• Reflective exploration into connected care in Larvik - <span style="font-size:  34px; font-weight:600">Reflective exploration into connected care in Larvik</span>

<span style="font-weight: 600; color:grey">Master of Design at The Oslo School of Architecture & Design</span>
<span style="font-weight: 600; color:grey">A collaborative project with Larvik Kommune for our Service Design Futures</span>
<span style="color:grey">*Professor: Josina Vink | Manuela Aguirre  | Alberto Soriano*
</span>

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<span style="font-size:24px"><span style="font-weight:600">Overview</span></span>

<span style="font-size:  26px">During 10 weeks, we worked alongside Helsehjelpen and Remote Care, two innovative pilot projects which are entangled in the complexities of Larvik’s healthcare system</span>

<span style="font-weight: 600">What</span>
Helsehjelpen focuses on helping people help themselves by connecting them to the right healthcare services. Remote Care provides assistive technologies and connectivity between patients and health service providers.

<span style="font-weight: 600">Why</span>
To support awareness and a culture of exploration in Helsehjelpen & Remote Care. To support the ongoing evolution of the services and ultimately the service ecosystem.

<span style="font-weight: 600">How</span>
We developed this project through field research, data analysis and designerly experimentation with multiple actors in Larvik’s healthcare system.

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<span style="font-size:24px"><span style="font-weight:600">1. Approach</span>

To start working within such a complex environment, we used certain approaches to help us untangle the situation.

<span style="font-weight: 600">Three horizons</span>
A look into the current, future and transitional phases of a system. We used it to discuss Helsehjelpen and Remote Care’s long-term vision and challenges in reaching it.

<span style="font-weight: 600">Service Ecosystems Design</span>
An approach that focuses on the intentional, collective shaping of social structures to co-create value in a specific context. This approach helped us explore the relations between the different Larvik actors

<span style="font-weight: 600">Social Structures</span>
People’s shared rules, norms, roles and beliefs and their physical enactments. This was used to reveal the ‘taken for granted’ habits and thoughts the staff members in Helsehjelpen and Remote Care have embedded.

<span style="font-weight: 600">Tiny Tests</span>
Simple experiments that help bring awareness to and test social structure changes. Through tiny tests we explored the underlying assumptions of the participants.

<span style="font-weight: 600">Participatory Service Design</span>
A service design approach which engages actors in a codesign process. The approach helped us gather rich data from all of the diverse actors we interacted with.

<span style="font-weight: 600">Field Research</span>
Our primary way of gathering data during the research period. We used structured and unstructured interviews, on-site observations, visualization and tangible tools to engage with the interviewees.

    Reflective exploration into connected care in Larvik

    Master of Design at The Oslo School of Architecture & Design
    A collaborative project with Larvik Kommune for our Service Design Futures
    Professor: Josina Vink | Manuela Aguirre | Alberto Soriano


    Overview

    During 10 weeks, we worked alongside Helsehjelpen and Remote Care, two innovative pilot projects which are entangled in the complexities of Larvik’s healthcare system

    What
    Helsehjelpen focuses on helping people help themselves by connecting them to the right healthcare services. Remote Care provides assistive technologies and connectivity between patients and health service providers.

    Why
    To support awareness and a culture of exploration in Helsehjelpen & Remote Care. To support the ongoing evolution of the services and ultimately the service ecosystem.

    How
    We developed this project through field research, data analysis and designerly experimentation with multiple actors in Larvik’s healthcare system.


    1. Approach

    To start working within such a complex environment, we used certain approaches to help us untangle the situation.

    Three horizons
    A look into the current, future and transitional phases of a system. We used it to discuss Helsehjelpen and Remote Care’s long-term vision and challenges in reaching it.

    Service Ecosystems Design
    An approach that focuses on the intentional, collective shaping of social structures to co-create value in a specific context. This approach helped us explore the relations between the different Larvik actors

    Social Structures
    People’s shared rules, norms, roles and beliefs and their physical enactments. This was used to reveal the ‘taken for granted’ habits and thoughts the staff members in Helsehjelpen and Remote Care have embedded.

    Tiny Tests
    Simple experiments that help bring awareness to and test social structure changes. Through tiny tests we explored the underlying assumptions of the participants.

    Participatory Service Design
    A service design approach which engages actors in a codesign process. The approach helped us gather rich data from all of the diverse actors we interacted with.

    Field Research
    Our primary way of gathering data during the research period. We used structured and unstructured interviews, on-site observations, visualization and tangible tools to engage with the interviewees.

  • Reflective exploration into connected care in Larvik - <span style="font-size:24px"><span style="font-weight:600">2. Research</span>

We (A class of 12) conducted <span style="font-weight: 600">46 Interviews</span>
over <span style="font-weight: 600">2 Days</span>
at <span style="font-weight: 600">Larvik Kommune</span>

<span style="font-weight: 600">Our interviewees included</span>
Ambulant nurses / specialists / partners of patients / primary care doctor / politicians / cancer nurse / home services /organisational leaders / nursing home / occupational therapists / project leaders and more.

<span style="font-weight: 600">Experience</span>
In this first phase, we created guidelines and tools to help our interview process. For two days, we conducted field research with several actors from different organizations in the system. We also brought prompted activities into the field and used visual note-taking approaches in our interviews.

<span style="font-weight: 600">Learnings - Reflections</span>
It was critical for us to be flexible and adaptive, as we faced unexpected situations and unforeseen changes that altered our plans. Holding constant sharebacks, making on-the-fly tools, and exchanging our findings in a rich work space helped to keep us up to speed and determine how to proceed with the next interviews.

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<span style="font-size:24px"><span style="font-weight:600">3. Analysis</span>

After gathering all this data, we needed to interpret and analyze it in a way that made sense, so we examined 4 focus areas. We later facilitated online workshops to dig deeper.

<span style="font-weight: 600">Service Ecosystem</span>
Through the Service Ecosystem we wanted to get an overview of who were the actors across Larvik, as well as how they are related and connected across different levels of aggregation.

<span style="font-weight: 600">Remote Care</span>
We wanted to explore the future vision of Remote Care and the potential challenges they face to get there.

<span style="font-weight: 600">Helsehjelpen</span>
We aimed to get a clear idea of how Helsehjelpen wants to define themselves in the near future and explore how they can get there.

<span style="font-weight: 600">Emerging Themes</span>
We were looking to understand and explore the common themes that came up during our interviews with the different actors of the system.

    2. Research

    We (A class of 12) conducted 46 Interviews
    over 2 Days
    at Larvik Kommune

    Our interviewees included
    Ambulant nurses / specialists / partners of patients / primary care doctor / politicians / cancer nurse / home services /organisational leaders / nursing home / occupational therapists / project leaders and more.

    Experience
    In this first phase, we created guidelines and tools to help our interview process. For two days, we conducted field research with several actors from different organizations in the system. We also brought prompted activities into the field and used visual note-taking approaches in our interviews.

    Learnings - Reflections
    It was critical for us to be flexible and adaptive, as we faced unexpected situations and unforeseen changes that altered our plans. Holding constant sharebacks, making on-the-fly tools, and exchanging our findings in a rich work space helped to keep us up to speed and determine how to proceed with the next interviews.


    3. Analysis

    After gathering all this data, we needed to interpret and analyze it in a way that made sense, so we examined 4 focus areas. We later facilitated online workshops to dig deeper.

    Service Ecosystem
    Through the Service Ecosystem we wanted to get an overview of who were the actors across Larvik, as well as how they are related and connected across different levels of aggregation.

    Remote Care
    We wanted to explore the future vision of Remote Care and the potential challenges they face to get there.

    Helsehjelpen
    We aimed to get a clear idea of how Helsehjelpen wants to define themselves in the near future and explore how they can get there.

    Emerging Themes
    We were looking to understand and explore the common themes that came up during our interviews with the different actors of the system.

  • Reflective exploration into connected care in Larvik - <br>
<span style="font-size:  26px">Analysis of Helsehjelpen (The Focus area that I worked with)</span>

Duration: 1 Week
Google Docs/ Miro

<span style="font-weight: 600">The role of the patient</span> is currently passive. But their possible role in the future could be of a proactive partner in their own healthcare. To enable this, we need to switch the mental model. 

RIght now there is no clear <span style="font-weight: 600">role for Helsehjelpen.</span> A possible way to solve this would be to have a dialogue with the whole service ecosystem on helsehjelpen and their tasks as a navigator. 

There seems to be an <span style="font-weight: 600">identity crisis and lack of understanding</span> as to what actually Helsehjelpen is. A branding and positioning exercise could prove to be quite useful for them.



    Analysis of Helsehjelpen (The Focus area that I worked with)

    Duration: 1 Week
    Google Docs/ Miro

    The role of the patient is currently passive. But their possible role in the future could be of a proactive partner in their own healthcare. To enable this, we need to switch the mental model.

    RIght now there is no clear role for Helsehjelpen. A possible way to solve this would be to have a dialogue with the whole service ecosystem on helsehjelpen and their tasks as a navigator.

    There seems to be an identity crisis and lack of understanding as to what actually Helsehjelpen is. A branding and positioning exercise could prove to be quite useful for them.

  • Workshop

    Duration: 30 minutes
    Tools: Zoom (Annotate Tools)

    Brain-dump
    What could be done to make the user more responsible for their health? Write any big, small, practical or far fetched ideas!

    Hypothetical service experience
    Imagine Helsehjelpen was guiding a hike. What personality traits would it need? What tools would be useful? Why?

    Metaphor exploration
    What image is the best metaphor to express the identity of Helsehjelpen? Why? Which one do you not relate with Helsehjelpen?


    The emergent themes from our analyses drove us into three exploration realms for the upcoming designerly experimentation.

    Clarifying & communicating identities
    One of the things that surfaced in our observations is that it was difficult to communicate the desired identity and service offering to patients and providers in the system. We were curious about how uncovering different actors’ points of view might help in shaping their identity a bit more.

    Focusing the service scope
    With such a novel and broad service offering, it became difficult to draw the line on where Helsehjelpen and Remote Care should fit in or not. We experimented how they could provide services in uncommon scenarios and help them reflect on what they want to do and what they can do.

    Supporting Collaboration
    From the research, it was apparent that having good collaboration was critical for moving forward, but difficult to manage inside and across the organizations in the system. Since these collaborations are so important for the patient’s services, we thought it would be valuable to spark conversation around this
    tricky topic.


    4. Tiny tests

    What?
    Tiny tests are small experiments that help explore and bring awareness to social structures. They differ from testing detailed prototypes because their value is not output centered; rather, their value is mainly centered on the insights provided by the process and how they inform directions for long-term change.

    Why?
    Tiny tests were used in this phase because they help bring awareness to social structures in a quick, accessible and iterative way. We used them as a method to explore the participant’s social structures under specific situations. Through the tests we also examined our own hypotheses and assumptions.

    How?
    The tests were performed by focusing on which rule, norm or behavior to challenge; setting a specific goal and task to explore it; and reflecting on the experience. This way the participants can feel what it is like to do something differently, talk about something in a new way, or notice roles and norms they wouldn’t usually think about.

  • Reflective exploration into connected care in Larvik - <span style="font-size:  26px">Tiny test A letter from Helsehjelpen (Ameesha + Ann Kristin)</span>

Participants: 3
Duration: 30 minutes
Tools: Zoom + MIRO

<span style="font-weight: 600">Task</span>
In a facilitated discussion, the Helsehjelpen team built a letter that could be sent to all the residents of Larvik.

<span style="font-weight: 600">Aim</span>
The aim was to portray Helsehjelpen in the right way, and to create a dialogue between Larvik of citizens and Helsehjelpen.

<span style="font-weight: 600">Social structure</span>
Introducing a new norm

<span style="font-weight: 600">Learnings + Reflection</span>
There was an ongoing and interesting discussion going on around not only words, but also: why are words important? What is the purpose of the letter itself? There was common agreement around moving from a formal, typically “public sector language”, to a more emotional, engaging and personal language, to help increase the feeling of ownership. It is important that the users feel ownership to the service, this can be done through thoughtful use of language. “I think that “to offer” something, is words that are creating distance, it’s something that we use when we talk about goods and services, not people.”

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<span style="font-size:24px"><span style="font-weight:600">5. Reflections</span>

<span style="font-weight: 600">Keeping it tiny</span>
In conducting these tests we experienced the value of keeping the test “tiny”, low threshold and playful. Doing this helped the tests be engaging, understandable for the participants and insightful.

<span style="font-weight: 600">Engagement</span>
By having different test types to work with, it was interesting to notice that the engagement of the
participants varied per case, especially between the digital and physical formats.

<span style="font-weight: 600">Participants</span>
The amount of participants varied from individuals to small groups. In our experience both are equally valuable to get insights.

<span style="font-weight: 600">Being Flexible</span>
When the participants are reflecting on the test experience, it is important to ask open questions related to the task while still remaining flexible and observant of what we don’t expect.

<span style="font-weight: 600">Always a lesson</span>
There is always a lesson to be extracted. If the test goes as expected or not, the result will still reveal something about the participants and the social structures that guide them. It’s good to think: “If the test was not successful, what does it tell us about the surrounding social structures?”

<span style="font-weight: 600">Testing assumptions</span>
The tests were also useful to check our initial assumptions. In this sense, some of our findings were contradicted, reinforced and diverged from the data we gathered before.

<span style="font-weight: 600">Worth the time</span>
It is also important that the participants feel that the tests are relevant for them. Some participants expressed that the tests were useful in making them aware of things they take for granted in everyday work and routines.

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<span style="font-size:24px"><span style="font-weight:600">6. Big Picture Learnings (Helsehjelpen + Remote care)

<span style="font-weight: 600">Challenges</span>
Even though Helsehjelpen and Remote Care are originally two pilots, they are now deeply mixed in their tasks and routines, which affects their work structures and roles. These challenges are reinforced by the staff’s work ethics and their excessive amount of work.

<span style="font-weight: 600">Vision</span>
The Helsehjelpen team seems to be on the right path towards a common vision of what their service offerings and focus are, but they currently express it in different ways.

<span style="font-weight: 600">Communication</span>
By surfacing the different visions of what and who the team should be, they can quickly become even more aligned and communicate a clear message to the right people.

<span style="font-weight: 600">Ownership</span>
Patient ownership is a core element of Helsehjelpen’s service offering, this can be reinforced in the use
of the communicated language. We see the phrase “Help to self help” as core to the future of Helsehjelpen and Remote Care.

<span style="font-weight: 600">Our project deliverables</span> are not focused on typical service design outputs like service blueprints or journey maps, but instead on lessons and reflections from the whole process. We recognize that the processes we went through, from research through to the tiny tests, only scratch the surface of the Larvik healthcare system. However, by supporting the already existing culture of exploration with more intention and thoughtfulness, we hope the staff at Remote Care and Helsehjelpen can proactively study and shape their collective and individual social structures through small-scale actions, and ultimately inspire the bigger system to make a difference for the citizens of Larvik.

    Tiny test A letter from Helsehjelpen (Ameesha + Ann Kristin)

    Participants: 3
    Duration: 30 minutes
    Tools: Zoom + MIRO

    Task
    In a facilitated discussion, the Helsehjelpen team built a letter that could be sent to all the residents of Larvik.

    Aim
    The aim was to portray Helsehjelpen in the right way, and to create a dialogue between Larvik of citizens and Helsehjelpen.

    Social structure
    Introducing a new norm

    Learnings + Reflection
    There was an ongoing and interesting discussion going on around not only words, but also: why are words important? What is the purpose of the letter itself? There was common agreement around moving from a formal, typically “public sector language”, to a more emotional, engaging and personal language, to help increase the feeling of ownership. It is important that the users feel ownership to the service, this can be done through thoughtful use of language. “I think that “to offer” something, is words that are creating distance, it’s something that we use when we talk about goods and services, not people.”


    5. Reflections

    Keeping it tiny
    In conducting these tests we experienced the value of keeping the test “tiny”, low threshold and playful. Doing this helped the tests be engaging, understandable for the participants and insightful.

    Engagement
    By having different test types to work with, it was interesting to notice that the engagement of the
    participants varied per case, especially between the digital and physical formats.

    Participants
    The amount of participants varied from individuals to small groups. In our experience both are equally valuable to get insights.

    Being Flexible
    When the participants are reflecting on the test experience, it is important to ask open questions related to the task while still remaining flexible and observant of what we don’t expect.

    Always a lesson
    There is always a lesson to be extracted. If the test goes as expected or not, the result will still reveal something about the participants and the social structures that guide them. It’s good to think: “If the test was not successful, what does it tell us about the surrounding social structures?”

    Testing assumptions
    The tests were also useful to check our initial assumptions. In this sense, some of our findings were contradicted, reinforced and diverged from the data we gathered before.

    Worth the time
    It is also important that the participants feel that the tests are relevant for them. Some participants expressed that the tests were useful in making them aware of things they take for granted in everyday work and routines.


    6. Big Picture Learnings (Helsehjelpen + Remote care)

    Challenges
    Even though Helsehjelpen and Remote Care are originally two pilots, they are now deeply mixed in their tasks and routines, which affects their work structures and roles. These challenges are reinforced by the staff’s work ethics and their excessive amount of work.

    Vision
    The Helsehjelpen team seems to be on the right path towards a common vision of what their service offerings and focus are, but they currently express it in different ways.

    Communication
    By surfacing the different visions of what and who the team should be, they can quickly become even more aligned and communicate a clear message to the right people.

    Ownership
    Patient ownership is a core element of Helsehjelpen’s service offering, this can be reinforced in the use
    of the communicated language. We see the phrase “Help to self help” as core to the future of Helsehjelpen and Remote Care.

    Our project deliverables are not focused on typical service design outputs like service blueprints or journey maps, but instead on lessons and reflections from the whole process. We recognize that the processes we went through, from research through to the tiny tests, only scratch the surface of the Larvik healthcare system. However, by supporting the already existing culture of exploration with more intention and thoughtfulness, we hope the staff at Remote Care and Helsehjelpen can proactively study and shape their collective and individual social structures through small-scale actions, and ultimately inspire the bigger system to make a difference for the citizens of Larvik.

Reflective exploration into connected care in Larvik

Service Design