Even though Innoclusion has been a European or at least a bi-national endeavour here we focus on the current situation and what led to it in Germany for two reasons: Firstly as Germans we have first-hand knowledge primarily about the developments concerning the German social system and, secondly, its long history and complex setup highlight the typical problems of a brown field transformation as if under a magnifying glass. 

Here we will focus on what we have called above the „failed digitisation“1, its history and its consequences mainly in the form of the dominance of legacy IT systems that make the integration of digital innovations into the care system extremely difficult. This is also due to the fact that these legacy systems have undergone various changes of scope. These systems had and still have to reliably map highly complex, strictly regulated processes that were and are also subject to repeated reforms. Imagine a family of dinosaurs that has been subject to a lot of genetic treatments over several generations with the consequence that even the smartest med AI fails when trying to make any sense of the resulting outer body characteristics and the positions and interactions of the internal organs let alone the messed up genetic code. 

Furthermore, what we can regard here is not only about problems with old, cumbersome technology and with overregulation. The development of the LLabs in St. Georgen and in Kork under these quite particular systemic conditions is also a showpiece of the dynamic relation of social behaviour and technology, which overall can promote or hinder necessary socio-technical innovations. 

In Germany, the systematic and increasingly IT-based approach to nursing documentation („Pflegedokumentation“) was a consequence of the implementation of the nursing process as a multi-stage, general problem-solving process in the 1980s. 

Starting as a means for professionalisation and a supportive tool for carer givers, nursing documentation became more and more an instrument for protection in liability issues and the collection of necessary data for verifying of remuneration-relevant services to cost bearers. What was intended as a tool to make work easier and improve quality became an ever-increasing bureaucratic obstacle to daily work. Ultimately, care documentation in Germany has become a major cost factor and one of the main reasons for low job satisfaction among nursing staff. 

Despite the implementation of SIS (Structured Collection of information - structured collection of information) to reduce bureaucracy and overhead costs in the care system, the overall costs for documentation are still around €2.7 B annually. This means that in Germany, on average, a professional caregiver spends about 11% of their working hours on documentation. One can easily imagine what this means to people who once started their working life with the aim of caring for people. It is easily imagined that in this context the openness of the care workers towards new „digital“ tools is not on its possible all-time high. But it's not only about the bad allocation of their work- and lifetime.  

Most of the current nursing information systems („nursing information systems“) can be called cumbersome at best. Their system architecture is monolithic. The underlying technology stacks date back to when they were developed in the 1990s. Data models and terminologies are proprietary by the providers and entirely non-transparent. Standardised interfaces do not exist. Interoperability with any other kind of IT system used in long time care, short time care, or any other sector of the health or social system is inhibited by design.  

To sum it up: On one hand we have a user group that  

• • Has made bad experiences with digital tools at the work place since years
  • Does not have a particular affinity for digital technology: ‘I am here to help people, not to operate computers.’ 
  • Suffers from a high workload and from a very high mental load.

On the other hand, we have an  

• • IT set-up that does not allow for the integration of external functions and services because of its closed architecture and
  • Established IT service providers that make use of the vendor lock-in effect and
  • Social service organisations that hesitate to change core IT systems because they can foresee the costs and the reaction of their employees.

Therefore, each new innovative tool is another non-integratable stand-alone solution that leads to additional overhead efforts from the login up to the documentation of its usage. These were the conditions, with their prevailing path dependencies, when the living labs in Germany started operations. They are typical (at least in Germany) of the starting conditions for actual digital transformation in all industries and societal sectors. 

Under these adverse conditions in both German living labs the lab managers achieved something that is fundamental to transformation and cannot be overstated: The active engagement of professional care givers, care managers, and other stakeholders in their respective organisations.

How this was achieved is subject to the reports of the Living Labs in detail. Therefore, here we only give some information about five most important key success factors: 

• • Management sponsorship:
    Both, the Evangelische Altenhilfe St. Georgen and the Diakonie Kork are innovative by purpose. The top management has a strong innovative attitude and works actively on using socio-technical innovations to both improving the quality of services provided and making the whole organisation more labour and cost efficient. Therefore, the Living Labs and their managers have full management support. 
  • Strategic approach:
    Innovation management follows a strategic approach and a positive vision. People know why and what for they want to innovate. Decisions on which innovative solutions shall be evaluated, what would be desirable outcomes, under which conditions an implementation in regular daily proceedings could be possible can be taken on the solid ground of a common understanding what has to be achieved in order to make the whole organisation „future-proof“. 
  • Social and vertical integration of the lab managers:
    Trust is key! As it is the case with all four Innoclusion living labs their managers are very well respected by the target groups and internal and external stakeholders, particularly by beneficiaries and their relatives, professional and informal care workers and the management. The lab manager's approach in selecting, evaluating and implementing innovative solutions is bottom-up and top-down as well. They are personae of an effective vertical integration. 
  • CoLLaboration at eye level:
    The living lab approach chosen here is a collaborative innovation approach. There are no technicians or other experts telling potential users what to do or how to use something. Members of the target group are encouraged to engage actively. They learn that their engagement is not only requested in terms of passive feedback, but also in terms of active engagement that delivers ideas and concepts for altering and improving existing processes. People learn that their input is not only accepted, but desired. This is because their input is truly valued, not just in words, but in action, when they see their proposals implemented in a new iteration of a device or service. 
  • Cross-sectoral expertise:
    When it comes to digital transformation the social sector in many countries could be regarded as a laggard. But the social sector is also delayed with regard to another, even more fundamental aspect of socio-economic development: industrialisation. Our societies are industrial societies organised on the base not of interpersonal relations but of institutions, laws, rules of procedures, and so on. The social sector is widely regarded as a residuum of the lost socio-transactional conception of our middle age societies and by many as a refuge of „profound humanity“. This idealisation does not work out any more as the basis of a social sector that provides good, really human care and support. The task at hand is the „industrialisation“ of care work that leads to a better care and more human work than before. The design of „industrial“ - that means thoroughly designed, fully integrated, technology-enabled - proceedings and processes allows for both, a maximum and stable delivery of care and the avoidance of any kind of waste - maximum efficiency. Industrial work at industry leading companies operates at a maximum level of quality of work. For example, at SEW Eurodrive it's the worker who is fully in charge with the design of her workplace and enjoys a maximum of freedom to operate in his area of responsibility. This leads to something widely regarded as impossible: SEW Eurodrive can deliver its products to lower costs and to a better quality than any competitor, even better than the Chinese. Not to mention that it is a “great place to work”. This is just one example for industrial approaches that could be adapted and used in the care sector. To make the use of the experiences and achievements of other industry sectors happen, cross-sectoral, namely industry expertise is necessary.

These factors have established the foundation on which what started as a Living Lab to determine the value that innovative solutions may (or may not) create for stakeholders in the care process has evolved into a key means of driving the organisation's digital transformation and that of the entire social sector.