mission and generate innovate business models to meet end users’ needs. By asking questions centered on how to alter current business practices for greater customer satisfaction, clients can identify areas for growth and ultimately find a new path forward. The PwC promoted business models are considered innovative, especially for the public sector, given that they reconfigure the model to meet new objectives established based on consumer input. Thus, by enabling conscious changing of an existing business model or the creation of a new business model, clients can strategically elevate models to better satisfy the needs of the customer. The associated organizational structures and methods for service/product delivery reflect a shift in mindset of the client and focus on impact and growth.

Challenges & Bottlenecks

Typically, larger organizations have more rigid organizational hierarchies and learned cultural habits, which can make implementation of flexible methodologies difficult. The objective of the PwC Experience Centers are to function as testbeds and incubators for entrepreneurial design thinking and help PwC evaluate hybrid/agile managerial approaches to public sector challenges, in-house. By having the Centers operate in this way, PwC can overcome organizational challenges and share niche-consulting expertise gathered through Center activities to internal PwC consultants. This sort of ‘Agile Desk’ unit of PwC is transformative for internal work cultural – both enhancing workflow and teaching nuanced strategies for managing client relationships. There is a tri-fold benefit from PwC Experience Centers as clients, their customers, and PwC, learn and improve from the co-creation sessions and find solutions to broad, complex problems.

Transferability & Replicability

The PwC Experience Centers can also serve as intermediaries and network enablers between actors that have struggled to communicate productively. According to researchers James Stewart and Sampsa Hyyaslo in their analysis of the role of intermediaries in the development and appropriation of new technology, intermediary organizations, such as PwC, configure the users and involved actors yet maintain a position of separation from the decided end use of the technology. This enables intermediaries to influence through workshops and co-creation sessions, however, the participants have the final decision-making power. Thus, as an intermediary PwC drives the new partnerships through six key “bridging activities” (Bessant and Rush 1995):
  • Articulation of needs, selection of options
  • Identification of needs, selection training
  • Creation of business cases
  • Communications, development
  • Education, links to external info
  • Project management, managing external resources, organizational development
When broken down further, it essentially tasks the intermediary with enabling transfer of knowledge, sharing knowledge across the user community, brokering to a range of suppliers, and diagnostic/innovation – trying to identify what end users actually want. These tasks are driven by three main social learning roles occupied by the intermediary: facilitators, configurers, and brokers. In the PwC context, Experience Centers are living out these archetypes as they bridge gaps between customers, companies, and the public sector. In practice, we have seen the importance of PwC occupying this intermediary role and facilitating critical client-customer interactions at the Centers. Contamination of approaches between the private and public sectors, knowledge transfer, and elevated understanding of shared challenges are just a few of the benefits in having PwC as an intermediary network enabler.

Success Factors

Social learning and/or contamination of techniques/approaches during interactions at PwC Experience Centers is another key way that public value is realized. Social learning refers to two simultaneous, complementary, and intertwined processes: innofusion (Fleck, 1988) and domestication of technology (Sørensen, 1996). Fleck defines innofusion as the innovation that takes place during the diffusion of new technology amongst participants. In this phase, users discover their needs and wants through a process of technological design, trial, and exploration. The other component, domestication of technology, addresses the pre-existing “heterogeneous network of machines, systems, routines and culture.” Essentially, it recognizes how cultural consumption habits influence user behavior and underlines the value of incorporating users’ creativity in product design processes. For PwC Experience Centers, a transfer of co-creation approaches and design thinking techniques to its participants is valuable for ensuring sustainability of solutions and enabling shared sponsorship to anticipate possible resistance to project implementation. Additionally, there is a cross contamination of techniques between participants as they originate from diverse backgrounds and bring to the workshops different views for how to solve problems. In this process, divergence in ideas and incorporation of distinct actors allows critical knowledge transfer that often precludes innovation and helps identify overlapping challenges. Outcomes generated from co-creation activities at the Centers have included the use of private sector business models by public organizations. By seeing the design elements of private sector models implemented by PwC, clients can interpret and apply similar structures in their own operations – thus initiating a transfer of proven strategies between private and public actors.

Lessons learned

Living Labs play a critical role in displaying the mutual value of co-creation approaches for public and private actors. In the public sector, there is a hesitancy to welcome consumer engagement throughout the service design process. Governments and public organizations are fearful that actively seeking consumer input is too cost and time intensive and are unaware of the potential benefits for engaging customers in the earlier design stages. Therefore, it is essential to understand the PwC Experience Centers’ role in helping enable public-private mutual understanding and fostering innovative co-creation solutions. They add value by acting as a platform for idea exchange between all actors, inciting and analyzing customer feedback, and promoting multi-perspective discourse. The resulting improvement in services and increase in public value benefit the supply-side and user-side equally, and substantiates the importance of intermediaries in opening communication channels. It enables organizations and companies to explore how to improve their own services and/or processes with consumer engagement as the central focus and at the Centers they can test, fail, retest, and optimize proposed strategies before actual implementation.

Stakeholders & Beneficiaries

Various actors in the local community become relevant stakeholders in this case, since one of the aims is to create more active links between the community and the elderly care services. Private businesses, civil society (NGOs and volunteers) and other public sector actors are invited in to provide inputs in the ‘co-creation’ of the village at the ideation and planning stages of the process. Moreover, local stakeholders are invited to ‘co-create’ the services when the new care facilities open. This can be volunteers taking part in arranging activities, schools or nurseries setting up performances, or private businesses providing services such as hairdressing, cafés etc. The main beneficiaries of the case are senior citizens suffering from dementia and their next of kin.

Co-creation process

The municipality has placed emphasis on co-creating the new services with potential residents, their next of kin, and other local stakeholders. To co-create the new services, the municipality is drawing on inspiration from service design and co-design. The design processes are mainly being carried out ‘in-house’ and facilitated by a development team with experience and training in facilitating innovation processes.

Digital Transformation Process

We have not focused on the technological aspects of the dementia village in the case study. However, introduction of new technology will be important for the development and operation of the new services.

Results, Outcomes & Impacts

There are two ways of understanding ‘results’ in the context of this case. First, the main results of the dementia village project are linked to the construction of the new care facilities. Second, we may also highlight the results of the co-creation processes undertaken to create new solutions in this new service setting. These processes have generated a range of ideas for new solutions that will shape the new services. In this case, it is too early to assess outcomes and impact of the dementia village and the various new solutions within the new care facilities because it has not yet opened. We understand outcome and impact as the effects of new solutions which may be measured in various ways.

Challenges & Bottlenecks

There are some obvious challenges involved in co-creating dementia care. When the end users have cognitive impairment, and may even lack the ability to communicate verbally, co-creation and co-design is difficult. Finally, the challenges and constraints of service design in this context largely concern the complexity of the project and in providing high-quality services in dementia care. Dealing with dementia is inherently challenging.

Transferability & Replicability

The dementia village concept is already spreading across countries and communities (I.e. from the Netherlands to Norway) and across municipalities in Norway. However, the concept may be implemented with more or less focus on involvement and co-creation. We find that there are potential for inspiration, learning and transferability in the way Bærum has aimed to co-create the new dementia services with users and other stakeholders.

Success Factors

Not relevant.

Lessons learned

One of the central lessons learned from this case is that co-creation of innovations with services users is possible also when service users suffer from cognitive impairments.

Stakeholders & Beneficiaries

Apart from PricewaterhouseCoopers, beneficiaries include public administrations involved in specific projects such as the Lombardy Region.  

Co-creation process

Uptake of co-creation by private companies is a relatively recent trend, spurred by increased connectivity, technological innovation, and prioritization of user experiences. A recent report from Hitachi Europe found that “58 per cent of businesses have piloted co-creation projects to help them innovate.” More rapid communication between customers and service providers has altered the typical business relationship and thus PwC Experience Centers are becoming critical for facilitating co-creation and producing viable solutions for public sector clients. At the Experience Centers, PwC builds business approaches and methodologies based on their BXT mentality – which recognizes the interconnectedness of Business, Experience, and Technology. It places the human experience at the center of business and technological transformation – ultimately drawing on multiple perspectives and disciplines in development processes. Summarily, the BXT mindset evaluates proposed solutions holistically and stresses the importance of collaborative approaches, building around questions such as; is the solution useable? Is the solution useful? Does the solution work? The Centers’ application of a BXT-minded Service Design for Growth model and its associated co-creation processes help PwC remain adaptable and adjust services to meet specific client demands. The Service Design for Growth model is comprised of four key stages: 1) Exploration, 2) Strategy, 3) Co-Creation, and 4) Growth and focuses on impact and growth delivery. For each design stage, the PwC team introduces exercises to gain clearer understanding, define the service through synthesis of research, generate solutions, and transpose the principles of open-innovation and collaboration in clients’ everyday business. However, different from the sequential and rigid Stage-Gate approach, the process remains Agile in design and replicates the Design>Test>Iterate steps until outcomes are approved by all actors. A final ‘rapid prototype’ is the expected output, which PwC underlines as “cheaply, easily, and quickly changeable.” This method is user-oriented – meaning it is human centric rather than a top-down process – and Co-Creation sessions allow PwC staff to bring together stakeholders in product/service conceptualization to secure equal investment and widespread of the project. PwC also importantly valorizes incremental innovation, focusing on the small deliverables and touch points throughout the design process. At the Experience Centers, PwC teams move clients through the co-creation process that consists of two pre-project phases, Discovery and Session Design, then the Co-Creation Session itself, and lastly is followed by two post-session activities, De-brief and Deliverable Realization. Co-creation sessions can last anywhere from 1-5 days, depending on the client’s request, and are customized to meet specified objectives. The flexible and iterative nature of the co-creation methodologies at the Centers also allows for bi-directional learning. PwC benefits from leading co-creation sessions by refining their own approaches and learning what works with clients and clients revise their own business models to match consumer demands. Applying co-creation approaches brings new knowledge to the firm while also attracting forward thinking clientele. To better understand the specific exercises used in each design stage, we will analyze the use of co-creation sessions and Design Thinking by the PwC Experience Center in Milan, Italy in the Portal for the Lombardy Region project. In July, the PwC Milan Experience Center hosted a collective group including representatives from Regione Lombardia, business and test users, service managers, and other relevant administrative personnel. The participants were selected based on their wide range of backgrounds and intentionally included portal end-users. From the beginning, the co-creation session objective was clearly defined and the following goal was shared with participants: How can we help the project back office (Lombardy Municipality administrators) to operate smoothly to support users in a simple and immediate accession of the project? PwC staff then provided an overview of Design Thinking methodologies and the Design Sprint approach, which aim to promote a multidisciplinary vision, are human-centric, and ultimately deliver solutions in a time efficient manner. PwC staff divided the group into two sub groups, the citizens and the firm, and the groups were given a secret task that involved the user portal in order to initiate the service road mapping exercises. In the mapping process, there was emphasis placed on asking ‘why’ behind each problem solving statement to help uncover what the root issues were for the service providers and consumers. Giving each group a persona with specific user characteristics helped participants develop mutual understanding for the needs of the user portal and the challenges faced by firms developing the products. Further, PwC bases proto-personas used in the exercises on real data and market research to guarantee that the alignment in communication resulting from the session is applicable in a real world setting. After discussing the frustrations and needs of each persona in their groups, participants played a word association game where they could role-play and discover their overlapping concerns. Next, in the analysis phase, participants identified the various touch points for the portal services and discovered where there were issues within the service delivery model. Lastly, they worked together to generate solutions for how to enhance communication between stakeholders and improve the operational flow from a “What I Need From You” perspective. Overall, in the Lombardy Portal use case, the Experience Center’s co-creation session was instrumental for bringing together stakeholders using an all-inclusive approach and for creating an innovative, user-friendly service/product delivery model. The final output was a new ready-to-use portal for standardization in resolving of public works issues and improved assistance for Lombardy residents. The role of front-end employees/public service staff in co-creation. In co-creation sessions, front-end employees are essential for facilitating and guiding participant interactions. At PwC Experience Centers, there are two main types of employees working with external clients. The first group, are the creative specialists (digital engineers, industrial designers, UX technicians) that bring clients’ visions to fruition. The second group, are the facilitators of the co-creation sessions. The PwC staff in the facilitator roles are extensively trained in facilitator methodology and are well experienced at bringing together different perspectives in collaborative design thinking. Critically, the plurality of employees’ job profiles at the Centers allows for creativity in services offerings and guarantees that various types of clients will have the necessary personnel to execute the co-creation session objectives. To quote a Senior Manager at the Rome Experience Center referencing the value of staffing Centers with a variety of skillsets “the team (PwC) must be ready to support the different projects in every moment.” As aforementioned, the PwC staff act also in a ‘meta-consulting’ capacity – sharing information with and teaching internal PwC consultants. The normal managing consultancy team structures are not applicable to PwC Experience Center project teams. Instead, the front-end employees play dual roles as they are also actively participating in the co-creation process and the member composition is distinct from the usual partner, manager, senior associate, and junior associate team format. This is vital for co-creation to remain focused on the user and decentralized in structure. Additionally, the PwC Experience staff are tasked with procuring transformative interactions between stakeholders and ensuring that solutions from sessions are participant driven. This function is divergent from a typical PwC-client relationship, which can be less iterative and more unidirectional. The role of users/citizens in co-creation As noted in the section on how co-creation is outlived, co-creation prioritizes users/citizens at every stage and incorporates participatory design thinking. One of the main priorities of co-creation is iteration – allowing for user feedback and touch points throughout the development process. PwC considers customers/users/citizens as co-designers and their involvement is critical for avoiding product-centric outcomes and replication of past implementation mistakes. Part of PwC’s intermediary role is to relay the value of active user involvement to clientele, including public organizations and governments contracting the Centers’ services. This is executed through PwC’s creation of user and provider ‘personas,’ which helps cluster common characteristics and fosters mutual understanding among participants. Users/citizens need to feel a sense of commonality amongst themselves and development of personas also reveals universal concerns, frustrations, and challenges that were previously unacknowledged. There are several examples where PwC Experience Centers engaged multi-stakeholders and served as platforms where users/citizens could express their needs and wants of certain products/services. In the Lombardy case, for instance, in addition to the co-creation session PwC helped organize a call-for-feedback session, where Lombardy citizens were able to submit their opinions on the new public portal. Through this process, the Regione Lombardia could collect responses and better understand the fundamental issues of the application based on the user experiences. Another example, the Meet Sweden project pioneered by the PwC Stockholm Experience Center in partnership Swedish Industrial Design Foundation (SVID) and Swedish public agencies, highlights how the public sector is growing increasingly interested in the role of users/citizens in service model development. Asylum seekers in Sweden often struggle with long and arduous processes when trying to resettle and legally immigrate to Sweden. Information is lost between multiple visits to disjointed public organizations and refugees does not feel in control of their own asylum journey. To remedy some of these issues, PwC Stockholm brought together private and public actors as well as the migrants themselves at the Experience Center to participate in co-creation sessions and generate human-centric solutions. Assessing the needs of the migrants was essential when developing the layout and in-app design features in the Meet Sweden mobile application. As a result, the participants jointly created a new mobile application that streamlines the asylum process and saves time, money, and energy of all involved actors. This is just one project where livelihoods were improved based on co-creation design thinking and it exposes the potentialities of Experience Centers in enhancing public service delivery models. The role of other stakeholders (private actors, communities) in co-creation Given the Service Design for Growth delivery model’s emphasis on multi-stakeholder engagement, other private actors and the community at-large are valuable contributors, especially in co-creation sessions. Community stakeholder groups and private actors are active in participatory design thinking exercises in order to keep the target focus group, end users, at the core of solutions. Becoming representatives and managers of the public services/products instills important leadership characteristics in participants and ultimately facilitates self-governed, sustainable organizational processes.

Digital Transformation Process

PwC Experience Centers’ principal objective is to bring together customers and businesses in dynamic spaces to establish business models that incorporate user feedback at all design stages. In occupying this intermediatory role, Experience Centers help identify user needs and the root causes of customer dissatisfaction through co-creation processes so the resulting business model used by the client satisfies needs of end-users. This open-innovation environment attracts private companies and public organizations looking to modernize and transform the business-consumer service delivery relationship. Their human-centric nature makes these spaces distinct and helps concentrate varied perspectives and problem solving tactics in a central meeting location. Overall, PwC builds its Centers’ objectives around four key pillars:
  • Customer: placing the user at the center of the design process
  • Power of perspective: incorporating multiple perspectives in solutions
  • Always in Beta: maintaining iterative solutions that can be adjusted
  • Experiment with tech: enhancing existing tech and/or brainstorming new uses
  • Through iterative activities at the Centers, including group brainstorming in the Sandbox rooms, usability tests of company products and design thinking exercises, PwC works jointly with the public sector, its providers and the citizens to develop approaches that align with the above pillars. PwC intentionally outfits each Experience Center with adjustable, client-friendly workspaces and focuses on developing efficient and agile solutions. While Centers in every country belonging to the PwC network abide to a shared set of methodologies and approaches, each has its own focus and peculiarities. PwC structures each physical space differently to match regional and cultural characteristics. One example is the PwC Rome Experience Center. Inside the Center, there are flexible spaces with adjustable walls and moveable tables to accommodate activities organized for and with clients. It has a work café with objects of Italian design to create a familiar environment conducive to make people unwind and spur a positive ideation and reflection process. Additionally, the interactive technology and writeable walls incorporated in the central Sandbox meeting room offer clients unique spaces for meetings, workshops, and trainings with PwC UX design and technology professionals. The Testing Lab and Observatory Room include a unidirectional mirror so clients can carry out usability tests and observe real time client reactions to services/products. The Rome Experience Center also has AI technology, 3D printing, and contemporary digital programming to collaborate with clients in the development of prototypes. Typically, larger organizations have more rigid organizational hierarchies and learned cultural habits, which can make implementation of flexible methodologies difficult. The objective of the PwC Experience Centers are to function as testbeds and incubators for entrepreneurial design thinking and help PwC evaluate hybrid/agile managerial approaches to public sector challenges, in-house. By having the Centers operate in this way, PwC can overcome organizational challenges and share niche-consulting expertise gathered through Center activities to internal PwC consultants. This sort of ‘Agile Desk’ unit of PwC is transformative for internal work cultural – both enhancing workflow and teaching nuanced strategies for managing client relationships. There is a tri-fold benefit from PwC Experience Centers as clients, their customers, and PwC, learn and improve from the co-creation sessions and find solutions to broad, complex problems.

    Results, Outcomes & Impacts

    Living Labs play a critical role in displaying the mutual value of co-creation approaches for public and private actors. In the public sector, there is a hesitancy to welcome consumer engagement throughout the service design process. Governments and public organizations are fearful that actively seeking consumer input is too cost and time intensive and are unaware of the potential benefits for engaging customers in the earlier design stages. Therefore, it is essential to understand the PwC Experience Centers’ role in helping enable public-private mutual understanding and fostering innovative co-creation solutions. They add value by acting as a platform for idea exchange between all actors, inciting and analyzing customer feedback, and promoting multi-perspective discourse. The resulting improvement in services and increase in public value benefit the supply-side and user-side equally, and substantiates the importance of intermediaries in opening communication channels. It enables organizations and companies to explore how to improve their own services and/or processes with consumer engagement as the central focus and at the Centers they can test, fail, retest, and optimize proposed strategies before actual implementation. Social learning and/or contamination of techniques/approaches during interactions at PwC Experience Centers is another key way that public value is realized. Social learning refers to two simultaneous, complementary, and intertwined processes: innofusion (Fleck, 1988) and domestication of technology (Sørensen, 1996). Fleck defines innofusion as the innovation that takes place during the diffusion of new technology amongst participants. In this phase, users discover their needs and wants through a process of technological design, trial, and exploration. The other component, domestication of technology, addresses the pre-existing “heterogeneous network of machines, systems, routines and culture.” Essentially, it recognizes how cultural consumption habits influence user behavior and underlines the value of incorporating users’ creativity in product design processes. For PwC Experience Centers, a transfer of co-creation approaches and design thinking techniques to its participants is valuable for ensuring sustainability of solutions and enabling shared sponsorship to anticipate possible resistance to project implementation. Additionally, there is a cross contamination of techniques between participants as they originate from diverse backgrounds and bring to the workshops different views for how to solve problems. In this process, divergence in ideas and incorporation of distinct actors allows critical knowledge transfer that often precludes innovation and helps identify overlapping challenges. Outcomes generated from co-creation activities at the Centers have included the use of private sector business models by public organizations. By seeing the design elements of private sector models implemented by PwC, clients can interpret and apply similar structures in their own operations – thus initiating a transfer of proven strategies between private and public actors. The ability to measure performance varies from center to center, as there is not a standardized system of analysis at the macro level. At the above-mentioned PwC Stockholm Experience Center, they have begun testing ways to assess the effectiveness of their products/services in terms of end user impact. Labeled as a ‘creative audit,’ PwC Stockholm staff retroactively analyzed their work in the past year. The criteria used to measure impact were developed around questions such as “How many end users have we reached?” and “How many lives have improved as a result of innovative business and service models?” There is a distinction in how PwC aims to measure the performance of Experience Centers against the broader PwC mission, which has traditionally been more concerned with client value. The underlying driver for evaluation is improvement of end user experiences rather than profitability and other conventional business metrics. While still in its early stages, the results from the Swedish case to a certain extent validate the value of PwC Experience Centers as innovation incubators. In addition, external organizations and other Living Labs are also looking to collaborate with PwC to actively monitor the impact of co-creation in their respective sectors. Based in Norway, the Asker Welfare Lab, a citizen engagement lab that “adopts an investment mind-set and treats citizens as co-investors,” has contracted PwC to help develop key performance indicators for the lab’s projects. They are working with PwC to develop a measurement model that, together with Norwegian Association of Local and Regional Authorities, can monitor outcomes and trace results of how the lab is driving innovation. The PwC Experience Centers’ role in measurement practices is still yet to be determined, but validating the Centers’ activities and helping other labs track their progress are chief priorities.

    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

    PwC Experience Centers strive to alter existing unidirectional service/product deliveries. In regards to the service experience for users, more specifically there are two principal focuses:
  • Become more human centered in solutions for problems through qualitative based research approaches and human insight
  • Produce agile and iterative ways of working that draw multiple perspectives and provide timely/efficient testing of concepts for enhancing user experiences
  • Theoretically, in applying these principles PwC can foster multidirectional and collaborative relationships between developers and consumers. Improving co-creation interactions has two potential effects for the customer: (1) It reduces transaction costs, risk, and uncertainty, and (2) it reduces the costs of the interaction for the consumer, which leads to greater satisfaction with and trust in the company (Rajah et al, 2008). These improvements for the customer are interlinked with enhanced productivity for the supplier and for the contracted firm (PwC in this case). In working with the end users throughout the co-creation process, subsequent organizational models used by clients reflect specificities of the customers and provide material for PwC Experience Staff to utilize in their role as meta-consultants to the firm. The resulting service experience/relationship is circular, valorizing iteration and human input in design. Clients and customers can walk away from experiences at the PwC Experience Centers with new levels of understanding and transparency, which then translates to sustained changes in business models and provider-customer relationships. Uniquely, the Experience Centers allow PwC to diversify its approaches away from traditional Stage-Gate methods toward more Agile On-Demand approaches and this has also impacted the inside work culture at PwC. Stage-Gate is a methodology where the project is divided into separate phases and the manager leads the continuation of the process. Developed to avoid reworking or redirecting processes, the Stage-Gate model remains limited in its ability to incorporate external feedback and in its dynamism. Amidst the digital revolution, Agile approaches emerged and gained traction as they were inherently more responsive and emphasized the role of people over processes. At PwC, the adoption of Agile methodologies by its Experience Centers has expanded and permeated across other business units and has attracted new and varied clientele. Further, through the Experience Center unit, PwC experiments with additional forms of flexible approaches and this has contributed to its successes in rapidly developing product/services that alleviate misalignments between the client and their customers.  In the public sector, transforming the service experience to be more human-centric is growing in popularity and in several cases PwC’s involvement has helped spur new private-public partnerships. Another use case from the PwC Stockholm Experience Center is the Storsthlm project. In response to Stockholm’s recent growth, the Greater Stockholm municipalities needed to reorganize management processes in the areas of politics and public administration. Together with PwC, the municipalities and the County Council collaborated on the Health and Support initiative as part of the new Regional Development Plan that aims to enhance citizens’ mobility and access to public resources. One aspect of the plan focused on improving public assistance programing for the aging population. Within the PwC co-creation sessions, outputs were constructed around a core objective: How can we make sure to deliver on helping citizens through the aging process? In working with the public municipalities, engaging with elderly citizens, and integrating co-creation methodologies, PwC helped keep the solution human centered and rooted in qualitative research. The municipalities reinvested in their citizens and relied on PwC business approaches to solve reoccurring issues in administering of public services. This resulted in improved interconnectivity between municipalities and a collaborative program design that moved away from typical silos and disjointed public assistance organizations in the public sector.

    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

    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.

    Stakeholders & Beneficiaries

    Regarding the actors most relevant in the process of value creation, clearly the purpose of policymakers is to create value and co-creation is a means for them to do their job better. However, the value created by having more insights helps not only the strategic level, but also at the operational one. Therefore, the elderly people are the centre piece in value creation: they are involved in the service design phase, as in the evaluation phase as testers, who give directions to the companies and the city administration to adapt product or services to their special needs.

    Co-creation process

    Regarding the concept of co-creation, interviewees stressed the fact that users and companies involved provide specific insights can help for the design of the project and of the public services. For instance, in ZorgLab people involved in the co-creation activity provided their own insight on which are the tools most useful for everyday life and how it is become more difficult for them to use such tools. Also, they provided their insight on how the house should be organised, also taking into account the necessity to keep a rich social life. An interesting aspect of co-creation is also mediation, as different individuals do not share the same idea of what is a liveable and sustainable neighbourhood. For what concerns the kind of value created in the service, as afore mentioned the initiative from one side wants to enable elderly people to stay longer at home in an independent way. From the other side, people involved in the co-creation activity have an experiential value, as they can give their contribution and still be active in the society. In the respect, for them it is very important to have a true recognition of their effort on the side of the policy makers. Interviewees reported some cases in which policymakers consult but do not follow the insights in the end. Apart from participation aspects, co-creation is also seen as a mean to increase democracy and social cohesion, like the example provided Bologna City of Commons project, where citizens can take initiatives to organise their lives together. On the other hand, such initiative has also a clear economic value, as it brings more companies in the healthcare sector so it can be an economic differentiator for the city. In fact, in the ZorgLab facilities, companies can test their innovation, make better products and have a real economic impact. So, Aalst is really becoming a city based on the healthcare sector and ZorgLab of course has been an advantage in comparison to other cities. Value is created in every stage of the initiative, but especially in the beginning where the insights are extracted from the participants to the co-creation activities. It is crucial to be able to extract such insights combining people working alone and in group: there rarely is a Eureka moment when you do co-creation. So clearly it is the interaction that creates the most value, even though the same value it is delivered at the end of the project (e.g. improved living condition for the elderly). Regarding the actors most relevant in the process of value creation, clearly the purpose of policymakers is to create value and co-creation is a means for them to do their job better. However, the value created by having more insights helps not only the strategic level, but also at the operational one. Therefore, the elderly people are the centre piece in value creation: they are involved in the service design phase, as in the evaluation phase as testers, who give directions to the companies and the city administration to adapt product or services to their special needs. In this regard, the service experience/relationship is paramount in the creation of tailor-made products and services for the elderly, especially for what concerns the interaction between front-line staff and the service user. Front-line staff are linking all stakeholders together, so that they can meet and create value. A continuative relationship reinforces also the co-creation activity as individuals get really motivated and experienced so that the feedback you get from grows in quality. It is very important to work closely and to have proofs the approach is working since from the beginning. Also, it is crucial not to have an academic approach, but to work closely with the participants learning to really listen carefully and understand exactly what they need, in order to gain their respect and to get relevant information from them. Considering the contribution of citizens or communities to the process of value creation, there is a clear distinction between participation (sharing ideas and taking part to decision) and co-creation (really being part of the process of creation). In that respect, only the most motivated citizens really provide great effort. In that regard, it has also to be considered that individuals taking part to co-creation activities are also the most cultivated and well-off, as it is very complicated to motivate marginalized individuals.

    Results, Outcomes & Impacts

    As already mentioned, the aim the case study is to investigate the concept and process of value creation and co-creation in the initiative. In this respect, value was defined by interviewees as any benefit for users or citizens stemming from the use of the public service as well as from the participation of the co-creation activity. In this specific context, value is conceived as the benefits of potential and actual users of the elderly home, who will be able thanks to the service to live longer and safer independently and to continue to be part of the society. On the other hand, the volunteers taking part to the testing keep being socially active and to provide their contribution to society with this project. So, they feel they are still having an aim in their life.

    Challenges & Bottlenecks

    A first obstacle is regulation hampering innovation, not only at local level, but also at Flemish, Belgian and European levels, especially for what concerns data sharing and assisted living. Furthermore, often private companies have a wrong estimation of co-creation, which is seen as a way to quickly get feedback on a developed product, rather than a way to co-create a product from the beginning. Clearly the latter process is more time and money consuming. Also, it is difficult to convince the elderly to test the house living there from 1 to 3 weeks: in that regard, direct contact with them helped. A final obstacle and drawback is the lack of structures to evaluate the impact of the initiative and to measure value. In fact, there are some evaluations of the Flanders living labs overall, but not for any of the local project. But in any case, how do you measure value? Measuring contacts and interactions face to face and on social media is not a really metric or indicator of value. On the other hand, value is not limited to the economic gains from an initiative. Overall, value can be measured only by mean of subjective reported impressions in questionnaires, so that generalization is difficult. Regarding the specific case, one possible bottleneck is also financial because if the product/service produced is too expensive or if people with low budget cannot really address the service the goal of the process is lost.

    Lessons learned

    The most important mean to involve citizens in co-creating value is to recognize their effort and to show them that their views and insights have been taken into account. Another crucial aspect is a good definition of the objectives of the co-creation activity. In this respect, it would be helpful to teach individuals to work with design-thinking to some extent. Organisations and companies sometimes come with big expectations about co-creation, as they expect to come up with fully new products. However, only the small things can be innovated at a time and often small things make the difference in the end. Also, lots of organisations are coming too late in the co-creation process: they just want to quickly test their product, instead of testing their idea first and progressing along the way. Also, many of their ideas stem from technology itself, which is sees as a solution itself rather than as a mean to bring about change. Another important aspect is to pay attention to the quality of participants: projects need to involve a lot of professionals and future users of the service, because their insights are the most important part in the process of co-creation. For example, dignity is key element for future users, together with the fear of independence loss in the elderly home. An interesting idea concerning the selection of participants is to combine users and experts, and in any case to provide a benefit for the user /expert to participate in terms of moral recognition of their contribution. A final important element consists in the development of the right context for such kind of projects, based on a strict collaboration among caring facilities, hospitals, services and products providers, policy makers and civil servants. A follow up project could be to rethink the public elderly homes, as well as to influence the current culture of staying too long in our home, by convincing individuals to move to another more sustainable home.