Stakeholders & Beneficiaries

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

Co-creation process

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

Digital Transformation Process

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

    Results, Outcomes & Impacts

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

    Challenges & Bottlenecks

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

    Transferability & Replicability

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

    Success Factors

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

    Lessons learned

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

    Stakeholders & Beneficiaries

    The main target of the programme is Roma community. An experiment has been carried out in Paris and Toulouse.

    Co-creation process

    The Melting Potes network gathered numerous partners: – the Unis-cité association, and in particular the Toulouse office (as architect of the project) – the Civic Service Agency is a Public Interest Group under the supervision of the Ministry of National Education. – the Di-Air (Inter-ministerial Delegation for the Reception and Integration of Refugees), which is the structures in charge of refugees in temporary accommodation centre), CHU (University Hospital Centre), CADA (Centre for Asylum Seekers). – the National education, in particular the Academic Centre for the education of newly arrived allophone pupils and children from itinerant families and travellers). The teachers of FLE who are involved in the Unis-cité programme. Schools in which allophone families will register their children. Schools for French as a Foreign Language. -The platform “health-precariousness” of the city of Toulouse, which is a platform gathering all the actors of precariousness (health, housing, professional integration). -The regional and departmental directorate for youth, sports and social cohesion), in charge of managing long-term programmes on territorial level. -Other partners are also part of this innovation network, health professionals, for example school medicine, volunteers of the Médecin du Monde association and associations dedicated to refugees. -Funders: Unis-cité private national funders, the Civic Service Agency, the National Education, local funders (local authorities, etc.).

    Digital Transformation Process

    This case study is not about a digital transformation process, but it’s a social innovation. Social innovation refers to the target of the programme, the search for diversity and cultural mix  and the community support.  

    Results, Outcomes & Impacts

    It is difficult to measure some of the integration process, but the integration of refugees or Roma through the community support is effective. A snowball effect is noticed from the moment a child of a community is sent to school thanks to the actions of the community support. Even if the impact is difficult to estimate, an increase in social cohesion due to the reduction of prejudices among young people in civic service, the sensitization of young people by the Melting Potes group and the sensitization of the families of young volunteers has been noted.

    Challenges & Bottlenecks

    The main challenges that the programme faced during its implementation was related first of all to human obstacles. Roma are often confused with Travellers, which gives the image of people who would not want to settle on the territory. In addition, young Roma or some refugees are subjected to discrimination when they want to open a current account to undertake their civic service. Another obstacle relates to differences in equal treatment depending on the territory.  The new law regarding refugees is still very recent, it has emerged that the Civic Service Agency does not give the same answers on the admission of refugees into civic service according to the territorial offices.   Financial barriers are important for the Melting Potes programme, especially in its Roma Melting Potes version. Indeed, large private companies and local authorities are reluctant to put a large amount of money into helping Roma communities, even if they would like to. Companies do not want to associate their image with that of the Roma, and communities are concerned about the return of voters who may blame them for this initiative. There are also logistical challenges. Melting Potes volunteers are forced to undertake missions corresponding to office hours (9am-5pm) and not on Saturday. This temporality limits the missions. Another potential obstacle for the next year group is the recruitment of refugees.

    Transferability & Replicability

    The ambition of the Unis-cité association, hosting this innovation network, is to develop this programme throughout the country. Unis-cité has just obtained a partnership with the DI-Air (Inter-ministerial Delegation for the Reception and Integration of Refugees) to increase the number of refugees welcomed throughout France. This method is now being spread to other associations willing to invest in this type of programme.  

    Success Factors

    Among success factors, a key role has been played by the city of Toulouse and the amendment of the 2010 law. To be more specific, the city of Toulouse has carried out with the Interministerial Delegation for Housing and Access to Housing (DIHAL) an ambitious and intelligent territorial strategy for the reduction of slums. Since 2012, the DIHAL has been monitoring the dismantling of illegal camps in the territories and has provided financial support for partnership initiatives to reduce the number of slums. A total of 329 people (115 of them minors) were rehoused, including 298 in the City’s insertion and accommodation system. The operation was carried out under good conditions and in partnerships with the services of the prefecture, the town hall of Toulouse, the Departmental Directorate of Social Cohesion, the Central Directorate of Public Security, the municipal police and social workers from the Soliha and France Horizon associations, and the French Red Cross. The successful running of these operations and pre-existing partnerships in the territory have helped to facilitate the development of the Melting Potes programme.   Second, the amendment of the Civic Service Act has allowed beneficiaries of international protection, and some other refugees, to access civic service.

    Lessons learned

    The hosting structures were initially difficult to convince, on the one hand because the association did not have any concrete results to present on this programme, and on the other hand because the programme had to be set up over a very short period of time. As a result, the local coordinator began by offering this program to Unis-cités’ historical partners (Emmaüs, Les restos du cœur, la banque alimentaire). When the programme was presented, some associations were reluctant to welcome young people from the Roma community, explaining the difficulties they might have in communicating with this community. Paradoxically, solving these types of communication difficulties is the purpose of the programme. The aim is to resolve the difficulties of understanding which exist between the French community and the Roma community or the families of refugees. From the third year group of Melting Potes, the trend was reversed, i.e. a large number of associations and organisations came forward to ask for Melting Potes civic service volunteers. More generally, this case study revealed the importance in the case of social innovation of disseminating innovation and sharing good practices between associations.

    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 main beneficiaries are the ten authorized territories for the testing phase. These territories are the following ones: Pipriac and Saint-Ganton (Ille-et-Vilaine), Mauléon (Deux-Sèvres), Thiers (Puy-de-Dôme), Jouques (Bouches-du-Rhône), Villeurbanne, Saint-Jean Disctrict (Rhône ), the Community of Commons (between Nièvres and Forests) (Nièvre), Paris 13th, the Community of communes Pays de Colombey and South Toulon (Meurthe-et-Moselle), the European Metropolis of Lille (North) and Colombelles (Calvados). This experiment targets the long-term unemployed, who have been deprived of jobs or employees who have been in a reduced activity for more than one year. The eligibility criteria are i) to be unemployed for more than one year and ii) to be domiciled in the selected territory for at least 6 months. Around 1,000 to 2,000 people for the whole set of territories are expected to benefit. This national project, and the corresponding local experiments, is carried out by a network of public and associative actors (such as regional and local authorities, the National Employment Agency (Pôle emploi); associations fighting unemployment and exclusion, Social and Solidarity Economy companies. In each of the authorized territories, a local steering committee is created. The committee includes the local authority concerned, a representative of the State, the National Employment Agency, employers’ and employees’ unions, ordinary companies and the person who will set up the company that aims to create employment, associations whose purpose is to combat unemployment and reduce social exclusions, and all representatives of the persons concerned by the project.

    Co-creation process

    This project comes from the associative world, the innovation process is bottom-up. The first experiment (1995) could not be completed because of legal rigidities. Thus, the members of this Bottom-up project had to find other associative partners to give credibility to the project, as well as the support of a parliamentarian so that the project could be validated by the government on a national level, and be launched. Therefore, at this stage, the innovation network moved to a top-down approach. Therefore, it is a nice process of co-creation of public services by the government at different levels and by a network of associations. The TZCLD project includes the creation of Job-Oriented Companies, which objective is to provide long-term unemployed with jobs that meet their personal projects as well as the unsatisfied needs of the territory. The management mode of these companies is based on horizontality and transversality functions and participatory work. The management of the activity is done collectively, employees establish their working conditions. Jobseekers are project leaders. Every day, people innovate about how to work together.

    Digital Transformation Process

    The main innovation is a conceptual and social innovation, rather than digital transformation. This project applies to long-term unemployment, on a given territory, a business model already used to enable disabled people to work. This methodological innovation leads to organizational innovations (the creation of a job-oriented company); an innovative financial mechanism (the reallocation of unemployment-related expenses and costs to enable employment); and informational innovations (development of communication tools, management tools…).

    Results, Outcomes & Impacts

    Many (human, societal and economic) benefits derived from the TZCLD experiment. These expected benefits can be split according to the type of beneficiary: – For the long-term unemployed, the benefit is gaining a “right to work”, in order to get out from exclusion. The experiment is still ongoing but the first observations indicate that the beneficiaries of the Hauts-de-France experiment have been reintegrated into society, at least at the civic level and through social ties. – For local economic actors, the benefit is to have access to a potentially available workforce, This workforce accepts to do useful works that is not completely solvent on the market place. – For the territory, the main interest of a JOC is to recreate territorial social links.  As the local labor is locally prepared, this makes it possible to locate or relocate productions or services on the territory. – For the economy of the country: On the economic level, JOCs contribute to taxes and social contributions, they create value. Permanent job creations boost purchasing power. It also reduce social problem issues such as health problems, school dropouts, etc).

    Challenges & Bottlenecks

    At the national level, the project met barriers from the financial administration which was reluctant to have to advance public funds without being assured of the success of the experiment. It was also necessary to convince the government and members of Parliament of the non-destruction of employment. It has been decided to create local committees to ensure this non-competition. This fear of competition has slowed down the start of this project. At the local level, the barriers may be human, financial technical and territory-related. As for the challenges, one of the main is that jobs created must not compete with existing jobs. Also, when this experiment will be over, if the process continues, all partners/organisations who are currently concerned by indirect costs (such as social security) will have to pay the corresponding amount of money. Currently, the cost is covered by the territorial Fund. In each local experiment, researchers are currently working on indicators that will have to establish the social prevention that has been carried out on the territory thanks to this experience.

    Transferability & Replicability

    Given the difficulties related to territories, this project could be extended to other interested communities but not generalised to all territories. Sometimes, local authorities are not enthusiastic to create activities from grassroots contributions, they may be afraid of losing their authority. Thus, the success of the project depends on the involvement of the territorial stakeholders. The project can only work on the logic of volunteering. Such a system cannot be established by the government without the approval of the unemployed. This means that generalisation across the country will not be possible.

    Success Factors

    As the project is in the inception phase, it is not yet possible to evaluate its success. However, a large number of jobs have already been created. The number of contractual workforces from January 2017 to June 2018 in the 10 territories included in the project has increased from 33 to 564 people.

    Lessons learned

    The lessons learned so far will focus on the weight of the state regulation in this social issue, on the importance of building the project on existing links on local territories, on the nature of the jobs created by the JOC, and finally on the importance of the choice of the territory. The first lesson learned is that social innovation including national social issues are impossible to implement solely with a bottom-up process. This type of project as TZCLD can only be achieved with the intervention of the government in terms of regulation. Another important lesson is related to the importance of existing territorial networks to implement the project. The network of partners at the local level may be different from the national network of partners. First, because national partners do not always have local branches on the authorized territories, while partners must belong to the territory to take advantage of existing social links, and to favour the creation of links with other partners at the local level. When it comes to the nature of activities created by the JOCs, it is necessary to clearly identify the role of each stakeholder of a TZCLD territory to send the long-term unemployed to the most appropriate structure according to its degree of exclusion, in order to avoid the destruction of value. Finally, the nature and size of the chosen territory is an essential element for the success of the project. The local level creates social bonds that cannot be achieved at a macroeconomic level. The identification of needs, and of competing activities can also only be established on a very limited territory.

    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

  • Policy makers
  • Public health managers
  • Health professionals
  • Chronic Patients
  • Co-creation process

    The interaction between professional health providers and chronic patients is of great value in order to improve quality of life of patients and the evolution of their illness. At the same time, health policy makers and health managers affect this process with their understanding of the relationship between health providers and patients and their allocation of the scarce resources in the public health system.

    Digital Transformation Process

    This project is not about digital transformation process.

    Results, Outcomes & Impacts

    Value created in the provision of health services to chronic patients is much more than curing individuals. The main goal is to improve quality of life of the elderly taking into account both physical and mental capacities. Quoting one of our health managers, “it is about filling the years with life and not filling the life with years” Value is created in all stages  (co-design, co-production, co-construction and co-innovation) and by all stakeholders. In fact , the stage at which co-creation is more important mostly depends on the type of service. However, the most important interaction is that of public service staff and patients. Quoting another of our health managers, “about 70% of the quality of life of the elderly has to do with their lifestyles (diet and habits), which are much more important than genetics. Therefore it is very important that the elderly takes a leading role in the provision of public service provision through prevention, and through the patient empowerment”.

    Challenges & Bottlenecks

    Each stakeholder performs differently in the co-creation of value. Health policy makers allocate the resources and decide which services are the priority for their health policies. Their interaction and communication with health managers but also with the society in general will make them more sensitive to their needs. Chronic patients find that the Community is not engaged with them, and in a sense, they feel a bit abandoned. This is important as the Community may affect the direction of health policies. There is room for increasing the importance of the role of patients in the provision of health services. Even if in the last decades, there has been a continuous process of taking more and more into account the patient, in what has been named as a patient centred health system, they still feel that they are not sufficiently asked about their needs and levels of satisfaction.

    Transferability & Replicability

    Even if this case study was performed with a special focus on Parkinson patients, with the collaboration of Asociación Parkinson Madrid (an association of Parkinson patients in Madrid), most of the lessons are applicable, with limitations, to the co-creation of value in the interaction of the different stakeholders in the organisation and provision of care for patients with other chronic conditions.

    Success Factors

    The interaction between health professionals, providing health services and patients is a success in the creation of value, which is not only to cure patients (many times unfeasible solution for chronic conditions) but to improve the quality of life of patients. They, through a better engagement in the process of health provision, may understand better their condition and improve their quality of life through their lifestyle and habits, delaying the progression of the disease.

    Lessons learned

    The interaction of the different stakeholders is key in all stages, from realizing the need of a change or innovation to the design of the service provision, or to the actual production and construction of the health service provision. The clearest interaction is that of health professionals with chronic patients. However, health policy makers and the Community, are somewhat disengaged with the real needs of patients.    

    Stakeholders & Beneficiaries

    The main goal of INTRAS Foundation is thus helping people suffering from mental illness and cognitive impairment restore their life project through the delivery of an integral circuit of care resources and services and the deployment of different R&D&I activities. This integral circuit of care resources involves: a) prevention/intervention/rehabilitation; b) monitoring & evaluation; c) education & training; d) self-management & empowerment; e) fight against stigma; f) labour integration; g) management and coordination.

    Co-creation process

    Even though the activity is focused on people suffering from mental illness and cognitive impairment, IDES provides help and “guidelines” in the living lab sessions, but final decisions are ultimately taken by patients so as to ensure that they live the life they wish, taking into account that users’ capabilities are rather different according to the degree of impairment, which obviously is conditioning the degree of involvement.   IDES vision advocates that the best ideas come from involving people, and without the insights gained through the lived experiences, policy makers and professionals run the risk of developing costly services that do not meet the needs of those who will be using them.   Notwithstanding this, co-creation as a concept has fairly evolved along with different key projects implemented so far at IDES. In fact, two different periods may be distinguished. Thus, a first period (2007-2014) is characterized by the creation of a new stakeholders´ ecosystem. In this first stage, user was fairly considered a tester. The second period, which started in 2014 and is still on-going, strongly advocates participatory design and user co-creation. Different projects implemented throughout the period have helped gear this major shift (e.g CAPTAIN or MinD). Period 2019-2028 is set to evolve through an encompassing community-based approach, where co-creation is not focused merely on users, but on citizens.

    Digital Transformation Process

    This case study is not about digital transformation

    Results, Outcomes & Impacts

    Outstanding effort is being devoted to come up with metrics aimed at measuring contribution of users in co-creation processes and experiences. IDES do provide evaluation of sessions in terms of, for example, usefulness or satisfaction, but they lack systemic/overall evaluation tools. Furthermore, evaluation is very much anchored on qualitative (subjective) indicators that do not provide robust evidence for comparison (i.e. levels of satisfaction and/or empowerment), whereas quantitative indicators are not usually considered because they are not easy to obtain as co-creation deal with perceptions and people interactions. ROI type of impact measurement would be also quite necessary in terms of accountability, thus providing evidence that projects do work, which eventually may imply higher attention by the public sector and better project funding. Notwithstanding this, some specific and pioneering assessment methodologies are being developed in the context of specific projects where IDES is engaged (e.g., CAPTAIN, where a new protocol of cost-effectiveness indicators is being created). Finally, it should be mentioned that users´ level of engagement (recurrence) is also considered a way of measuring performance by IDES projects. As such, if users are keeping on attending subsequent co-creation sessions, this is a clear sign of good performance.

    Challenges & Bottlenecks

    A major challenge is how effectively measure outcomes and impacts of IDES activity and how to gauge user co-creation according to the level of impairment. Furthermore, IDES living lab is at the centre of a vast ecosystem bridging healthcare service providers, research and technological centres, technology-based companies and users and the public sector, whereby a major challenge is how to arrange this ecosystem in a meaningful and useful way to achieve IDES goals. In that sense, IDES role as a “network/linking infrastructure” is paramount.  

    Transferability & Replicability

    This “user co-creation” based framework is is set to evolve through an encompassing community-based approach, where co-creation is not focused merely on users, but on citizens. As such, according to this scenario, co-creation is far from being a “niche” concept intended to be operated by users to become the centre of many citizenry-based settings. That is, it will imply using co-creation as the raison d’etre of providing participatory solutions where the citizen (and not the user) is the ultimate protagonist. As it may be noticed, this is to be a major shift at IDES activity in the future, since co-creation practices are meant to be somewhat different and the role of the different stakeholders would need to be accordingly adapted. In this sense, IDES is working on evolving the concept of living lab into “impact hubs” that will combine innovation deployment with the introduction of further levels of citizen´s participatory models to build upon the very concept of community (instead of “group”).

    Success Factors

    The motto of IDES is “nothing about us without us”. Involving users in a participatory process creates commitment, empowerment and appropriateness, thus making up a “convincing case”, a “service ambassador” and an incentive against sceptical people. Massive collaboration and participation are in the DNA of IDES, as “cross-fertilisation” is a major driver of success (i.e., more than 2,000 people of different nationalities do collaborate in different initiatives put forward by INTRAS-IDES). Heavy involvement in different projects (some of them European-based, such as CAPTAIN, MIND or PROCURA) has enabled the deployment of innovative and pioneering methodologies & technologies spurring co-creation.

    Lessons learned

    Co-creation unleashed by IDES Living Lab activity allows the achievement of higher levels of trust, self-empowerment, self-autonomy or perception of identity on the user side. Furthermore, public value is also created by improving social engagement (with other patients, staff, family and friends) and community building.  

    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

    The main stakeholders and beneficiaries include the ministries, the other circa 40 Danish Authorities including for example the tax and the working environment authorities, Danish and international businesses, the Confederation of Danish Industry.

    Co-creation process

    DBA has close cooperation with all its stakeholders including businesses and business organization. DBA has involved them, and still involves them directly or indirectly in all the phases of the digital transformation. Such co-creation activities take multiple forms including co-initiation, co-design, co-implementation, co-delivery, and co-assessment.

    Digital Transformation Process

    DBA’s digital transformation goes ten year back in time and started in 2009 due to old legacy IT systems that created several problems such as difficulties to implement IT changes to comply with the law changes, problems to meet customer demands concerning digitalisation and inefficient operations. The digital transformation has taken the starting point in both DBA’s customer needs and employees’ knowledge. In 5-6 years, DBA has transformed 14 different registration systems into one IT system. This has several advantages for DBA including digitalisation of data that can be used to improve service provision as well as a decreased amount of resources needed to perform the same tasks.

    Results, Outcomes & Impacts

    The results of DBA digital transformation is creation of public value in several forms: economic value, administrative value, democratic value, and citizen value. The democratic value include making life easier for businesses, making the customers happier, stronger companies’ control and potential increased societal wealth. The value for the business includes minimisation of the administrative burden, one stop shop, better services due to quality standards, personalised overview as well as transparency. The administrative value include business self-sufficiency and data sharing. The long-term impact of DBA’s digital transformation includes savings of citizen taxes on public administration tasks and decreased company fraud through increased control.

    Challenges & Bottlenecks

    In the implementation of the digital transformation, DBA has encountered a number of challenges including financial problems, organisational resistance, collaboration among different authorities, IT systems implementation priority, attitude change.

    Transferability & Replicability

    DBA’s digital transformation is a best practice example of efficient and effective digital transformation. For a period, DBA has organised in–house meetings during which people from all over Europe came to hear about their digitalisation journey.  It is expected that such digital transformation could be replicated in other parts of the Danish 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 organisations located in other national contexts depends on the way public administration is organised in such contexts as well as the level of digitalisation of both businesses and society.

    Success Factors

    An important success factor is that the digital transformation supports The Danish Business Authority to reach its goals “to create predictable and responsible business conditions, in order to make it as easy as possible to run a business in Denmark”.

    Lessons learned

    Embarking and implementing digital transformations is not an easy task that implies many challenges. It requires strong and committed leadership to make them successful.

    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.