Stakeholders & Beneficiaries

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

Co-creation process

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

Digital Transformation Process

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

Results, Outcomes & Impacts

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

Challenges & Bottlenecks

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

Transferability & Replicability

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

Success Factors

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

Lessons learned

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

Stakeholders & Beneficiaries

The SIILAB was created by the DRJSCS and 15 other founders, from the social economy (association networks, social entrepreneurs networks, R&D institute for transfer of social innovations, a regional research and training chair), decentralised directorates from State services (social security, employment, housing, family allowances, environment, energy, social economy, statistics) and national public financial institutions. The Regional Directorate of Youth, Sports and Social Cohesion is the node of a larger network of public and private stakeholders that were used to work together but wished to improve their collaborative practices to create new solutions for digital and social inclusion. Beneficiaries are citizens that need social aids or at least inhabitants far from digital transformation of public services.

Co-creation process

The SIILAB charter sets out methods in order to «foster the emergence of territorial innovations (and) the evaluation of the impact of social innovations». The methodology follows 3 phases: 1) Co-design of public policies with users for their real needs ; 2) Prototyping and test of solutions; 3) Project development with agile methods. Specific tools inspired from design methodologies are used, such as «Lego games» as Icebreaker between people who come from diverse institutions with different professional mindsets. Other tools and co-creative methods are powered by the DITP (a governmental service for the transformation of administrations). A small team of managers and limited-term employees are in charge of co-creative workshops in a dedicated room equipped with mobile tables, large screens and software often forbidden in the French administration. The SIILAB team is beta-tester for these software, creates fact sheets for users and diffuses innovations on social medias. The SIILAB is a space which favours interactions between administrations and their stakeholders, that allows the “right to fail” and a collaborative work based on agility and a non-hierarchical organisation. Even if the stakeholders are first interested by the SIILAB to experiment new digital tools rather than creative methodologies, the Living Lab helps stakeholders to change their work habits to foster innovative projects.

Digital Transformation Process

The role of the SIILAB in the digital transformation is twofold: 1) exploring impacts of the administrative dematerialization on public agents and in particular on social workers in the region; 2) finding solutions for the digital inclusion of inhabitants whatever their social level and the territory where they live. Indeed, the national program Action 2022 aims at 100% administrative dematerialization in 2022 and at reducing the number of public officials: Internet has to become the main access to public services. But what will be the consequences in a region with a lot of inequalities? The SIILAB is a Living Lab for helping public agents with new digital practices, not only in the dematerialization of administrative requests but also to co-create new procedures beyond paper forms removal. Collaborative workshops were organised on the themes of end-users (digital vulnerability, reception in social centres), digital training of social workers or about authorised software (licences, security, hacking). To reduce the negative impacts of digital exclusion on fragile populations, the SIILAB designed and prototyped an interactive map of all social centres or other institutions than can help beneficiaries in their digital administrative requests. According to a Living Lab approach, a first inventory of local initiatives to improve the digital accessibility to public services was realised, by students of the university. A prototype of the map was invented in co-creative sessions, then tested on an “interactive table” in the SIILAB at Lille during the national «Week for Public Innovation» (2018). Accessible on the web, the interactive map constitutes a new public service against illectronism. An incremental updating of the map (800 places in 2018, 1500 places in June 2019) and user-returns about quality and accessibility are also a type of “evaluation in progress” of this new digital public service.

Results, Outcomes & Impacts

The SIILAB is a tool for administrations to experiment new digital tools and work practices without the logic of signature books and with less political control than usual. As a public innovation Lab, the Lab managers are authorised to test disruptive rules for public procurement, such as the purchase of small equipment on the Amazon website or the use of a credit card. Thanks to the Living Lab, public agents can test online meetings or the national digital platform called “demarches-simplifiees.fr” (simplified processes) that helps public officials to co-product e-administration. As a Lab dedicated to social economy, social innovation and public innovation, the SIILAB is used by more than 150 public or private actors in the region. For transforming the SIILAB into “a network of networks”, the aim is to enlarge the audience of the Living Lab thanks to a mailing list of 1600 addresses (in 2019) of associations, local communities, State administrations, or through more than 1000 followers on Twitter. This social network is also used by the Lab managers to bypass the usual hierarchical communication with the ministries and elected people. Examples of outcomes are: a digital kit to train social workers in digital inclusion practices (access to social rights with Internet); a video prototype to explain «domiciliation in Social Centres»; an interactive map of places for digital inclusion not far from home (training, help of social workers to guide users in e-administration). The map has three aims: 1) helping inhabitants in their digital requests; 2) showing inequalities between citizens according to the territories where they live; 3) encouraging public authorities for improving the geographical diffusion of resource centres for e-administration.

Challenges & Bottlenecks

The SIILAB is a Public Innovation Lab managed by a State institution, the DRJSCS, under the authority of the Préfet (representative of the State authority in the regions). Even if a national call for project is a lever for public innovations, the change in administrative routines and the hierarchical top-down decisional process are real challenges. Another challenge linked to the call for project as a tool for public innovation is the short-term funding, too short to co-create with users and to prototype innovations. So, there is a gap between political discourses about co-creation and Living Labs (that need funds) and the national incentive for reducing public expenditure. According to the SIILAB experiments, a second bottleneck in transforming administrations is the digital process in itself. Cost, skills and data security can be barriers for the use of software in co-creative sessions with any public agent engaged in the digital transformation. And co-creation is not a priority when the digital transformation in public services implies more work to implement new software, new design and new rules (once only, easy to read and understand, etc.). Another barrier to the efficiency of Public Innovations Labs is that projects are based on partnership, too often based on engaged people but who could leave the experiment following changes in their careers.

Transferability & Replicability

The diffusion of the SIILAB experimentations is made by online social networks or through events “in the real world”, in the region or in France. From 2016, the SIILAB projected the scaling up of innovations at the regional scale, at the trans-border scale with Belgium and at a national scale through social economy networks. At a regional scale, the mapping of digital resource centres is a way of replicability in more and more local communities. At a national scale, other public innovations labs or social innovators come to visit the SIILAB in Lille in order to transfer some experiments. But considering the short time funding of the Living Lab, the uncertain future of the SIILAB makes it difficult to imagine the diffusion phase. Moreover, as a public innovation Lab created for the Hauts-de-France region, the SIILAB has no administrative authority to diffuse new public actions in other regions in France. These regions could just try to imitate the SIILAB, but probably in the limited framework of a call of project. A way to get around this obstacle was the participation of the SIILAB to the creation of a «Connected France Hub», a regional hub of public and private actors for digital inclusion (national call for projects from the “Bank of the Territories”). Linked to the national incentive for creating Living Labs in the public services, replicability of Public Innovation Labs as tools for administrative transformation goes also through a MOOC developed with the Sorbonne University in Paris to explain how to create a Public Innovation Lab.

Success Factors

For the government that launched projects for transformation of public action, the criteria of success are: cost-savings in public expenditure, a better quality of public services for users, a better work environment for public agents, an innovative digital project, the quality of governance. For the SIILAB, additional success factors are: an increased organisational performance, the learning of collaborative practices, a better implementation of public policies, new services for vulnerable people (poor, elderly, undergraduate, immigrants…). Moreover, SIILAB managers consider as a success the visibility of the social innovations by the Préfet (representative of the State in the regions) and by the government in Paris. Success criteria of the SIILAB were measured in 2019: more than 150 stakeholders; more than 3050 persons participated in 310 workshops or events (more than 200 participants in November 2018); 50 projects launched; 1600 persons in the mailing list; more than 1000 followers on Twitter and around 25 000 views per month; national prices as indicators of recognition and efficiency (Télécoms Innovation 2018, Best innovative strategy 2018). But a success factor to achieve these success criteria was the SIILAB capacity to reinforce the previous habits of decentralised State services to work together, as well as with the public and private actors of the social economy, including associations, universities and local authorities.

Lessons learned

The role of the SIILAB, as a Public Innovation Lab supported by the French Government, is to experiment digital tools and co-creative methods, often inspired from service design. Public Innovation Labs are elements of a national policy that aims to restore the legitimacy of public action by responding to three objectives: a social issue (linked to digital change), a budgetary issue (cost-savings), a governance issue (Public, Private, People Partnership). The specificity of the SIILAB is focused on social innovation and digital inclusion in a region where a lot of vulnerable people are far from e-administration. Its governance (a committee for strategic decisions, a self-organised partnership for actions, a regional networking) is one model among others in Public Innovation Labs. Introducing the Living Lab methodologies in a bureaucratic organisation allows the “right to fail” and new relations between State administrations, local public agents and private stakeholders (no subsidies but funds for a collective project). But some bottlenecks appeared through the SIILAB or other Public Innovation Labs: 1) co-creation with intermediate-users (public agents, associations) and not final vulnerable users; 2) when an innovative practice becomes a norm, it is more difficult to quantify how it changes public action; 3) it is difficult to evaluate the costs avoided by co-creation; 4) a short-term funding (2 or 3 years) does not allow to test innovations and change practices; 5) the Anglo-saxon model of «impact measurement» does not allow to evaluate the collective value creation (Commons).

Stakeholders & Beneficiaries

The amount of stakeholders and beneficiaries of GovLab Arnsberg is small. The main stakeholder of GovLab Arnsberg is the regional president. As he initiated GovLab Arnsberg, he is particularly interested in its activities and success and offers the employees at GovLab Arnsberg continuous support. The other important stakeholder group within the administration of GovLab Arnsberg are the front-line employees that deliver the services. The employees of GovLab Arnsberg perceive them as experts and value the knowledge they incorporate into the co-creation process. Furthermore, to carry out their projects, the employees at GovLab Arnsberg collaborate with actors outside the regional administration. Those are civil society organizations, private firms and individual citizens. Those collaborations are vital for the success of GovLab Arnsberg’s projects. For example, one civil society association payed for a chatbot-software that was needed to develop a chatbot for the regional administration’s website. Besides the private firms and civil society organization, GovLab Arnsberg also tries to interact with living labs from private sector organizations to share knowledge and information, that enables the employees of GovLab Arnsberg to improve the processes of the living lab continuously.

Co-creation process

The co-creation process of GovLab Arnsberg consists of two parts: idea generation and idea development. The process of idea generation is designed in a bottom-up way, as public servants are invited to submit ideas. For example, they can contact the employees working at GovLab Arnsberg and describe processes that need to be re-designed. One respondent described, that they have received over 100 messages from public servants with ideas for processes that could be improved. Therefore, the process of idea generation is open, as every public servant can submit ideas. Besides the individual submission of project-ideas by public servants, the employees of GovLab Arnsberg also act proactively and look for processes or services that could be redesigned. The ideas submitted by the public servants or the GovLab employees themselves are turned into improvements through design-thinking workshops hosted by the employees of GovLab Arnsberg. The participants in these workshops are internal users, for example, frontline employees or external users that receive a service. The design-thinking process is split in two parts: in the first part, user research is conducted. The participants are asked to adopt a perspective of users to identify user needs and problems. From the information received, personas are developed that depict the needs of users. In the second part the participants create user journeys to analyse the process or service in question. From those user journeys a prototype is developed. The co-creation process is driven by the participants of the individual workshops. The role of the GovLab Arnsberg employees is to facilitate the workshops by moderating the discussions and providing resources.

Digital Transformation Process

In GovLab Arnsberg, the co-creation processes primarily aim at re-designing processes and services and the respondents did not mention that they are automatically digitized. However, the employees of GovLab Arnsberg are aware, that digitizing processes might help them to achieve the goals of being more efficient and effective. So, they opt for digital solutions when they can. For example, they developed a chatbot to improve the website of the regional administration. As one respondent described, the chatbot had several positive effects, as they enabled the administration to collect data on how users use the website and those additional data helped them to improve the website even more. However, those benefits of digitizing services and processes are small, as GovLab Arnsberg had, at the time of data collection, no plans to upscale the developed solutions to other agencies. Instead, the initial goal was to develop small-scale solutions that help to convince sceptics within the organization that GovLab Arnsberg can be valuable to the whole organization.

Results, Outcomes & Impacts

There are several results produced by GovLab Arnsberg. The first one are prototypes of re-designed processes and services. Those can be, for example, the chatbot that was described above. Besides the benefits of collecting data and improving the website as making it more user-friendly, the successful re-design of services and processes might also lead, in the long-term, to a change in the organizational culture. This is the case, because the employees of the regional administration changed their attitudes towards GovLab Arnsberg. In the beginning, they were skeptical and interest in the workshops offered by GovLab Arnsberg was low. This changed after the first projects of GovLab Arnsberg were successful. Besides a change in mindset of the frontline employees, also top-level employees changed their mindset about innovation practices in the regional administration. The change in mindset occurred, as GovLab Arnsberg demonstrated that developing (digital) solutions must not necessarily be costly but can be achieved with small changes in the administrative set up. However, the long-term impact of the initiation of GovLab Arnsberg cannot be assessed with the data collected, as GovLab Arnsberg was in an experimental stage at the time the data was collected. Instead of producing long-term solutions, they focused at experimenting with different methods.

Challenges & Bottlenecks

There are three main challenges of GovLab Arnsberg: legal challenges, the mindset of public servants as well as the skills of individual employees. The legal framework was a challenge for GovLab Arnsberg, as they limit the freedom and room for maneuver. For example, the implementation of the chatbot was hindered by the existing laws, as they could not use a cloud-based service which limited the amount of software to implement the chatbot. Furthermore, the laws limit the creativity at design-thinking workshops as the public servants were concerned to break laws when they were re-designing existing processes and services. Therefore, public servants are careful when thinking about the use of technology to implement new or re-designed services. The second challenge is the mindset of individual public servants. At the beginning, some public servants did not allow their employees to participate at design-thinking workshops as they did not see the advantages. This demonstrates that some public servants are risk-averse. The risk-aversion is also seen in the interpretation of the existing laws, described in the paragraph above. The third challenge is the skillset of the employees of the regional administration. Most of the employees receive extensive legal training in their education, so the main skill of public servants is to interpret laws. What is missing are skills to assess and evaluate technologies. This is problematic, as for the implementation of the prototypes developed within the design-thinking workshops the regional administration needs employees can implement those technologies at large scale.

Transferability & Replicability

As GovLab Arnsberg was only a year old at the time the data was collected, it was still in an experimental stage and scaling up the prototypes developed was not an initial goal. Therefore, there are only hints in the data on how the results of GovLab Arnsberg can be transferred to other contexts. However, the strategy of GovLab Arnsberg, that is to be successful on a small scale to convince sceptics and enhance the legitimacy of its actions might be also a strategy that works in other contexts, as the co-creation barriers described earlier are not unique and might be present (to varying extent) in other contexts.

Success Factors

There are three success factors that enabled GovLab Arnsberg to carry out their projects: political support, acting outside organizational hierarchies and provision of material resources. The political support GovLab Arnsberg has enables experimentation at GovLab Arnsberg. The regional president grants them the freedom to experiment with different ideas and make decisions independently. Furthermore, GovLab Arnsberg directly reports the progress to the regional president in regular meetings instead of writing reports. Furthermore, the regional president supports the activities of GovLab Arnsberg which legitimizes the projects of GovLab Arnsberg and makes them immune of criticism stemming from middle managers. The second success factor lies in the organizational arrangement GovLab Arnsberg is embedded in. Formally, GovLab Arnsberg is part of the IT department and from the budget of the IT departments the salaries of the employees are paid. However, the head of the IT department is not involved in the operational business and strategic alignment of GovLab Arnsberg. This leads to faster decision-making processes and contributes independence of GovLab Arnsberg, that is also stemming from the political support. The third success factor is the equipment that enables GovLab Arnsberg to carry out design-thinking workshops. Here, the goal was to provide a room that is visually and physically different from the other offices of the regional administration. For example, the employees bought furniture from Ikea instead of using the official procurement system. This influences the overall atmosphere of the lab and stimulated creative thinking.

Lessons learned

From this case study, it becomes evident, that political support is crucial for the labs survival and success. Without the top-level support, GovLab Arnsberg would not have been able to carry out its activities independently. Furthermore, the top-level support enhances the legitimacy of the lab within the regional administration. This freedom is reflected also in the organizational set-up that grants the GovLab freedom from the rigid hierarchical structure that slows down decision-making processes. In addition, the analysis of GovLab Arnsberg has shown that most of the barriers that inhibit the co-creation processes within an administration are deeply ingrained in the regional administration. The organizational culture as well as the mindset and skills of individual employees challenged the co-creation activities of GovLab Arnsberg. However, the analysis has also shown, that those barriers can be overcome, if the initial projects are carried out successfully.

Stakeholders & Beneficiaries

Stakeholders include:
  • Consejería de Educación, Formación y Empleo (the Department of Education, Training and Employment)
  • The unions (UGT, CCOO)
  • The regional association of enterprises (FER)
  • Other relevant social stakeholders in the region (Asociación Promotora de personas con Discapacidad intelectual Adultas, ASPRODEMA, Consejo Estatal de Representantes de Minusválidos, CERMI, and the political parties)
Beneficiaries include:
  • The citizens of La Rioja

Co-creation process

This was a project that aimed at providing citizens with services, co-designed and co-produced with them (through the unions and most representative companies’ association in the region). This is demonstrated in the 2, 3, 4, 5 and 6 (out of 6) objectives stated by the working group for this Plan: (2) To set specific priority objectives in terms of PE and employment to guide the development of skills through-out space and time along the current office term, and promote them among citizens. (3) To lead the strategic approach of all the actors involved in PE and active employment policy in La Rioja, seeking to link their actions to the proposed objectives. (4) To integrate and coordinate the available resources in terms of PE and employability, both in the educational and employment markets, so that they support the objectives more effectively and efficiently. (5) To improve the interrelation between the different PE-providing subsystems and modes and, essentially, between all of them and actual employment. A greater involvement of the regional production system is essential. (6) To reach the highest degree of consensus in the formulation of the Plan from the technical, social and political points of view, so that public and private actions are mainly oriented towards shared strategic objectives.

Digital Transformation Process

Not applicable.

Results, Outcomes & Impacts

The general guidelines that grouped the results of this project aimed at improving employment qualification of human resources were:
  • To reduce structural unemployment and to promote employment of quality;
  • To achieve a qualified active population through lifelong learning;
  • To improve the quality and results of education and training systems at all levels;
  • To promote social inclusion and to alleviate poverty reinforcing social protection systems, lifelong learning and active and comprehensive inclusion policies, with special attention to women.
Additionally, the EU 2020 Strategy helped identify other results along the objective of smart, sustainable and inclusive growth:
  • Smart growth, through the development of an economy based on knowledge and innovation;
  • Sustainable growth, by promoting an economy that uses resources more efficiently, that is green and more competitive;
  • Inclusive growth, through the promotion of an economy with a high level of employment that results in economic, social and territorial cohesion.

Challenges & Bottlenecks

Regarding R&D and innovation investment, La Rioja presented certain weaknesses. According to Eurostat data, it reaches 0.87% of regional GDP. This is lower than the national average (1.33%) or that of the European Union (2.02%) and far from the 3% target of the Europe 2020 Strategy. La Rioja had 23,083 companies in 2015. Out of the total, 99.92% were companies without employees, micro-enterprises and SMEs. More than 50% of business units do not have salaried workers (12,314, according to the latest published statistics). This atomization is also reflected in the fact that most of the companies in the region are legally formed as solo-corporations or freelances. Likely, this bears an individualization effort to promote and engage these individuals into employment and training policy.

Transferability & Replicability

The Plan FP+E is a complex strategical project. Our selection of this case is justified as an example of the tremendous impact that PSINSIs may have in all sorts of public sector initiatives. In this case, a strategic plan for a social issue of major relevance such as unemployment and your professional education was handled with such a type of network. What surprised us from this case, beyond the formation of the network itself, is the publicity and openness of the initiative. It is true that it was subject to criticism, but the Working Group developments and final version of the plan was publicly and easily available from the regional government website. Moreover, the sessions of the Working Group, being a heterogeneous group including less qualified organisations, or certainly, not used to develop strategic political and operational plans, must have been rather complex to coordinate. Still, using the European, Spanish and earlier regional mandates and frameworks, they put together a complex plan that includes not only young people entering the labour market, but also long-term unemployed, disabled people, and those willing to re-qualify to improve their employability.

Success Factors

One of the major drivers for this Plan FP+E is the willingness of all economic actors to regain the competitiveness of the economy of La Rioja. Even along the economic crisis of the 2008-2013, the greater weight of the secondary sector justified that the economy of La Rioja was more productive than the Spanish economy. Measured through the relationship between GDP and the number of hours worked, La Rioja’s productivity was 36.37 in 2012, compared to 34.75 in Spain as a whole (Regional Accounting, Base 2008, INE). Another decisive driver of this Plan was the (EU) 2015/1848 Decision of the Council (October 5, 2015) on the guidelines for the employment policies of the member states for 2015. It set the following guidelines in terms of employment within the EU:
  • Boost the demand for labour.
  • Improve the job offer, qualifications and skills.
  • Improve the functioning of labour markets.
  • Promote social integration, fight poverty and promote equal opportunities.
  • Lessons learned

    The 3rd Plan for Professional Education and Employment (Plan FP+E: Plan de Formación Profesional y Empleo of La Rioja) for the 2016-2019 office term represented an effort towards facilitating access to employment of the citizens of La Rioja, a region in the central northern Spain, World-famous for its wines, shoes and agriculture. The new federal government of La Rioja soon declared the care for its youth and unemployed a priority of its policies and public actions. And it embarked in a new plan towards improving professional education and employment in the region. This initiative was led by the Consejería de Educación, Formación y Empleo (the regional Department of Education, Training and Employment) and was the result of a very close temporal collaboration with the most representative unions (UGT, CCOO), enterprise association (FER) and other relevant social stakeholders in the region. Together, they built a Working Group to design and implement a new plan for professional education (PE) and employment for the 2016-2019 term. This has been a project then that can be associated with the new public governance paradigm (NPG) paradigm, and fits into the public sector innovation networks for social innovation. Besides the specific context described earlier, there have been several news concerning the implementation of the Plan FP+E since its inception. Maybe the most relevant is that the Spanish Court of Auditors, in its evaluation of the different instruments for employment policies in La Rioja, 2016 has observed a degree of implementation of the objectives of the Annual Employment Policy Plan higher than the average of the Autonomous Communities. In the case of Plan FP+E though, there is an absence of an evaluation. Also, some criticism from the political opposition publicised the plan was delayed in some of its proposals.

    Stakeholders & Beneficiaries

    Stakeholders and Beneficiaries include:
    • Fundación Alas and the Special Employment Center Trefemo
    • The families that support the Foundation
    • The disabled elderly supported by the Foundation
    • The regional government of the Comunidad de Madrid (Spain)

    Co-creation process

    The content of the participation process included three related innovation elements:
    • The services model. This affects the facilities and types of services the elderly demand. But it also affects the type of professionals involved in providing the services. Finally, the measurement of the relevance and impact of the services is subject of review.
    • The facilities’ design. Residences need adaptation, but also the Foundation must develop new facilities to train and fulfil the needs of ageing disabled.
    • The relationships with other agents. If the earlier two might be related to services innovation, this concerns the processes and how the Foundation launches and consolidates new relationships with different public and private agents to help elderly sustain themselves and fulfil their rights to autonomy and proper care.

    Digital Transformation Process

    No digital transformation process involved.

    Results, Outcomes & Impacts

    The ageing project of Fundación Alas is centered in solving wicked problems associated with the longer life-expectancy of people with disabilities (Plena inclusión, 2014) thanks to the improvement on their life conditions and treatments. Far from technological, the types of social innovations the foundation designs and executes are related to a public function that public agents in Madrid (Spain) have traditionally left to private agents. Indeed, at least in Madrid, the public agents have failed providing adequate services to this community and currently acts as mere funder of private initiatives – mostly supported through conventional tenders. The effectiveness of the intervention strategies for elderly with intellectual disabilities depends on the ability of the technical teams to develop and communicate clearly the plans to other professionals (Morgan, 1990; Shaddock et al., 1986 in Novell, et al., 2008), but also on the capacity, training and motivation of professionals who have the direct responsibility to carry them out (Aylward, Schloss , Alper and Green, 1995 in Novell, et al., 2008), as well as the coordination between all of them.

    Challenges & Bottlenecks

    Dimension: Physical fitness

    • Lack of health care standards
    • Communication and identification difficulties of pain threshold
    • Participation in the promotion and living a healthy lifestyle
    • Lack of specific resources and standardised protocols for the evaluation of elderly with   intellectual disabilities
    • Insufficient training of socio-health professionals in ageing issues and intellectual   disabilities
    • Insufficient physical therapy

    Dimension: Emotional well-being

    • Integration of the information from the field of dual diagnosis[1] and the gerontology   area[2]
    • Environmental situations having a negative impact on the adaptive abilities of elderly or   could raise behavioural problems or stress
    • Training professionals in ​​ageing and dual diagnosis

    Dimension: Material well-being

    • Adaptation to the needs of elderly with intellectual disabilities
    • Less opportunities to participate in meaningful leisure activities, less stimulating   environments, lack of staff preparation and relationship difficulties between individuals
    • Lack of experiences with the rest of the ageing population
    • Segregated and expensive environments
    • Existing geriatric or gerontological intervention models are scarce and are not easily   transferable to services
    • Decreased productivity associated with ageing, difficulty to make personal and social   adjustments beyond the 50
    • Few work or occupational itineraries to support elderly with this condition
    • Pension plans different to those available for those without disabilities
    • Lack of assessments due to disability and ageing to maximise compensation when   leaving   work activity

    Dimension: Human Rights

    • Physical access
    • Access to information
    • Disability recognition associated with ageing
    • Right to decide where and with whom to live
    • Right to health, training and rehabilitation
    • Barriers to keeping an adequate standard of living and social protection
    • Right to develop and keep plans and goals

    Dimension: Self determination

    • Lack of information necessary to identify or recognise abuses
    • Transition to retirement getting actively involved in self-care

    Dimension: Social inclusion

    • Opportunities to participate actively in their environment
    • Lack of relevant social goals and aspirations
    • Greater contact with people without disabilities and greater autonomy
    • Lack of promotion of the inclusion of the elder with intellectual disability by the support  professionals
    • Ageing of the main carers
    • Lack of coherence in the implementation of an inclusive model
    • Shortage of personnel

    Dimension: Interpersonal relationships

    • Continuous changes of professionals
    • Housing size
    • Physical and social barriers
    • Long stories of institutionalisation and change of services that make it impossible to   consolidate a social network
    • Behavioural problems
    • Adaptive and communication skills

    Dimension: Personal development

    • Feeling of ‘disconnection’ with the activities carried out in earlier stages
    • Favouring free-time of their main carers
    • Lack of a process of active ageing
    • Lack of services and opportunities that promote rest, fun and personal development
    [1] For example, to know the most frequent psychiatric conditions in the population with ID or specific etiologies that present a higher risk of certain types of mental illness. [2] Identification of which behavioural and psychological changes are associated to the overall ageing process.

    Transferability & Replicability

    The institutional needs and problems detected in the main services that might affect the project of Fundación Alas are summarised below (Novell, et al., 2008):

    Services of homes-residence / supervised homes

    Personnel ratios are insufficient, both in residential homes and in homes, when it comes to addressing needs arising from cognitive deficits, behavioural issues and the functional deficits associated with ageing.

    Occupational Centres

    The ageing process generates continuous adaptation needs that pose an opportunity for the innovation of these services. Most generally, personnel in the occupational centres are not well prepared to carry out the work of Psycho-geriatric Day Centres – e.g., they are not provided with physiotherapy services. These centres usually lack transition services from the world of work towards a compatible satisfactory activity able to meet the needs of people who cannot continue in Special Employment Centre but still can work and get paid and that enhances their skills.

    Leisure and educational activities

    Elderly with intellectual disabilities need enough and varied social activities, adjusted to their age, to choose from according to preferences and accessibility. Enjoying free time and leisure is one of the most rewarding activities and making them accessible is a good indicator of the quality of a service. The elder with disability has motor and cognitive difficulties to self-organise and, depending on the level of disability, also to enjoy leisure. Promoting adapted leisure for elderly would benefit them normalising activities and improving adaptive behaviours, socialisation, fun and distraction, and quality of life.

    Individual level

    The need to enhance their self-esteem and personal growth, fighting loneliness; the need of full social acceptance; and the need to make decisions about aspects of one’s life in the most similar way possible to people without disabilities.

    Success Factors

    Dimension: Physical fitness

    • Sleep, food, activities of daily living
    • Health (physical and mental), health care and access to socio-health services (including technical aids)

    Dimension: Emotional well-being

    • Community environments, ordinary or supported employment, significant learning opportunities, absence of problems social or emotional behaviour and support
    • Depression and anxiety, stressors – social exclusion, stigmatisation or lack of social support
    • Healthy lifestyle and food, access to valued activities, health and well-being in the housing environment, adequate emotional response to separation or death of parents

    Dimension: Material well-being

    • Economic status (i.e., having enough income to buy what one needs or likes), employment (i.e., having decent work and an adequate working environment), or housing (i.e., having a comfortable home where one feels comfortable)
    • Adequate standard of living
    • Social protection
    • Searching, getting, keeping the employment and having the possibility of returning to it
    • Having the right to choose where and with whom to live

    Dimension: Human rights

    • Rights that may be violated at ageing
    • Proposals to empower disabled elderly to educate them to self-manage their lives and defend their rights

    Dimension: Self-determination

    • Autonomy or personal control self-regulation or setting own goals and values
    • Training or psychological competence
    • Self-realisation or own elections

    Dimension: Social inclusion

    • Active participation of the elderly in their community
    • Residence or housing options that favour social inclusion during ageing

    Dimension: Interpersonal relationships

    • Natural supports: significant relationships with family and friends
    • Interpersonal relationships through leisure experiences integrated into the community
    • Collaboration with community services belonging to the network of services for the elderly
    • Interpersonal relationships (friends, partners): emotional, sexual and social

    Dimension: Personal development

    • Education, personal competence, performance, functional skills
    • Use of support technology and other alternative communication systems

    Lessons learned

    This case presents the collaboration process of a private institution with users and their families to provide a public service that is not properly covered by the public sector. It answers a pressing concern of the families and the elderly with disabilities, as this latter group has become a relevant part of the total disabled population. This is not the normal case of a PSINSI, as the public agent is just one of the actors involved by the initiating agents, and mostly covers what relates to the overarching legal or normative framework of the caring for the ageing disabled people. Besides those differences with other social innovation cases, we appreciate similarities that even in the absence of a strong public actor are well covered by the PSINSI theoretical framework. This is relevant as it may indicate that the focus on the social innovation aspect might drive agents, independent of their ascription, to form similar types of networks.

    Stakeholders & Beneficiaries

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

    Co-creation process

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

    Digital Transformation Process

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

    Results, Outcomes & Impacts

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

    Challenges & Bottlenecks

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

    Transferability & Replicability

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

    Success Factors

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

    Lessons learned

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

    Stakeholders & Beneficiaries

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

    Co-creation process

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

    Digital Transformation Process

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

    Results, Outcomes & Impacts

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

    Transferability & Replicability

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

    Success Factors

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

    Stakeholders & Beneficiaries

    The 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.