FoUiS - Enhancing personcenteredness through experience based communication
FoUiS face the challenge as well as many other public actors to work for the greater involvement of citizens in daily activities as well as in the development of the same - person-centeredness. This requires organizations to change their prevailing notions about what is most important; from the organization to focus its citizens, which is also referred to as a paradigm shift of researchers in public administration.
This study builds on three completed person-centered projects within municipalities and the county council where service design was used to understand, involve, develop and communicate in and around the projects. The projects resulted in some changes at the individual level and resulted in altered actions (practices) as well as the challenge of spreading these within the organization and to other organizations.
The initial phase examines whether, how and what experiences from these projects has been critical to this change and identifies institutional barriers and opportunities for dissemination. Based on the results new formats are co-created within an action research approach, which is jointly tested and evaluated. The final year the researcher will conduct one analyze with focus on the potential change in language and communication and a critical reading of designs role in society-changing efforts.
This study connects service logic, organizational change and service design and rests on a pragmatistisk ethos of how experiences are formed and changed.
This study builds on three completed person-centered projects within municipalities and the county council where service design was used to understand, involve, develop and communicate in and around the projects. The projects resulted in some changes at the individual level and resulted in altered actions (practices) as well as the challenge of spreading these within the organization and to other organizations.
The initial phase examines whether, how and what experiences from these projects has been critical to this change and identifies institutional barriers and opportunities for dissemination. Based on the results new formats are co-created within an action research approach, which is jointly tested and evaluated. The final year the researcher will conduct one analyze with focus on the potential change in language and communication and a critical reading of designs role in society-changing efforts.
This study connects service logic, organizational change and service design and rests on a pragmatistisk ethos of how experiences are formed and changed.
Final report
Strengthened person-centeredness through experience-based communication
The project's purpose and development.
Like many public actors, Sörmland's region and municipalities faced the challenge of working for increased involvement of the citizen in the development of their organizations. This means, among other things, that public organizations need to change prevailing notions of what is most important; your own organization or those for whom the activities are for. Not least, government investigations have pointed to the importance of increased person centeredness. The transformation towards an increased person centeredness is often referred to as a paradigm shift by researchers in public administration. The Flexit project was located at Research and Development in Sörmland (FoUiS), which is a county-wide resource for social services and adjacent health care in Sörmland.
The purpose of the research project was to contribute with increased knowledge based on theory and practice about how individuals' actions change and spread within and between health care and care organizations with a direction towards an increased degree of person centredness. Based on previous research on how service design can contribute to transformation through adjustment of actions, the project was carried out in close collaboration with the concerned actors. The project has had a pragmatist position in how it is structured methodologically and how it views knowledge and the role of experience.
Sörmland County Council (now region) and a few municipalities were early users of service design to strengthen the organisation’s focus on the citizens. This study was intended to be based on previously implemented projects for person centred care within the region and municipalities. Projects where service design had been used to understand, involve, develop and communicate in and around the projects. Then to conduct further studies that explored new formats to challenge and change prevailing norms and routines. As it developed, an action research project became central in driving both research and development regarding these issues forward. During the Flexit project, it has also become clear that there is a need for Swedish-language literature on service design, not least to support knowledge-based development in the public sector.
The research project has been in a context where interest and efforts at the national level have moved in the direction of increased collaboration based on individuals' needs and conditions, which has greatly contributed to interest in issues and results.
Briefly about the implementation
Already during the first week of the Flexit stay in January 2017, I was asked to conduct a follow-up research study on the introduction of new guidelines for "Safe and efficient discharge from inpatient care". The guidelines were based on the inquiry Collaboration in discharge from closed health care (Prop. 2016/17: 106), then the Act (2017: 612) on collaboration in the case of discharge from closed health care, which was released on 1 January 2018. In Sörmland, an agreement and guidelines had been developed in 2016, and 2017 was to be used as a year to both test and implement the guidelines. As the work focused on transitions between regional and municipal administrations, and organizations, it was decided that the Flexit project would contribute through an action research approach with the intention of increasing the degree of person-centeredness. In addition, the work offered a clear link between individual actors and institutional governance mechanisms such as laws and guidelines. Based on this, adjustments were made in the research plan, action research was prioritized, the interview study was postponed.
The intervention and follow-up research project "Safe and Efficient from a patient and related perspective", worked actively with the guidelines in project form with participants from various principals. In total, the work actively involved just over 55 people and 20 different organizations. In addition to participatory observations, recordings of sound and images as well as interviews during the project, follow-up interviews took place 6 months and 2 years after the end of the project.
The work was continuously reported to the political committee, the regional cooperation structure and the secretariat that had the overall responsibility for the development of the guidelines. The work was completed through an open presentation, a project report and a research report published in 2018. Within the framework of the project, a literature study was conducted that explored the connection between person-centred care and service design by me together with researchers from both care and design fields. The clearest project result was a name change to the guidelines, which in their final form is called Safe Homecoming and Effective Collaboration, instead of the previous Safe and Efficient Discharge. Region Sörmland was early in seeking forms for how the legislation could be transposed into regional and municipal guidelines, and the work attracted great interest in neighbouring regions and nationally.
During the period Sep 2018-Sep 2019, I was on leave, which meant further changes in the research plan, at the same time as it enabled a follow-up of a more longitudinal character. During the late autumn of 2019, a number of people in the region and municipality were interviewed, who during the term of the Flexit project were identified as key people in the introduction of person-centered care and service design. Furthermore, a survey was conducted in 2019 with participants in the Node for service design as a basis. The purpose of the study was to investigate the spread and perceived changes in service design linked to person-centeredness. In parallel, a revised study was conducted to further explore how design methods can affect social systems with a focus on breaking norms and established patterns with co-workers within FoUiS.
Based on the realization that there is a lack of relevant literature in Swedish, contact was made with the publisher Studentlitteratur and the main part of the last Flexit year were devoted, in addition to compiling the research results, to writing and completing the first textbook in Swedish in service design together with Stefan Holmlid. The book contains many practical examples, several of which are from my work with FoUiS.
How the project has contributed to increased collaboration between universities and organizations outside the academy.
Collaboration has primarily taken place between Sörmland's region and municipalities and universities other than Örebro University where the Flexit project has been located. This was probably due to the researcher's already established collaboration with other higher education institutions. During the project, two doctoral students in the Marie Curie-funded project Design Design for Innovation (https://cordis.europa.eu/project/id/642116) participated from their respective universities Linköping University and Karlstad University. Together with me and each of them, they have contributed to different contexts such as training, lectures, and knowledge development. Furthermore, the project has contributed empirical material and joint publications. In addition to this, it has involved input, lectures, and participation of researchers in various parts of the mentioned action research project. Furthermore, contacts have been made with senior researchers, who have participated in applications for both development and research projects. To promote the work with person centeredness through service design, a Node for service design was established in 2018 with the aim of further disseminating and establishing knowledge about service design, the development of the node was supported by Vinnova. The node became a meeting place for employees from Sörmland's regional and municipal development activities.
The project's three most important results
The project's most concrete result are the changed ways of working that were developed during the project and which still remain, together with impact on the guidelines. This shows a shift from an internal focus on the companies' processes to a greater focus on those who are actually going home from inpatient care. In later revisions of the document, person centeredness has also been integrated into the writings.
Scientifically, the project has developed knowledge that clearly describes how knowledge about and in service design connects to and supports a development towards an increased degree of person-centeredness. Furthermore, it is linked to how change at the system level can be initiated and spread through design-driven interventions.
For a wider audience, the book Tjänstedesign: principer och praktiker (Service Design: Principles and Practices) is an important result. The book compiles the authors' own research and experiences, international research, and a large number of real case descriptions for the first time in Swedish.
How the project group has disseminated the research, and whether and how collaboration has taken place.
Results from the work have been disseminated at international research conferences, via articles and at invited seminars to, for example, Baerum Municipality, Norway and Northumbria University, Newcastle. As well as at national regional and national conferences such as SKL’s kick off conference for Close Care. The results from Safe and Efficient were presented together with the chairman of the Committee for collaboration on social services and care at Service Convention Sweden 2018 and at two different sessions of the R&D Welfare Conference 2018. Furthermore, via two podcast sections on the R&D podcast.
The Flexit seminar was held at Service Convention Sweden 2020, where the book Tjänstedesign: principer och praktiker was previewed. The book has been presented in various digital contexts together with actors who contributed with cases.
The project's purpose and development.
Like many public actors, Sörmland's region and municipalities faced the challenge of working for increased involvement of the citizen in the development of their organizations. This means, among other things, that public organizations need to change prevailing notions of what is most important; your own organization or those for whom the activities are for. Not least, government investigations have pointed to the importance of increased person centeredness. The transformation towards an increased person centeredness is often referred to as a paradigm shift by researchers in public administration. The Flexit project was located at Research and Development in Sörmland (FoUiS), which is a county-wide resource for social services and adjacent health care in Sörmland.
The purpose of the research project was to contribute with increased knowledge based on theory and practice about how individuals' actions change and spread within and between health care and care organizations with a direction towards an increased degree of person centredness. Based on previous research on how service design can contribute to transformation through adjustment of actions, the project was carried out in close collaboration with the concerned actors. The project has had a pragmatist position in how it is structured methodologically and how it views knowledge and the role of experience.
Sörmland County Council (now region) and a few municipalities were early users of service design to strengthen the organisation’s focus on the citizens. This study was intended to be based on previously implemented projects for person centred care within the region and municipalities. Projects where service design had been used to understand, involve, develop and communicate in and around the projects. Then to conduct further studies that explored new formats to challenge and change prevailing norms and routines. As it developed, an action research project became central in driving both research and development regarding these issues forward. During the Flexit project, it has also become clear that there is a need for Swedish-language literature on service design, not least to support knowledge-based development in the public sector.
The research project has been in a context where interest and efforts at the national level have moved in the direction of increased collaboration based on individuals' needs and conditions, which has greatly contributed to interest in issues and results.
Briefly about the implementation
Already during the first week of the Flexit stay in January 2017, I was asked to conduct a follow-up research study on the introduction of new guidelines for "Safe and efficient discharge from inpatient care". The guidelines were based on the inquiry Collaboration in discharge from closed health care (Prop. 2016/17: 106), then the Act (2017: 612) on collaboration in the case of discharge from closed health care, which was released on 1 January 2018. In Sörmland, an agreement and guidelines had been developed in 2016, and 2017 was to be used as a year to both test and implement the guidelines. As the work focused on transitions between regional and municipal administrations, and organizations, it was decided that the Flexit project would contribute through an action research approach with the intention of increasing the degree of person-centeredness. In addition, the work offered a clear link between individual actors and institutional governance mechanisms such as laws and guidelines. Based on this, adjustments were made in the research plan, action research was prioritized, the interview study was postponed.
The intervention and follow-up research project "Safe and Efficient from a patient and related perspective", worked actively with the guidelines in project form with participants from various principals. In total, the work actively involved just over 55 people and 20 different organizations. In addition to participatory observations, recordings of sound and images as well as interviews during the project, follow-up interviews took place 6 months and 2 years after the end of the project.
The work was continuously reported to the political committee, the regional cooperation structure and the secretariat that had the overall responsibility for the development of the guidelines. The work was completed through an open presentation, a project report and a research report published in 2018. Within the framework of the project, a literature study was conducted that explored the connection between person-centred care and service design by me together with researchers from both care and design fields. The clearest project result was a name change to the guidelines, which in their final form is called Safe Homecoming and Effective Collaboration, instead of the previous Safe and Efficient Discharge. Region Sörmland was early in seeking forms for how the legislation could be transposed into regional and municipal guidelines, and the work attracted great interest in neighbouring regions and nationally.
During the period Sep 2018-Sep 2019, I was on leave, which meant further changes in the research plan, at the same time as it enabled a follow-up of a more longitudinal character. During the late autumn of 2019, a number of people in the region and municipality were interviewed, who during the term of the Flexit project were identified as key people in the introduction of person-centered care and service design. Furthermore, a survey was conducted in 2019 with participants in the Node for service design as a basis. The purpose of the study was to investigate the spread and perceived changes in service design linked to person-centeredness. In parallel, a revised study was conducted to further explore how design methods can affect social systems with a focus on breaking norms and established patterns with co-workers within FoUiS.
Based on the realization that there is a lack of relevant literature in Swedish, contact was made with the publisher Studentlitteratur and the main part of the last Flexit year were devoted, in addition to compiling the research results, to writing and completing the first textbook in Swedish in service design together with Stefan Holmlid. The book contains many practical examples, several of which are from my work with FoUiS.
How the project has contributed to increased collaboration between universities and organizations outside the academy.
Collaboration has primarily taken place between Sörmland's region and municipalities and universities other than Örebro University where the Flexit project has been located. This was probably due to the researcher's already established collaboration with other higher education institutions. During the project, two doctoral students in the Marie Curie-funded project Design Design for Innovation (https://cordis.europa.eu/project/id/642116) participated from their respective universities Linköping University and Karlstad University. Together with me and each of them, they have contributed to different contexts such as training, lectures, and knowledge development. Furthermore, the project has contributed empirical material and joint publications. In addition to this, it has involved input, lectures, and participation of researchers in various parts of the mentioned action research project. Furthermore, contacts have been made with senior researchers, who have participated in applications for both development and research projects. To promote the work with person centeredness through service design, a Node for service design was established in 2018 with the aim of further disseminating and establishing knowledge about service design, the development of the node was supported by Vinnova. The node became a meeting place for employees from Sörmland's regional and municipal development activities.
The project's three most important results
The project's most concrete result are the changed ways of working that were developed during the project and which still remain, together with impact on the guidelines. This shows a shift from an internal focus on the companies' processes to a greater focus on those who are actually going home from inpatient care. In later revisions of the document, person centeredness has also been integrated into the writings.
Scientifically, the project has developed knowledge that clearly describes how knowledge about and in service design connects to and supports a development towards an increased degree of person-centeredness. Furthermore, it is linked to how change at the system level can be initiated and spread through design-driven interventions.
For a wider audience, the book Tjänstedesign: principer och praktiker (Service Design: Principles and Practices) is an important result. The book compiles the authors' own research and experiences, international research, and a large number of real case descriptions for the first time in Swedish.
How the project group has disseminated the research, and whether and how collaboration has taken place.
Results from the work have been disseminated at international research conferences, via articles and at invited seminars to, for example, Baerum Municipality, Norway and Northumbria University, Newcastle. As well as at national regional and national conferences such as SKL’s kick off conference for Close Care. The results from Safe and Efficient were presented together with the chairman of the Committee for collaboration on social services and care at Service Convention Sweden 2018 and at two different sessions of the R&D Welfare Conference 2018. Furthermore, via two podcast sections on the R&D podcast.
The Flexit seminar was held at Service Convention Sweden 2020, where the book Tjänstedesign: principer och praktiker was previewed. The book has been presented in various digital contexts together with actors who contributed with cases.