Carpe Diem Dementia Village

This case centres around dementia care and concerns the development of a ‘dementia village’ in one of Norway’s largest municipalities. The project is based on inspiration from the Dutch dementia village, the Hogweyk, and was initiated by politicians in the municipality after a visit to the Hogweyk in 2013. The new dementia care facilities are scheduled to open by the fall of 2020.

The village will have room for 158 residents suffering from dementia, with 8 residents living together in 17 smaller buildings with surrounding gardens. Inside the village there will be access to different facilities, such as a small shop, café, hairdresser and gym, and indoor and outdoor spaces for social gatherings and activities.

The idea behind the dementia village is to create an environment where residents can be free to move around in a safe environment, with more access to activities and recreation. This is contrasted with the more traditional nursing homes, which are often criticized for being too focused on the somatic aspects of care, which limits room for socializing and meaningful activities. By creating a more ‘homely’ atmosphere both inside and out, the municipality is seeking to provide dementia care services that enable seniors to continue living their life as before, as much as possible.

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.

Simplified follow-up

This case concerns efforts to improve counselling and follow-up services within the Norwegian Labour and Welfare Services (NAV). The aims of the ‘simplified follow-up’ project were to simplify, enhance quality and make the work-related follow-up of users more effective. The project was carried out between 2015 and 2019 and involved the development of various digital solutions launched at different points of time throughout the project period. A preliminary project was carried out in 2015, based on a service design approach.

A new concept for the follow-up methods was presented as a ‘service journey’ based on the perspective of users and frontline employees. Needs for innovation and development in the (digital) support systems were identified, and 30 ideas for new tools that could support the new directions for follow-up were presented. In the final stage of the preliminary project, a set of these ideas were prototyped, tested and assessed based on a cost-benefit analysis.

One of the central solutions that emerged from the simplified follow-up project was the development and implementation of a digital activity plan with an integrated chat for direct communication between users and frontline employees.

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.

Stimulab

‘Stimulab’ is an incentive scheme, initiated in 2016 as a two years trial program, but is now prolonged for at least three more years. It was set up to stimulate public sector innovation by focusing on the citizens’ perspectives and user-oriented experimentation. It was an initiative from the political leadership in the Municipality and Modernization Ministry (MMM) aimed to innovate public sector.

In the assigning letter to the responsible Directorate (Difi) in 2016 from the Ministry an important task for Stimulab should be: “Stimulate public agencies to use innovative methods, included service design, aimed to develop complete services which is an improvement for the end-users, and gives efficient use of public resources” [1]

The task was given to The Agency for Public Management and eGovernment (Difi), who has the administration of the scheme, in collaboration with “Design and Architecture Norway (DOGA), who has high competence in service design. Public sector organisations (municipal or central government organisations) can apply for participation in the scheme. Projects that are accepted receive financial support ( 1-2 mill. N.kr) to be used for procurement of service design and innovation competence. Moreover, the projects are supported with professional guidance on how to work with service design and service innovation based on the ‘triple diamond’ process, which is used as the Stimulab method. 14 projects are granted support through Stimulab thus far (Stimulab Report, February, 2019), and eight of these have been completed and finalised. The remaining six projects were initiated in 2018 and are still at a development stage. Seven projects are accepted for 2019.

[1] ) all translations are done by us

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.