Stakeholders & Beneficiaries

This programme, targeted at minors aged 16 to 18 who have dropped out of school, was launched in 2012 by the Unis-Cité association. Unis-Cité, which has extensive experience in mobilising young people and various profiles on civic missions, has decided to create a programme that complies with these specifications, in partnership with the Ministry of National Education and the Civic Service Agency. The Booster programme connects the Unis-cité association, the Civic Service Agency (as funder), the national education system (in particular, the MLDS – The mission that prevent school drop-outs under the French National Education System), partner Comprehensive or Vocational schools, national education volunteers, external lecturers. The networks also involves other funders: the national private funders of Unis-cité (e.g. Coca-Cola Foundation, HSBC or the SUEZ Initiative Foundation), the European Social Fund, local funders (for example the regional youth and sports department), local private foundation.

Co-creation process

The programme helps the main beneficiaries of the project, young people, to move from those who are accompanied and helped, to the ones who help others, which contributes to their revalorization. The specificity of the civic service association Unis-cité is to offer a team-based civic service, and to focus on diversity within groups. Through the Booster programme, since 2012, school dropouts are being remobilised by a partnership designed by Unis-Cité, the MLDS, and the Civic Service Agency, thanks to an alternating civic service programme combining missions of general interest (provided by the Unis-cité association) carried out with young adults in civic service, and sessions of school upgrading in partner Comprehensive schools (provided by the public partner). In the Booster programme, civic service is also adapted to the type of audience, with concrete solidarity actions. The supervision is more individualized and reinforced.

Digital Transformation Process

This case study is not about a digital transformation process, but rather social innovation. It has led to pedagogical and methodological innovations.

Results, Outcomes & Impacts

From an economic perspective, dropping out generates significant costs for society, much higher than those corresponding to the action of public policies in this field. The costs associated with the drop-out of a young person, accumulated over time, have been estimated for France at 230,000 euros for each student who has dropped out. The Booster programme helps to reduce this cost. The year of civic service solves a number of problems of young dropouts such as health check, opening a bank account, renew their ID card) in addition to a possible return to training or employment. On the year 2018-2019, Unis-cité welcomed between 7500 and 8000 young volunteers. For the Unis-cité association, each year, the number of school dropouts fluctuates according to the number of territories that develop the Booster programme (20 territories for the 2018-2019 school year; 18 territories in 2017-2018). For 2018-19, the programme includes 400 young people, including 200 minors.

Challenges & Bottlenecks

The programme costs money and cannot be financed by private funds because civic service missions associated with private funds are evaluated by funders who request quantified targets. To develop the booster programme more broadly, new funds will have to be found. At the local level, some interesting projects cannot be carried out because they require too much funding. At the same time, national education has a different culture from the Unis-cité association, if the partners on both sides are not sufficiently involved, and do not discuss among themselves, the support to young minors can quickly become inefficient. Obstacles linked to changes in partners, particularly on the national education side, with differences in the priority of the successors, can deconstruct dynamics on this type of programme. There also barriers related to the lack of tenacity of young dropouts. Getting involved in 8 months of civic service can be very long for a young dropout. In addition, apart from civic service missions, young people must also prepare their professional project, adapt themselves to their working team, and for some of them, fight their school phobias. Adapting to an audience of young dropouts is also a challenge for the Unis-cité teams because coordinators must have the profile to carry out this mission. Other challenges related to the successful implementation of the project are related to the lack of flexibility in public education and the difficulty of finding partners for civic service missions.

Transferability & Replicability

This project can be transferred to other communities. The ambition of the Unis-cités association would be to try to deploy at least one Booster programme in each national education academy. As soon as Unis-cité has access to an academy, this partnership gives access to several territories.

Success Factors

The method developed by this network of actors seems to be a major innovation in the field of early school dropout. The innovation concerns first of all the reverse method compared to the traditional methods previously proposed by the national education system or by integration organisations (academic upgrading, internships in companies, training). In the context of civic service, it is not the young person who is helped but the young person who will help others, which leads to a boost in the young person’s self-confidence. The impact is twofold: they engage in society and as a result, they help themselves. The coordination of actors is essential for the success of the programme. This requires an understanding of both the educational environment and popular education. While the two actors were initially able to operate as two parallel entities, it quickly became clear that coordination is essential for the Booster programme to be optimal. The territorial differences played an important role for the success of the project. The local offices offer quite different solutions depending on the context. The respondents pointed out that there is a great difference between rural and urban areas. In general, there are few solutions for young minors who drop out in rural areas, while solutions are often more numerous in urban areas.

Lessons learned

In the Booster programme, young people have 2 days of courses. One might think that the teaching method adopted was not only based on purely academic learning, but also on experimentation (personalised rhythm and social exchanges). However, practice shows that young people who agree to enter the Booster programme do not want to be differentiated in learning methods. They feel able to learn “like others” even if they have experienced failures with this method in their personal life. Another unexpected result concerns the themes of civic service missions offered to young dropouts. It appears that sustainable development missions are not generally appreciated by young dropouts. The reason could be that young dropouts are looking for direct solidarity missions, face-to-face with the beneficiary, as in the case of the restos du cœur. The missions relating to sustainable development have a concrete dimension, but solidarity is indirect, the beneficiaries are potentially all people, and also concerns future generations. Dropouts may not have the necessary distance to realise this.  

Stakeholders & Beneficiaries

The value creation of the MAIA method is first to improve the efficiency of the elderly pathway and the well-being of users (by improving the quality of care, the accessibility to services). The value creation is also directed towards professionals (as users of the MAIA office) and user’s family as it seeks to avoid the bad quality of answers given to the user’s family, to caregivers and health professionals. The MAIA method also create value via the professional dynamics generated through the harmonization and standardization of professional practices (by working on shared common tools, sharing knowledge, implementing protocols as a means to improve quality and equity). Partnership value is created over time by the mobilization of professionals, the pilot, and the case manager (identification of new resource persons). This dynamic should improve the service system (by identifying missing services, to avoid service disruption and wrong orientations, creating co-responsibility, by adjusting the offer to the needs). Finally, at an economic scale, it concerns citizens as taxpayers, the reduction of non-quality costs should reduce the amount of taxes.

Co-creation process

If the MAIA method is originally top-down, the deployment is left to the initiative of the MAIA pilot: this approach requires a bottom up process because the priorities and drivers of actions, which enable this method to be implemented, must emerge from the partners themselves. The MAIA system requires the commitment and the co-empowerment of stakeholders of the health, medico-social and social sectors. However, this co-empowerment is not spontaneously developed, especially in the context of instability of the ARS teams. In the MAIA system, the value is created by the whole set of professional partners who participate to the working groups to create common communication tools (e.g. orientation forms), who also try to articulate and adjust the existing committees with the tactical table. For example, the development of an integrated, one-stop service, can only be done with the partners (meetings, training). The value is created by all the stakeholders. They create the final value for the benefit of the user (through training, tool sharing, but also by transmitting information about dysfunctions of the system or transferring information about elderly people in precarious situation). They also use the MAIA framework themselves to find contacts and to orient patients towards case managers.

Digital Transformation Process

The MAIA method is more a social innovation, rather than digital transformation, which seeks to transform the health system by implementing new forms of organization of collective work.   Nevertheless, it implies a digital innovation related to MAIA’s three communication tools. (a) A shared Multidimensional Analysis Form (used by professionals from the one-step services) and the multidimensional assessment tool (used by case managers). (b) The Individualized Service Plan (PSI). It is a case management tool used to define and to plan in a consistent manner all the interventions provided to the elderly in a complex situation. (c) Shared information systems (it gathers information from the one-stop service, from the MAIA pilot, and from the case managers …). It requires the development of a common shared information system and action-steering tools, to create a directory database to identify local resources, and to be able to create the integrated, one-stop service.

Results, Outcomes & Impacts

One of the main value creations of the MAIA method is the improvement of the accessibility to services by providing an adapted answer to a problem. The aim is to avoid the bad quality of answers given to users, user’s family and caregivers. Thus, monitoring indicators have been developed and used during the implementation stage of the MAIA method especially to assess the number of contacts a senior must have established to access to the right resource. The result is that the integration of orientation counters into a one-step services simplifies people’s pathway and substantially reduce the number of contacts. At the local level, the impact in terms of organization is measured in different ways, such as the participation rate of partners at the tactical table, or the territorial distribution of seniors being managed for the case management. Regarding the participation rate of partners, the results indicate 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.

Challenges & Bottlenecks

Before the denomination of “Method of action for the integration of healthcare and support services in the field of autonomy”, the acronym MAIA was used for “House for autonomy and integration of Alzheimer disease”. The use of the first denomination of « MAIA » as a « House » resulted in a misunderstanding of the method.   Beyond the misunderstanding of the denomination, the notion of integration is not well understood by a lot of actors. Actors are often seeking for interstitial measures, such as accommodation solution after hospitalization, Psychogeriatric mobile team, night nurse, etc. But these interstitial measures are clinical solutions instead of an integration system. Moreover, the MAIA method needs time to be implemented, because trust and relationships between actors take time to appear. Another barrier comes from the competition between the MAIA project and other national projects from which objectives are close to the MAIA method. On the top of that, there is a problem with the choice of the territory. The MAIA pilot must first choose the geographical territory that will be affected by the method and within which professionals will be contacted. This choice is important because it has to correspond to Regional Health Authorities, which are coordinating the project. The result of the experimental phase showed that the private actor as a holder of the project is not appropriate because it could lead to conflict of interest. It also poses a problem of data confidentiality.  

Transferability & Replicability

The MAIA method is transferable. MAIAs were tested on 17 sites in France to refine tools, work procedures, and training content for case managers. Following this experiment, the method was extended on the French territory. Currently, the MAIA method is a public policy institutionalized in the Family and social action code.  

Success Factors

The MAIA method as social innovation led to a methodological and organizational method: The MAIA project is a working method disseminated all over the territory so that the healthcare, social and medico-social actors of local territories work better collectively. Therefore, it leads to organizational local innovation: various stakeholders innovate together in order to find corrective measures to organizational dysfunctions observed on the local territory. This method promotes the mutual adjustment of each other actor’s missions. Otherwise, the actors may ignore each other by lack of legibility of the system, or may feel in competition with each other.  

Lessons learned

A partially unexpected result is about the role of private partners and the data privacy issue raised by the concept of integration. The integration process implies the participation of private partners. The private partners could be the holder of the MAIA project. During the experimental phase, the “Private holder” management did not work for reasons of conflict of interest, which results in a problem of credibility of the (private) holder. The other professionals of the territory do not accept the holder and its practices. This lack of credibility is compounded with the problem of confidentiality of patient data. The private holder may use this data to charge services or may not protect these data enough.

Stakeholders & Beneficiaries

Library Living Lab was incepted as a good example of inter-institutional collaboration with all relevant stakeholders making up the “quadruple helix”: the City of Sant Cugat del Vallés, the Provincial Council of Barcelona, the Autonomous University of Barcelona, the Computer Visión Center (CVC) and the Association of Neighbours of Vollpellieres. Some support from the powerful industrial base surrounding the area was also acknowledged. The beneficiaries are the library users, who have spanned thanks to the different pioneering and activities delivered (let alone the rise of new “communities of knowledge” that have been built thanks to the library).

Co-creation process

Users are fully involved in co-producing and co-innovation and decisions are taken along with the project director. Notwithstanding this, co-creation is not based upon “open participatory processes”.   A co-creative strategy was rolled out based on the definition of different user profiles. Thus, users have been classified according to the degree of involvement (and accordingly, co-creative potential):
  • Alpha users.
  • Beta users.
  • Gamma users.
  • Delta users
Alpha users the most motivated/engaged users and delta users the lowest.

Digital Transformation Process

This case study is not about a digital transformation process

Results, Outcomes & Impacts

Development of robust metrics to measure performance is a pending (and crucial) issue in the Library Living Lab. Nevertheless, a protocol has been set up to define actions, as all projects and activities are shaped according to a triplet of (Social) challenge- Action-Return. This approach based on three different stages is aligned with the main pillars described in the Responsible Research and Innovation approach (European Commission, 2016), which is used to tackle dimensions such as awareness, transparency, and openness. Notwithstanding this, some projects have been monitored and followed up in a more ad hoc and closer way and some KPIs rolled up accordingly. Unfortunately, possible lessons learnt have not been capitalised to be somehow “plugged & played” to other projects.

Challenges & Bottlenecks

The definition of the governance & sustainability model has proceeded at a low pace, and it has been very recently when the model has been consolidated with the hiring of a Living Lab manager, who was considered to be an imperative need from the beginning. The consideration of the Library Living Lab as an example of a multi-layer institutional collaborative project implied a tremendous effort of alignment to set up a common language to be shared across all institutions by fixing terminology and procedures, defining new fields of common knowledge, understanding what was and what was not allowed in the public space, etc. Something which is still in the pipeline is the idea of a “living lab as a service” implying the design of a “service portfolio” to be offered to different stakeholders. This is a (still lacking) and relevant step that could help jump the lab to a higher status in the future, as well as ensure a lab self-sustainability path over the coming years. Finally, some cultural barriers may still exist (e.g. library assistants, once in the library, may realize that some required tasks are not sufficiently known or expected, and some kind of reluctancy may arise).

Transferability & Replicability

One of the inspiring figures of L3 was the former Mayor of Sant Cugat, who eventually became the President of the Provincial Council of Barcelona. As President of the Provincial Council, she supported a new project, called BibloLab. BiblioLab entailed the commitment to spread the experience of the L3 to the whole network of libraries located in the Province of Barcelona, that is to say, 250 libraries. This new shift allowed working on a new model where the library becomes a space of interaction amongst communities around.

Success Factors

The Library Living Lab has enabled the achievement of a new range of experiences offered, thus opening the library up to other types of the library users, who probably otherwise would not visit it, and increasing the possibility of user participation in joint projects with rich profiles. The concept of “community of interest” or “community of knowledge” is something which is behind the library success, as it has become a rather creative space where something new or not previously planned can happen as a result of a collaborative work ensemble. One major contribution of L3 is that decision making processes are fully open, and library users (along with other stakeholders) are engaged in such dynamics. This is a distinctive and differential aspect of the Library Living Lab when succeed in building up and consolidating communities. In fact, user co-creation practices started at very early stages, when they were required to identify communities of practice in order to build and scale projects around.

Lessons learned

Technology is considered to play a relevant role around this initiative, but as an enabling factor. In fact,  L3 is about people and around the mechanisms governing individuals and inter-institutional collaboration. The society may obtain transformative socio-economic impact from the innovations arising from the collaborative processes only when people are truly engaged (i.e, users and other stakeholders). As a result of this initiative, the libraries are no longer considered “book repositories”, but “meeting points of knowledge exchange”. The motto of these libraries is the same: “create, explore, innovate”. To sum up, the main contribution of the Library Living Lab is the push towards a systemic change and as such, it can be deemed as a rather pioneering initiative.  

Stakeholders & Beneficiaries

Citizens from towns of less than 20,000 inhabitants (10,000 inhabitants in the initial phase) and neighbourhoods located in the most under-populated and disadvantaged areas of Andalusia. As such, Guadalinfo was born to foster social cohesion and regional development by minimising both the urban-rural divide and the emergence of exclusion in processes of innovation.  The project is organised as a massive network with a strong degree of capillarity.

Co-creation process

Three different levels of co-creation can be emphasised: – Low co-creative content. Activities of this kind have to do with eAdministration procedures. Thus, in this level the basic aim of citizens when accessing a Guadalinfo centre is to be engaged in eAdministration procedures as users and being provided guidance on how to proceed with it. Co-creation in this case is almost negligible as the activity (and the outcome) is known and pre-defined – Medium co-creative content, where a training action is usually the “spark” to unleash co-creation practices. Good examples are those training actions of high technological & hands-on nature (e.g. robotics, 3D printing) where users co-create and co-innovate along with the local innovation agents and the other users. -High co-creative content. Here co-creation goes a step further, arising long-standing projects that were born or “incubated” in the living lab thanks to social innovation and collective intelligence. Usually co-design & co-production “shake hands”.

Digital Transformation Process

Guadalinfo was initially set up to close digital gaps and break down several barriers (i.e., technological, skills, etc.) and the centres were led by what was called an animator, in charge of bringing ICTs closer to people so as to ensure universal digital literacy.  Notwithstanding this, it greatly evolved from a digital literacy-based network to a powerful tool spurring social innovation and citizens´ empowerment, thus unleashing fruitful processes of co-creation.

Results, Outcomes & Impacts

Quantitative and qualitative assessment of Guadalinfo policies was set up through a scoreboard of indicators In the Guadalinfo living lab themselves, an online internal monitoring tool has been used since the beginning of the initiative in 2004 and provides results indicators for every Guadalinfo centre, updated every month.   Furthermore, the Second Strategic Plan (2016-2020) contained a very robust monitoring and evaluation system that is organised under periodic reports (quarterly, biannual and annual). The reports include a portfolio of indicators measuring the degree of completion of every action. A particular action of the Second Strategic Plan (n. 2.2.3) is called “Living Lab” and is targeted at “boosting social innovation through cooperation, collaboration and citizenry participation in order to take up projects and initiatives”. Two specific outcome indicators, namely, “number of projects taken up”, and “level of satisfaction of users” have been designed to measure the real impact. Finally, within the realm of some specific projects, results indicators are aligned to some macro indicators coming from external sources to determine the real impact of the measure.

Challenges & Bottlenecks

In the past, a major challenge was to how to effectively turn into a powerful social innovation tool, as Guadalinfo has been traditionally associated to a tool aimed at providing digital literacy. Currently the major challenge is how to cope with such different needs and expectation from the citizens ‘side. Guadalinfo is a pervasive network of living labs and a great deal of coordination is a priority. Local innovation agents need to be properly skilled to meaningfully interpret and provide useful responses, giving rise to different co-creation layers.

Transferability & Replicability

Guadalinfo is a showcase of replicability, as the project is organised as a massive network with a strong degree of capillarity. As such, about 770 centres are operating throughout Andalusia. Guadalinfo network is mostly funded by Andalusia Regional Government (Junta de Andalucía), which provides 66.66% of total funds, whereas the eight Provincial Councils (Diputaciones Provinciales) provide the remaining 33.34%. As a conclusion, the network is 100% public owned, and it is managed by the Fernando de los Ríos Consortium (Consorcio Fernando de los Ríos), which in turn is owned by the Andalusia Regional Government (50%) and the eight Provincial Councils (the remaining 50%). The Consortium provides strategic support and guidance, network capabilities, technical equipment, training, projects and innovation.

Success Factors

Guadalinfo is perceived as an element of trust and confidence for Andalusian population. The presence of Guadalinfo is pervasive in Andalusia, in such a way that whatever ICT-project involving public bodies you may think of, Guadalinfo will be somehow engaged.   Local innovation agents play a crucial role in the effective and successful implementation of Guadalinfo activities and vision. Local innovation actors are the main drivers of co-creation, and three specific skills have been identified as especially relevant to unleash co-creation potential, namely:
  • Versatility: as the local innovation agent is trained in whatever digital competence is considered necessary (having the European competence framework as a backdrop), versatility seems paramount
  • Pedagogic skills: these are especially necessary to create the atmosphere of trust and reliability “made in Guadalinfo”.
  • Soft skills (e.g. self-confidence, active listening, problem-solving, etc).

Lessons learned

The importance of trust and reliability to explain Guadalinfo success. Guadalinfo has been able to become a relevant social innovation platform in such a way that a sound alignment between supply (Guadalinfo centres) and demand (users and citizens) does exist. By doing so, Guadalinfo is: a) Increasing regional innovation and entrepreneurship potential of all Andalusians; b) Having a knock-on effect for the economy and growth in Andalusia, especially in rural areas and depressed areas; c) Promoting local and regional culture so as to reinforce local identity, having a further positive impact on the wellbeing and the quality of life of the Andalusian population as a whole.  

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

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.