Stakeholders & Beneficiaries

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

Co-creation process

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

Digital Transformation Process

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

Results, Outcomes & Impacts

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

Challenges & Bottlenecks

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

Transferability & Replicability

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

Success Factors

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

Lessons learned

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

Stakeholders & Beneficiaries

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

Co-creation process

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

Digital Transformation Process

This case study is not about digital transformation

Results, Outcomes & Impacts

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

Challenges & Bottlenecks

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

Transferability & Replicability

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

Success Factors

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

Lessons learned

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

Stakeholders & Beneficiaries

NEMO exists to take care of patients with neuromuscular diseases and their families. They are frequently grouped in family associations. The team of doctors, specialists, nurses and the management are all devoted to putting the patients at the centre of the treatment / care. The city of Messina is talso an important community for Nemo in terms of local support, because the city is small, so the Centre is more representative within that context and all the community is involved in the project. When patients die, the family raise donations for the Centre, and all of the persons involved participating in all the stages, even in the death moment. Professionals also mention ASL – the local public healthcare institution, but maybe even more important are the suppliers/home care providers, that understand the functioning and the bureaucracy to which they are subject to and are flexible in efficiently providing Nemo with necessary supplies.

Co-creation process

Co-creation is taking place in all three phases: planning, structuring and service delivery. Not yet in the part when patients go home (domicile phase), as the Centre is not completely well structured for that yet. According to patients, value is created in both the design and the delivery of services, as Nemo works, in co-creation, co-production with them, on innovation, listening to their needs and treating them with dignity. The importance of the families’ integral participation in the process is highlighted in the professionals’ testimonial as well. All stakeholders also agree on the evaluation of services, as it allows the professionals to redesign and adapt their service, which do not exist separately, but it is a result of all phases in which the patient is present.

Results, Outcomes & Impacts

The patients and families are all very satisfied with the non-standardised, or individualised, care model applied in Nemo. They rate each professional they meet during their treatment on a scale from 1 to 7 as follows: nurse coach: 6,71; physiotherapist: 6,65; nurse: 6,76; speech therapist: 6,69; doctor: 6,75. According to page 21 of the CSS report, their perception of the treatment received from their arrival through their stay in Nemo’s facilities is as follows: possibility of accessing Nemo 24/7: 6,69; respect to their privacy: 6,67; their perception of being treated as a person, and not just as a patient: 6,60; respect and approach regarding their religious beliefs: 6,59; dedicated spaces to leisure time (recreation, tv, games): 6,56.

Challenges & Bottlenecks

In spite of the unarguable evidence collected in the different fieldwork approaches regarding value creation, the question of value destruction was also brought up by some of the involved parts. Nurse coach brought up the risk from the part of healthcare professionals of being too involved in their jobs and ultimately “loosing” their sense of personal life. Also, the “excess” of care can highlight a consequence of value destruction for the patients as they could expect too much care and forget that they have a brute, degenerative pathology that needs an active role from them too to be fought. Political relations must be carefully managed too, otherwise a wrong move can lead to value destruction, like in the nonprofit world, where egoism of its actors can sometimes lead to conflicts and disruption, or in the social media world, with the propagation of various news, which can generate conflicts and disruption in the value creation process. Finally, the risk of creating excessively high expectations and not delivering what patients expect, i.e. the cure, because it has not yet been found for neuromuscular diseases, also represents a big challenge.

Transferability & Replicability

The model of the nurse coach is already inspired from something that is well-known in the U.S. Model. Also, the methodologies is applied in four different clinical facilities throughout Italy. So, the clinical medical concept it not related to any very specific, local context and can be replicated or transferred.

Success Factors

Creating a symbiosis among all the stakeholders is what makes the individualised care system work: patients must be aware and feel confident towards the multidisciplinary team; healthcare professionals must carry certain types of value (respect, dignity, etc.) not only in their professional life but also in their personal one to be able to use them with the patients; family associations play a crucial supporting role (financially, emotionally, in research); the supplier/home care providers, that understand the functioning and the bureaucracy to which they are subject to and are flexible in efficiently providing Nemo with necessary supplies, are facilitators; the local health public institutions need to be involved as well; and the citizens and communities are key too. All stakeholders work hand in hand towards the same goal, i.e. allowing people with neuromuscular diseases to not only survive but actually live quality lives.

Lessons learned

Evaluations are critical to constantly improve the services and keep as close as possible to the patients’ needs. Through constant monitoring of how much they offer to every patient, they can improve the answers to treatment needs. Based on this principle, they have developed a system for evaluating the satisfaction of patients accessing the services, based on their perception of the care/operating model. In concrete, Nemo has developed a customer satisfaction survey which is the result of a multidisciplinary work, through which the professionals of Nemo have expressed their point of view on the issues to be evaluated. For the first time, topics such as the respect for the individual and his/her choices, the perception of being ‘at the center of care’, welcoming to the patient’s family nucleus, were studied. This system also allows for the healthcare professional to redesign their role based on the indicators that are measured not only by the patients, but also by the public healthcare system.

Stakeholders & Beneficiaries

MAIA aims to ensure the decision-making process (interaction, collaboration) between stakeholders at two levels: at a strategic level – in order to develop a collaborative and decision-making space between decisionmakers and funders of gerontological policies (ARS, departmental councils, and others); at a tactic level – in order to create a collaborative and decision-making space between the operators responsible for the healthcare and support services that help seniors to stay at home. For seniors in complex situations, an intensive and long-term follow-up (including during hospitalisation periods) is implemented by a case manager (a new professional skill). This professional is the direct contact with the senior, with the general practitioner, with the professionals working at the senior’s home, and becomes the referent of complex situations.

Co-creation process

At the institutional level, there is a top-down approach to co-creation, designed to better fit the realities of the territories: the Regional Health Agency selects, via a call for application, an infra-departmental institution (non-profit organisation) which can mobilise local actors. This non-profit will be in charge of implementing the MAIA pilot on its territory, by connecting the professionals in healthcare to fit the territorial reality. At the user level, the co-creation materialises through the dialogue between the senior (the user) and the case manager, who becomes the spokesperson for the user and translates the user’s needs and wishes to the healthcare professionals (sometimes against the advices of the health professionals).

Results, Outcomes & Impacts

In its interactions with the users and professionals, the care manager helps to improve the organisation of the care system by identifying any dysfunctions observed on the territory.

Challenges & Bottlenecks

According to Policy maker, MAIA activity reports are done by the MAIAs but require a thorough understanding. Starting to introduce indicators for measuring value creation raises problems relating to the instrumentalisation of such indicators. Ideally, a territorial roadmap used by all the operational actors would be interesting to develop, but given the fact that data would be analysed on a very small territorial scale and then structured at a regional and national level, it requires money and tools. This is not done today. Monitoring indicators have been developed and used during the implementation stage of the MAIA method (e.g. number of contacts a senior must have established to access to the right resource). Currently at the local level, the impact in terms of organisation is measured (participation rate of partners at the tactical table, or for the case management, the territory distribution of seniors being managed). It has been noted that the participants to the tactical tables are always the same volunteers, actors who encounter difficulties in their daily practice do not often wish to participate (as this could be viewed as failure) and general practitioners are rarely part of the table. According to the pilot at the local level, a tool has been evaluated, but there is no local evaluation of the value creation of the MAIA for the territory. It would be interesting to know for example the impact of MAIA on the reduction of hospitalisation in emergencies, the reduction of user orientation towards wrong services. The partners should be involved to create these indicators. For the case management, the value creation is evaluate via the decreasing needs of the senior that the case manager has to fulfill. The creation of value can be measured via satisfaction surveys but this is not a global value creation, that is, the medico-social system as a whole. Care Pathways Operational Committees are currently working on impact indicators (non-use of emergency, scheduled hospitalisation). The current problem is that the databases are currently partitioned between the medico-social, social and sanitary field, so there are difficulties to measure the impacts on a pathway of a user. Finally, MAIA is on a voluntary basis, so there is no incentive (legal, financial), for professionals who are solicitated to take part in brainstorming sessions and one can find always the same people involved.

Transferability & Replicability

This initiative is applicable to the various sub-territories of the French regions, because of its very locally-oriented – and even user-oriented approach. The concept is therefore replicable to other territories. Also, the MAIA project was already copied from a similar initiative in Quebec, Canada.

Success Factors

An integrated, one-stop service provides, at any place of the territory, a harmonised answer adapted to the needs of the users, by directing them towards the adequate resource. It integrates all the reception and orientation counters of the territory. The MAIA method includes the development of common information-sharing tools and action-steering tools (a shared multi-dimensional analysis form, a standardised multidimensional needs assessment tool, and individualised service plan). If the MAIA method is originally top-down, once the project holder chosen by the network, the deployment is left to the initiative of the Maia pilot. Thus, this method is deployed on territories in very different even innovative ways, depending on the diversity of actors and networks already existing on the territory. Thus, the approach is considered as “help-it happen” by the policymakers. Various forms of MAIA multi-stakeholder networks have emerged at a territorial level.

Lessons learned

All respondents have stressed that it is difficult to determine the moment of value creation. National and regional public manager, partners, pilots agree on the fact that the creation of value of the MAIA method is mostly upstream, as a back-office function, during the constitution of the network, when the pilot and the partners discuss together to facilitate the articulation between services (creation of a professional dynamic). The users here are the partners. Thus, the value creation takes place before the services are delivered. However, the respondents point at that the value creation is also continuous, throughout the accompaniment of seniors all over the care process (according to the national and regional public manager and partners). When a single patient joins the healthcare system, this is value creation. According to the case manager, the value is created once the professional chain around the senior is stable and complete. Thus, mostly once the service is delivered, even if the senior monitoring continues to be provided.