Co-creating a new remote service for and with elderly people in the Netherlands

Moving to a retirement home is not something most elderly people look forward to. Fortunately, nowadays it is possible in the Netherlands to get a lot of care and support at home. In particular, remote services offer elderly people maximum flexibility and freedom from dependence, as they no longer have the trouble of travelling to locations outside their homes.

A consortium of adult social care organisations in the Netherlands commissioned the design research firm STBY and the service design company Waag Society to co-create new remote services for and with elderly people. The commissioners included two primary care providers (Zuidzorg and PuntExtra), the council of Geldrop Mierlo (with about 40,000 inhabitants in the South-East of the Netherlands), and a building society. At every stage of the project the target group - elderly people and their carers - were involved to make sure the team kept their point of view firmly in mind.

Dr. Bas Raijmakers of STBY provided Government International with this case study on the user-driven development of services for independent living on 28 October 2010.

One of the starting points for the project was the observation that, when elderly people become dependent on care, they often find it hard to get used to the range of support services available. In particular, they tend to know little about the potential of remote services. This project aimed to help elderly people to familiarise themselves with remote support services at the point before they become dependent on care.

The first step was to discover what type of services people would welcome in their lives at this stage. Later in the project ideas for new services were discussed and validated with elderly people and their carers, in a series of interviews and co-creation sessions, eventually using a prototype of the proposed service.

From the perspective of the target group, the main benefit of these new services would be that they offer an opportunity to connect more easily with organisations and with other people, from the comfort of their own homes. The primary target group was people aged 75+ who live independently at home and are still reasonably healthy, although less mobile than previously. The secondary target group was the family, neighbours and close friends of these elderly people, who regularly help out with small-scale tasks and generally keep an eye out for how things are going. The remote services aim to facilitate the day-to-day communications between these people, as well as enabling contact with care organisations.

The name of the overall service offering Woonservice Gemeente Geldrop-Mierlo probably only makes sense in the local context, so we use the abbreviated name WSG here. It basically means the ‘Geldrop-Mierlo local home service'.

The project started with a needs analysis. Semi-structured interviews were held with elderly people in their own homes. They were asked questions about their daily routines and their social environment. We also took pictures of their favourite spot in the house and the objects that were important to them. This enabled us to make an extended profile of each of the participants, based on the stories they told us. One such story came from an elderly woman who told us how she helped her grandson by allowing him to mow her lawn for money, so he could save up for something he really wanted.  While it was clear that she really needed help with mowing the lawn, typically she managed to disguise this motivation by stressing how she was helping someone else at the same time. Receiving help is much harder than giving it.

In a workshop with a multi-disciplinary team from the client consortium, the profiles of the participants were presented and discussed. In a co-creation spirit, the information collected in the interviews was analysed and clustered into different types of emerging insights. These insights were then used to explore new service concepts. Three initial concepts were developed, with a description of the kind of person for whom this concept would apply, what problems it would solve and how the service would be delivered.

The concepts solved problems in three different areas: participation (a story telling service), support (a skills swap service) and care (the 'I woke up well' service). Each concept was presented by means of a visual collage and verbal scenario.

In a follow-up workshop, these concepts were presented to a group of potential users (elderly people, their carers, and also representatives of associations for elderly people). Together with the client team, they discussed the ideas and looked at the materials that had been drawn up to illustrate the new services. They were then interviewed individually to discover if, when, why and how they would potentially use each service. Finally, all workshop participants worked together in a co-creation exercise to refine the further details of the service concept.

As a result of this overall process, WSG decided to develop further one of the service concepts - the 'Verhalen Estafette' ('Story Relay'), aimed at growing the participation of elderly people in the local community. This service is built up around personal stories from people in the local area, facilitated by lectures, radio, social networking and online video. The service offers members the possibility of reacting to other people’s stories and of sharing their own stories, not only from the comfort of their homes, but also elsewhere. Below is a scenario we used to develop prototypes for the service.

Mr Jones sees an add in the newspaper about an upcoming lecture about the old gingerbread factory he used to work in and decides to go to it. During the lecture, old memories flood back to him. At the end of the lecture, the lecturer asks if people in the audience have stories they would like to share. Mr Jones tells one of his funny memories, which is recorded and shared online on the spot. He also gets some ‘promotional business cards’ to invite people to come and listen to his story online.

At home, Mr Taylor sees on his screen that new stories are available. He chooses to listen to the story of Mr Jones, because he used to work at the Gingerbread factory too. The stories on the site bring back memories that he too would like to share, but since he has difficulties with walking, he calls the WSG service. A few days later, somebody comes to interview him and to give him his ‘promotional business cards’ to promote his own story and the service.

Mr Taylor, distributes the promotional cards to his friends and family, and also gives one to his neighbour Mrs Brown. Mrs Brown and her friend, Mrs Robinson listen together to Mr Taylor’s story. Mrs Robinson is so touched by Mr Taylor’s story that she sends a message that she would like to get in touch with him. Mr Jones agrees and he calls her. They have a nice little chat. Meanwhile, a WSG employee notices that Mr Jones’s story has been getting a lot of attention. She calls Mr Jones to ask him to give a lecture about his memories. He accepts and tells some of his favourite stories in front of an enthusiastic audience.

In the subsequent co-creation workshop with the client team, a full Service Blueprint was set up, mapping out how the various stakeholders would be involved and interact with each other.  After further improving and refining this Service Blueprint, we developed a series of Experience Prototypes for the new service.

These Experience Prototypes were then presented and discussed in individual interviews in the homes of the people in the target group. Based on their feedback, new insights were incorporated and agreed in a final workshop to adjust the service concept. At the next stage, prototypes of the service are going to be built. These will be validated by the target group at home during a live test period.

As this process clearly illustrates, co-creation with the client (WSG) and the target group (elderly people) has been a constant feature of the whole process.

The main achievements of the project are twofold:

The feedback from the elderly people in the target group indicates that they believe they will benefit from a service that allows them to stay socially active and connected, even though they are becoming less mobile.

For the organisations in the client consortium, the biggest change is that these new services no longer feature them as organisations that 'solve people's problems'. This was also one of the main outcomes of the needs assessment with elderly people and their supporters. The elderly people were very clear they wanted to remain in the driving seat when decisions were made about their lives – e.g. in deciding when they would engage in participation activities, and even when they needed more support or care services in the future.  The lawn mower story above is a nice example of such thinking. Like WSG, all the commissioning organisations are now positioning themselves as organisations that help people to solve their own problems, while they still can. This is a new, and more appropriate, way of addressing people who do not consider themselves as ‘needing care’ yet. Indeed, these citizens are generally averse to any services which suggest that they can’t look after themselves - and this is currently the main barrier for the uptake of remote care services.

Another major achievement for the client consortium has been the learning process about user-driven innovation and co-creation. This way of working was fairly new to them. They were eager to learn more about it, as they genuinely wanted their organisations to be more customer-oriented, but they had little experience with the appropriate methods. STBY and Waag Society, as experts in this field, have taken care to involve the client team in every step of the process. Full documentation of the process is currently being produced in a booklet for internal use. The organisations aim to do more of this kind of co-creation project in the future.

The costs for this project have been financed by the organisations in the client consortium, together with a contribution from the regional government. The main costs were for the public engagement, the concept development, the prototype development and the validation tests, all coordinated by the agencies involved. The hours spent on the project by the people from the client team were covered from their normal operational budgets. As one of the starting points for the project was to work with existing technology, no major costs for technical development was needed. In this nine month project, the cost of the initial design research with older people and their supporters, as well as the concept development and the Service Blueprint prototype, was about £60,000 (at 2009 prices), excluding the time of employees in the care organisations.

In the long run, the use of the new WSG service will generate savings for the care organisations, as they can now communicate more easily with their customers and deliver many more of their services remotely. The client consortium already has ample experience with remote care services for people who are in need of primary care. However, delivering services to older people who are still at the stage of not yet being dependent on care is new for these organisations, although it is seen as a well-worthwhile investment, shared with local councils who are keenly aware that they need to invest in making their communities stronger by supporting older people to be active participants. Services such as the Story Relay service help them to do that, in particular when it ties in with existing initiatives by citizens in the local area. Therefore, such services are seen as the best possible investments in a community to make it stronger, rather than being seen as investments seeking a financial return. The care organisation is looking for savings by piggybacking these new services onto its existing participation, support and care services. It expects to be able to scale up and introduce these services to 21 councils in the area.

More information on the project can be found on the websites of STBY and Waag Society:
http://www.stby.eu/2009/07/29/support-services-for-independent-living/

http://www.waag.org/project/zuidzorg