Living Labs as part of the framework for the successful digital transformation of social services

 in other industries with the use of ITC in the care sector its core came increasingly out of sight. A tool implemented to support the value creation process of the care system2 became a tool to serve administrative services and, in the end, a monstruous leviathan that serves overwhelming regulations and swallows ever more organisational energy. It seems the genuine value creation process, the care itself, became an unfortunately unavoidable side effect of the care system’s administration.  

To make digital transformation a means of enabling good care and support with those in need of it and of fostering inclusion, first and foremost this transformation has to refocus on the core of the value creation in the social system: 

• • What procedural and structural transformations are necessary to provide good care and support, to foster inclusion under the conditions of fundamental change of the system environment?
  • What kind of technical (not only digital, but typically convergent) tools and systems are necessary to enable and support new methods, proceedings, structural patterns etc.
  • How could all this be integrated into most effective and highly efficient new socio-technical practices?

Highly efficient integrated end-2-end processes do not rely on a fully integrated single peace of technology but on the seamless flow of data and information between different specialized applications that allow for a fully integrated, seamless workflow of different agents. 

The health sector in Germany is a showpiece of a very costly social sub-system that is highly inefficient due to a fully non-interoperable IT systems landscape, hence producing lots of unproductive process steps, high costs, and poor outcomes.  

Currently in the care sector “only” 11% of the working time in Germany is used for documentation. In hospitals physicians spend more than 50% of their working time on serving not patients but different IT systems often more than one time with the input of the same data. Because most of the IT systems in use have no interfaces, do not use a common terminology etc., data are not stored in a structured manner, therefore cannot be analysed automatically, and even have to be transferred between to departments by printer-scanner/keyboard interfaces. 

Aside from the consequences for the quality of medical treatment, another adverse effect of this ’system‘ is that the quality of data is very poor – too poor to be used for remuneration purposes. This results in extremely long cash-to-cash cycles and eight-digit annual deficits at large clinics, as medical services cannot be invoiced. 

Under these circumstances using data in order to increase the quality of medical care is nothing but illusive. 

Whether the over-aged technology stack for elderly care and support for people with disabilities has to be set up entirely new or could be renovated, interoperability that allows for a seamless data flow between innovative technical solutions and all involved systems is an indispensable prerequisite for a successful transformation of the social sector. 

Here this interoperability should not be limited to the social sector alone but extended to the health sector. For that reason, already existing international standards such as HL7 FIHR and openEHR should apply and if necessary extended e.g. with respect to the integration of LTC specific terminologies such as SIS. (For more information on this subject see Why interoperability matters!). 

At present, the usage of digital technologies in elderly care and disability support is still limited. With the closed documentation systems today in place in Germany each additional innovative solution would be a non-interoperable stand-alone tool, and its usage would lead to additional administrative overhead for the professional caregivers. The availability of data, their quality, integrity, and consistency would not increase but decrease. At the end of the day, without seamless interoperability on the base of international standards, the “digitalisation” of the care system would lead to a situation similar to the one in the German health sector. Nobody can really want that. So, when transforming the LTC sector lets learn from the health sector and leapfrog it be means of total interoperability 

We should never forget: It’s not about technology. It’s about good care and support for those in need. Not only administration but technology as well is not a purpose but nothing but a means to a social end. Humans are not created to serve technology. Technology is made to serve humans. 

The transformation of the care sector needs a systematic approach. This approach cannot be developed from a mere academic perspective. Practical experience is the basis for respected expertise that allows for an integration of the different stakeholders into a vertically aligned as well as bottom-up driven transformation process. The living labs, as established and developed within the Innoclusion project, create the ideal point at which to apply leverage for transformation. 

Here not only solution providers with members of the organisation to which the LLabs are attached could evaluate a/o develop single innovations together. The LLabs provide the space to systematically develop the new socio-technical action patterns that make up for the transition as a whole. This development will be collaborative  in integrating more and more care organisations into a joint initiative. First steps into this direction already have been gone, e.g. by setting up an “Innovators’ Meet-up”, an initiative by the LLab in Kork. LLabs in other European countries already existing or yet to be set up can become part of the initiative. Information and best practices will be spread and shared by the respective SIGs of the EU|BIC network, e.g. 

The role of these future transformation centres will be to orchestrate and manage development activities not in a mere user-centric but a joint collaborative way. As mentioned above, the subject of transformation centres will not be the development of technology alone. The transformation centres intertwine the exploration and if necessary, development of technical means with and for the development of new proceedings. In doing so they speed up the process of developing new socio-technical patterns that are the necessary prerequisite that an invention could become a large scale innovation (see Why Living Labs are so important for the transformation). This is the decisive edge of the transformation centres that allow the social sector to cope with exogen threats such as demographic change, less funding, less (skilled) workers, etc.

Even if the term industrialisation might cause some emotional deterrence when used in connection with the transformation of the care system we have to face reality: industrialisation is the only known socio-economic pattern that allows for the continuous provision of a large amount of goods in a stable state of predefined quality to affordable costs. To this end, it is not necessary to build industrial processes as it has been done in former times by Manchesterism or Taylorism (see Key success factors).  

It is utterly important to dispense professional and informal care workers as far as thinkable from everything that does not pay into the core value creation processes of the care industry and to automate each and every task that has (for jointly agreed reasons) not to be completed by real humans. Human labour is – for good reasons – the most precious and therefore the most expensive resource of the care system. It has to be allocated very thoroughly. Care workers may not suffer either from burn out nor from bore out. 

Standardisation is prerequisite to the industrialisation and the automatisation of processes. Standards and standardisation frameworks are to be developed there, where new applications, procedures, and with this new socio-technical action patterns for an industry will be developed. For the care industry the future transformation centres developed from the former Innoclusion LLabs have to take up that role – simply because there is no other place where the information necessary for standardisation can be collected systematically in such an easy way. National and international bodies for standardisation rely on the input by the transformation centres.

When it comes to the necessary increase of productivity of care workers, automatisation is key. Here increasing productivity and enhancing the quality of work have to go hand in hand. Structurally secured is enhancement of the quality of work by the vertical aligned bottom-up approach of the LLabs / transformation centres. Care workers are process owners when it comes to the development and with that the way of automatisation of their workplaces.  

There are several areas that are very suitable for automatisation, e.g.: 

• • Documentation: as mentioned above documentation costs care workers around 11% of their working time – time they cannot spend with those they care for.
  • Information management: Who needs which information with which context in which given situation? How can information flow and task management be aligned optimally? How could this contribute to reducing the mental load of carers and caring relatives?
  • Shift management: Shift plans are subject to daily changes. Shift management is very often reason for job dissatisfaction. AI based shift planning and management in real time not only frees one care worker per care unit from administrative hustle but also increases job satisfaction with the whole team.

There are a lot more opportunities to reduce the waste of time and resources by intelligent automation alongside an increase in the quality of care. The transformation centres are the place where automation of care processes and particularly it’s service and management processes can be developed systematically. 

Transformation centres developed from the Innoclusion living labs will have an important role when it comes to the continuous improvement of care and the necessary enabling processes on the level of an individual organisation and its system environment. The transformational processes will not always and in all aspects of the organisational life cycle run on the high pace level as it is necessary by now. Transformation proceeds discontinuously and its outcomes are necessarily subject to former improvement that is kind of a small-scale transformation. The same resource that supports the organisation to transform is optimally qualified to be the centre for a vertical aligned bottom-up approach for continuous improvement. The transformation centres provide all tools, methods and processes that are necessary to implement continuous improvement both as a standard procedure and a part of the culture of an organisation.

In all European countries the social and with it the system for care and support of elderly and disabled fellow citizens is subject to change and hopefully to improvement. The transformation centres are predestined to take part in developing and implementing the necessary structures for the continuous (and sometimes disruptive) improvement of a social care system on a regulatory, political, economic, und societal level.  

The more the transformation centres reach out to support other care organisations in their transformative development the more practical experience as well as data and information for evidence-based decision making will be aggregated by the transformation centres and their coLLaboration partners. When it comes to questions about the design of a social system that enables good care and good care work to reasonable costs the transformation centres can provide meaningful information and proven knowledge.