Bispebjerg-Nørrebro (BIN) Project

The research setting of the case study is the elderly care sector in the municipality of Copenhagen, Denmark. The municipality has been undergoing a paradigm shift towards an increased focus on what a good life contains to elderly citizens (Københavns Kommune 2015b). This is discursively constructed in the elderly care policy as a move from “passive to active” implying an increased focus on self-determination and participation of citizens (Københavns Kommune 2015a). An experiment with improving elderly care services were organized by the municipality over a three-year period in 2015-2017. The project was called “Quality of life for elderly people in non-profit housing areas” targeting loneliness amongst elderly people living in their own homes. The point of departure was three residential areas for elderly, but the focus in this case study is on one specific area, the sub-project Bispebjerg-Nørrebro (BIN). The project is an illustration of the interplay between “prolonged” activities (taken place in the residential area) and activities maintained by the same employees in the local Activity Centre (Activity Centre Bispebjerg). The main aim of the project is: to enhance life quality and lessen loneliness among residents by creation of residence-near activities, which promote the creation of network and friendships, that the residents themselves want to engage in and manage after project completion (Project description, 2015). The project activities ended in the beginning of 2018, but the findings of the project continues as spin offs at different levels in the municipality e.g. as a loneliness foundation and a new initiative at the Activity Centre focusing on how the elderly to a larger degree can use the city of Copenhagen.

Stakeholders & Beneficiaries

Policymakers define the strategy. Front-line employees implement the physical training and relationship building courses (in their own words, they “make an offer” to the benefiairies – the seniors) and senior participate in the activities. Sometimes, external actors are involved too, as with the Cycling Without Age, a voluntary programme initiated by one citizen (to take elderly citizens on bicycle trips in the city), where the municipality responded positively, by purchasing some bikes to scale up the initiative. Finally, private funds and private firms play a role in research projects in the municipality (via living labs activities), as well as in the development of welfare technology.

Co-creation process

Policymakers define the strategy for healthcare policy for the elderly. Based on this framework, the front-line employees of the Activity Centre design training sessions with the elderly who take part. After a long period of time, the elderly can take charge and interact with each other on their own.

Digital Transformation Process

The municipality further participates in several living lab activities, where welfare technology developed by private firms are tested by citizens.

Results, Outcomes & Impacts

The main success criteria of the project is that it is perceived as meaningful for the elderly and that the municipality ensures that the findings and the learning of the project are applied prospectively. The success of the Activity Centre is mainly measured by its occupancy rate and members receive a phone call on a yearly basis as part of a satisfaction survey. In both cases the Centre gets high scores, but there is a caveat: the evaluators do not visit the centre and don’t see how the activities and the daily life unfold. Also, the employees think there is a lack of focus on what they perceive to be main objective of their work; i.e. the measurement of parameters that can embrace relationship building, life quality, degree of loneliness, the excitement of the elderly in the daily activities, etc. They propose to measure the amount of readmissions among the elderly that use the centre, testing of functional ability and to use the start-up dialogue with the elderly and the subsequent evaluation dialogues (each year) to see if they have experienced a change in life perspective.

Challenges & Bottlenecks

1) There is a disconnect between the policymaking level and the operational level on value co-creation: when reacting to what the role of staff is in value creation, policymakers emphasize strongly both the need for political structures and for development work at the strategic level as a basis for public service staff in creating value, but, at the level of the projects, there is much more emphasis on the competencies, enthusiasm and the mood of the front-line staff in co-creating value in direct interaction with the elderly users. 2) Policymakers state that, at the strategic level, there is strong interest in user involvement. Yet the potential of user involvement is not realised in a systematic way in practice. There is a lot of rhetoric rather real user involvement. Whilst the municipality is making an effort to listen to the users, the impact of this approach is still weak. 3) Projects like this one are meant to become driven by the users/citizens over time. Citizens should create the value and take responsibility for it. But here, the elderly citizens do not see themselves as having a key role creating value for others. And it takes time for the front-line employees to build trust with the seniors (1.5 year, according to the log-books), so that, later on, they can slowly withdraw as main actors and let the elderly themselves be drivers – based on their new social relations.

Transferability & Replicability

The objective of the project is to foster the ability of the elderly to stay as long as possible in their own home and to be self-sufficient as long as possible thanks to a good mental and physical health – which are stimulated by physical training and relationship building. This very general objective is replicable in other municipalities.

Success Factors

1) To let the surrounding community (associations, evening schools) use the facilities of the Activity Centre, outside opening hours. 2) A condition for creating value to the elderly, is to work network-oriented in the municipality and to open up between the different institutions at an individual level. 3) Create platforms where it is possible as an individual to be something for the elderly – e.g. supported by digitalisation. 4) To counteract the practice of the public sector that classifies people and puts them into boxes (e.g. the box of an elderly that starts at 65+) more flexible housing areas for people across generations could be developed – also to support the changing family structures. 5) If there were resources to support the relationships outside of the Centre, improvements could be greater 6) Invite other Activity Centres and their events to our place or to do activities together with groups of elderly that have the same challenges/oppurtunities. 7) To increase the visibility of the Activity Centre – and to create opportunities for being or becoming e.g. a visitor. 8) To make sure the local environment is designed for the needs of the Centre’s participants (e.g. having a hairdresser, a grocery shop, a church, in the whereabouts).

Lessons learned

1) It seems as if the lingo of public services and value co-creation, as part of the policy terminology of the welfare state, is mainly mirrored at a tactical and strategic level, but less at the operational level. The danger is that policies might become detached from practice, which is why it seems pertinent to contextualize what is meant by value and to whom. Or to discuss whether the term value are analytically suitable if it becomes a straitjacket to understand the logic of public services from an employee perspective. 2) There is a change that has taken lace from a partial patronizing approach towards a more responsive approach to care. However, to provide care must still first of all correspond to professional standards, and then next be responsive to users’ expectations and experiences. It’s less advanced than in the MAIA approach, where the senior’s need are placed above the professional’s diagnostic. 3) There is a generational effect: the elderly of today come from a frugal generation. They do not expect the public sector to solve their problems and are therefore quite thankful for all initiatives they perceive to be beyond their rights as citizens e.g. medical care and hospitalisation. An offer such at the Activity Centre and being part of the BIN-project falls within these not-expected-categories.