Moving towards Person-Centred Innovation for Ageing Better
The report below was produced by David Wilcox and Drew Mackie in February 2015 following an exploration over several months with the Digital Inclusion Group of Age Action Alliance. Since then we have changed focus, as reported below, to Living Well in the Digital Age. We ran a workshop in March 2015 hosted by the Department for Communities and Local Government to take forward ideas for Living Labs. Workshop report here
The exploration into how to use technology for Ageing Better started in the autumn of 2014 with the idea that it should be possible to map organisations and resources in the field to enable more sharing of experience, reduce constant re-invention, and promote cooperation. The Big Lottery Fund hadn‘t done that centrally in 2014 for their five-year £82 million Ageing Better programme - could we demonstrate an alternative bottom-up approach, building on past work in the field?
This report summarises the journey that is documented more fully on our exploration site - and comes to the conclusion that we should switch our focus from technology in Ageing Better, at a policy and programme level, to technology for Living Well as individuals, together with what is needed to support that in local communities and centrally. The challenge is that every individual has different interests and preferences – so one size of support doesn’t fit all.
Over the four months from September 2014 we moved beyond the basic idea of mapping of resources and organisations to:
- establish a web site and blogs for the exploration, and on that …
- generate some talking-point provocations and challenges
- set up an ideas platform to gather suggestions on how to address the challenges
- show how ideas can be translated into action through workshop games and simulations
The rationale was that we needed to know what we were looking for in mapping, before starting a big trawl. It‘s been a voluntary effort so far, and we needed to focus. We decided that if we could generate ideas on tech for Ageing Better, and cluster those, we could then look at which organisations might share experience and perhaps work together.
We were able to test some of our emerging ideas against a wide-ranging discussion at a symposium on technology and innovation, organised by the South East Forum on Ageing. Our blog post linking our exploration to the SEEFA discussion was re-published by Age Action Alliance.
What emerged from that - and our other explorations - was that the idea of promoting cooperation among organisations in the field, to achieve greater benefits and innovation, was somewhat naive. As other commentators confirmed, co-operation is difficult because organisations are competing with each other for funding; innovation is difficult because few organisations actually use social technology. The major challenge is culture. We could map ideas, organisations, and resources - but the likelihood of making any difference is low.
At this stage - in February 2015 - we are considering a change of focus towards the individual. It seems likely that the greatest progress will be made by exploring how older people - and those who help - can choose and use technology for personal well-being.
Tony Watts, chair of the South West Forum for Ageing, has set out how to make progress by linking digital health and digital inclusion. Roz Davies provides a model of citizen-centred care and digital health provision. The Grey Cells initiative from the Department for Communities and Local Government provides a framework for digital engagement that could help connect the individual and programmatic models.
So at this stage we are considering reframing the exploration towards Living Well with Technology - what can be done to enable and support the individual. Although our focus is on older people, the lessons will be more widely applicable.
Mapping, connecting, convening is needed at the programme level, but we don’t have the resources to do that, or any leverage to achieve much change. We do, however, suggest some modest ways forward.
Aim of the exploration - and how it started
Ageing Better Innovation is an open, collaborative exploration into how innovations, enabled by digital technology, can help support personal well-being, and services for ageing better.
It builds on an earlier exploration carried out in 2012-13 for the Nominet Trust. That exploration was designed to produce a paper, with back up resources, and inform a funding challenge programme to support a number of substantial projects. The focus of the programme became life transitions, rather than later life.
We wanted to build on that work to see whether we could generate some ideas and actions that might not require special funding, build a network to enable some collaborations, and kits to help people adopt and engage with technology for ageing better. We wanted to do it in a way that is conversational in style and accessible to anyone interested, rather than a more formal research project. We‘ve worked on the basis that if people can‘t talk about issues in relatively straightforward terms, then they won‘t be able to take action.
The current exploration is being undertaken with the Digital Inclusion Group of the Age Action Alliance, and is led by David Wilcox and Drew Mackie. It is part of our development of a Living Lab, described here.
So far the programme has been unfunded, so at this stage it is more of a demonstration of what‘s possible than a full exploration of all aspects of a highly complex field.
The spark for a new exploration was the belief that the Big Lottery Fund‘s £82 million Ageing Better programme, launched in September 2014, could make a far greater contribution to tackling social innovation if it embraced the potential for digital innovation and wider knowledge sharing.
The exploration process
We then began a process similar to the early stages of that undertaken for the Nominet Trust. From September 2014 to February 2015 we:
- Developed some talking-point provocations
- Reviewed research - resources here
- Generated some challenges from discussion about the provocations
- Created a platform to gather ideas to address the challenges
- Added to the provocations and ideas, particularly from a seminar organised by the South East Forum for Ageing (SEEFA) in January
- Created a first map from the ideas
- Explored frameworks that would help connect the ideas to tech for personal well-being, and tech for services
- Further developed some of our LivingLab games that could provide the basis for design kits for individuals, enablers and organisations.
The provocations and challenges
The provocations and challenges are detailed here. After a first round of discussion, we summarised the provocations as:
- There isn‘t an opt-out from technology - but you can choose how much you participate. (Technology has changed the world dramatically, and it will continue to change. What‘s important is enabling people to choose how they engage).
- Government is concerned that many older people are not online - but there are limits to what government can do. (People will engage with what‘s interesting and useful to them, and use devices that most suit their needs).
- Everyone needs Internet access but beyond that, no one size fits all. (Cost is a barrier, and then personalisation is important).
- Computer courses and basic skills training don‘t meet the needs of many older people. (Tablets are much easier to use than computers for most purposes, and smart phones and smart TVs may also meet many people‘s needs).
- Simpler interfaces are needed for computers and mobile devices - not just more functions. (Older people should be involved in design).
- Relatively few organisations in the ageing field are actively engaged in the online world or using collaborative tools. (Using social technology should help enable greater cooperation).
- Digital social innovations in services are not scaling. (There‘s too much focus on the tech, and not enough on what it does, together with a lot of re-invention).
- There is a raft of research, but little knowledge-sharing of that and day-to-day practice. (A lot of research is hidden and not transferred to practice. A culture of competitive tendering reduces people‘s inclination to cooperate and use what‘s already available).
- The energy for change lies with apps, connectors and storytellers. (To which we can add, evolution of trusted technologies such as TVs. Bring the storytellers together).
- The digital divide is no longer a useful metaphor. Reality is more complex.
These propositions were validated and expanded by curating and blogging discussion at the SEEFA symposium on ˜Transforming not excluding “ the impact of information technology and innovation on later life‘. The blog post was then republished on the Age Action Alliance site - which gave us further confidence in the content.
From the provocations we distilled these challenges:
- Promote greater understanding of ways that technology is changing the world that we all live in
- Influence current digital inclusion programmes towards an approach that recognises the importance of familiar technology, mobile devices, and personalised routes towards adoption.
- Encourage and support organisations in the ageing field in the use of social technology
- Facilitate conversations and stories that make it easier to develop inclusive discussion of digital inclusion and innovation
- Make better use of existing assets - research, practical experience and innovative projects that could be scaled.
- Promote ways to introduce innovation into the Big Lottery Fund‘s Ageing Better programme, and other programmes.
Insights from the symposium provided a finer-grain understanding of the challengers. There was discussion about constant re-inventing of the wheel, lack of collaboration, and a culture that does not favour innovation. These insights are summarised here.
We created an ideas platform, provided some starter ideas, and invited additional ideas, comments and votes from the Digital Inclusion Group and others. The ideas forum is here: https://abinnovation.uservoice.com/forums/279832-ageing-better-ideas and also embedded in the exploration site.
When we started the exploration one of the key aims was that we should map organisations and assets in the field in order to plan how to promote sharing of experience, cooperation and collaboration. We introduced the development of challenges and ideas to the process in order to get some focus for mapping - on the basis that you don‘t know what assets and collaborations you may be looking for unless you know the problem or opportunity. More here about mapping.
After generating ideas, we used the kumu.io network mapping software to demonstrate how ideas can be related.
Mapping people, organisations and assets
The next logical stage would be to consider who could move the ideas forward, and what resources there might be. In order to do that - subject to further funding - we could:
- Extend the ideas-gathering process to engage more people as ideas sponsors or supporters
- Review who among the sponsors and supporters, and elsewhere, might have enthusiasm and assets to move things forward
- Map people, organisations and assets against ideas and then do some action mapping to develop pathways for further development
Below is an example of a map that we developed at a workshop with Southwark borough council, to explore how a council could develop a digital participation strategy that made best use of local resources, in times of austerity.
Each node on the map can have additional information about resources
London Borough of Southwark – map from workshop
However, before going down the route of mapping organisations and resources for Ageing Better, we needed to consider just what is involved in bringing ideas to fruition. We need a framework for relating the big picture of programmes for ageing better, and digital inclusion, to the reality of people adopting technology. There are substantial barriers to organisations engaging. Here are the ones blogged from the SEEFA symposium, and then republished by Age Action Alliance:
- Organisations operate in a highly competitive funding environment, so they are reluctant to share ideas that might be used by someone else in a bid
- Funders and sponsors want organisations to demonstrate how their resources produced results. Collaboration could dilute that.
- Organisations want to promote their work and profile.
- There is comfort in staying within your professional silo
- Managers want to control and deliver ” not encourage innovation and exploration that might not meet targets
- Government wants scale and it is easier to do that through one-size rather than personalisation
- Senior people in London-based organisations are more easily able to go to events and network with policy people and funders than people outside London. There‘s not much incentive for the London circle to share.
- Networking is what you do to increase your knowledge and influence - not to help connect others with ideas and opportunities
- While social technology does not, on its own, enable cooperation and sharing, it makes it far more possible, and among those who use it engenders a culture for that.
- Most organisations, and their staff, in this field are trapped in old tech systems designed for a different age. Even if they want to use social tech they may not be able to.
- Learning has to be done in people‘s own time, often with their own devices
- Where social media is used, it is mainly for broadcast and marketing, rather than sharing useful resources
- Unless people are using social technology, they don‘t know what‘s possible
The other challenge for any programmes promoting the use of digital technology for ageing better is that all adoption of technology is personal, as explored in this series of blog posts. Unless people have the connection, skills, interest, confidence and support - in various measures - they will not be able to engage with complex offerings. There are excellent courses, online centres and tutors through these two programmes in particular - Digital Unite and Tinder Foundation - but they may not meet the needs of older people because, for example, there may be an emphasis on using computers for work-related activities, when the individual‘s starting point may be Skype on a tablet or TV. Similar issues may arise with other local programmes. It is difficult for them to provide individual pathways for older people.
Tony Watts, chair of the South West Forum on Ageing, addressed the issue in an article on the Age Action Alliance site:
For instance, huge amounts of money were spent in our country on encouraging people to go into libraries and learn how to use Microsoft Word, on clunky personal computers that would put off any first time user. Many have been put off because they have been made to feel that they are too old, too stupid to be part of the digital world.
I speak to so many older people who tell me they have given it a go, but they found it complicated, even bewildering. They‘ve now forgotten what they were taught, and the computer their son or daughter bought them lies unused. Or that - yes, they do have a computer, but they only go on once a day to see if they have any emails, and that‘s as far as they feel able to go.
There have to be clear benefits. Tony goes on to argue that digital health and care programmes and apps can provide a good route to digital inclusion - something we return to later.
The Tinder Foundation has a powerful infographic here summarising the Digital Divide: who is online and who is not; what people are doing; what actions are needed.
The exploration into tech and ageing better suggests that we need other additional frameworks to complement this landscape view.
The Grey Cells initiative, being developed by William Barker and his team in the Department for Communities Local Government, drops down to a finer focus on areas for service transformation, and what works in different programme areas.
As I wrote here:
On the left side of the diagram is stuff that government has to get right, including access, affordability, usability, and standards “ and on the right are the activities government wishes to support and hopes other people will get right. These include health and well-being, community participation, quality of life, supporting learning, and economic and working choices.
Each of the Grey Cells has links to back up documents, and William explains on the Public Service Transformation Network blog* how they developed the framework **.
The Grey Cells initiative started with a focus on older people and technology, but now offers an overall framework for digital engagement. The framework is backed up by a really impressive database of local case studies and good practice, a resource pack, as well as results from a number of events. More links in this post.
Update: Public Service Transformation Network blog is no longer online
A person-centred approach
Grey Cells provide a framework for policy, programmes and projects - but what does the world look like for an individual in the middle of the right hand cells? They will be attempting to cope with, and possibly adopt, technologies in some or all of the cells. We need another layer to the framework, and health and wellbeing provides a good route for exploring what that might look like.
In his article Tony Watts outlines a vision of joined-up, connected, citizen-centred care that provide one strong rationale for adopting digital technology:
My vision, and that shared by a rapidly growing number of people, is to equip every older person‘s home that requires it with a piece of equipment - a tablet or smart TV - that enables them to connect with their doctor or health visitor through Skype.
Moreover, this equipment is fed by sensors that enable their vital signs … blood sugar or oxygen level, heart rate, temperature… constantly monitored, with any alerts being sent to a network of carers … family and neighbours possibly as well as their hospital or doctor.
Their whole living environment could also be monitored - the room temperature, whether or not they had remembered to turn off the oven, whether they have gone out of the home, or got out of bed, opened the fridge that morning to get food…
As their needs change, or technology advances, new apps can be loaded. It evolves with THEIR needs.
That person-centred care requires a surrounding ecosystem of engagement and support - as does, for example, the use of technology to combat social isolation. To make best use of technology, people will need to adopt the mix of technologies that suits them, as I suggested here:
Instead of planning how we get more people into/onto the Internet (digital inclusion), accept many won‘t go there, and think in more detail about the networks of information and relationships we each inhabit, served by lots of different media. Then work through how to improve that experience in different cases (social inclusion).
From that social ecology perspective, the challenge is how to help people build the blend of newspapers, magazines, phone calls, visits, relationships and maybe online activities that is right for them
Roz Davies has developed a model that relates the individual to the surrounding programmes and support services, writing here:
The diagram below presents a vision of patient-centred care with the house of care in the centre surrounded and supported by a ring of digital health tools and connected to citizens/patients and communities by a ring of citizenship approaches
On these models, we need ways to help people develop their personal ecology of content, tools and relationships, and then also ways to develop the wider social ecologies of services, connections and support. The idea of social ecosystems is explored here.
Conclusions from the exploration so far - and where next
We think that we can conclude:
- There‘s lots of opportunities for innovation and use of tech for ageing better - but it is difficult to move forward on a broad front because of cultural and other barriers in organisations in the ageing and inclusion industries. There‘s great work being done - but also much re-inventing of the wheel. Competition for funding inhibits cooperation. Lack of familiarity with technologies limits development taking account of the consumer adoption of mobile tech. As this blog post summarised, the energy is around people apps and connectors - not organisations.
- We need a shift of metaphor and framework from digital divide. Instead of thinking how to get people to learn about computers, we need to focus on how to help people adopt just enough tech for their needs, and how to support that. The models needed are personal and social ecologies.
- We now need to experiment at several different levels: the individual, the surrounding social network and support system, and in programmes.
Overall, the issue is Living Well with Technology - rather than Bridging the Digital Divide.
Here are several ideas for moving forward:
- Use the workshop games and simulations that we have been developing for our Living Lab to help people play through the options at different levels, and then turn the games into kits.
- Test the ideas at a neighbourhood level
- Explore the scope for work with partnerships in the Ageing Better programme, or with towns and cities aiming to create Age Friendly places.
Kits, games and ecologies
This exploration is part of our Living Lab, where we have been developing workshop games to model choosing and using technology in the different levels or ecologies that we have identified. For example we addressed:
- How older people can use digital technology for personal well-being: we ran a workshop with Age UK London around some fictitious characters to show how a kit could help them explore and adopt digital technology.
- How community enablers may use digital technology: in 2012 we used the fictitious town of Slapham (later renamed Slipham) as the setting for this exploration into how community enablers can blend digital technology with face-to-face activity. We have since updated this game in work with Croydon Voluntary Action.
The games generally use a system of cards that include personas to start discussion around people‘s needs and interests.
The games can be developed into kits, by linking activities and tools to how-tos. We have experimented with an online system that, if developed, would enable people to create their own package of appropriate tools and guidance.
There may be opportunities in testing ideas locally:
- We are currently working with Croydon Voluntary Action on local mapping of resources, and enabling community connectors with social technology. This could show the potential for developing supportive networks for wellbeing.
- Previous work on Age Friendly localities could provide a way into working with one or more other localities.
- The South East Forum on Ageing have invited us to discuss possible support for their work, following the recent seminar reported here, and we are also in discussion with Positive Ageing in London.
Ageing Better partnerships
The original spark for the exploration was Big Lottery Fund‘s £82 million programme, and the apparent lack of digital innovation or provision for sharing of knowledge.
One or more of the partnerships that receive confirmation of funding in April might be a testbed for our ideas, if they are interested. On the other hand, there are some 15 partnerships that failed in their bids, but may still be trying to innovate without special funding.
The game referred to above was designed to simulate this situation, and was run successfully at a seminar with Globalnet21 and LGIU.
Overall design and development challenge
The key issue seems to us to be how to help people use technology for Living Well in different contexts, for example:
- With no immediate local support
- Through friends and family
- Where there may be local projects – whether community development or tech-related
- In a location where there is a major programme like Age Friendly places or Ageing Better
We can prototype what’s needed using the games described above by:
- Developing a number of personas to fill out what Living Well with technology may mean to different people – as we did in the workshop with Age UK London
- Then exploring what support might be provided in different contexts – for example, as we did with the fictitious town of Slipham
- Further exploring what digital capabilities are needed by people who may help, in different roles: for example, friend or family member, professional health or care support, trainer, community enabler.
As a first step we are circulating this report to people who have been involved in the exploration, and to members of the Age Action Alliance Digital Inclusion Group. Then, subject to feedback, we will follow up action at the levels identified above.
- David Wilcox firstname.lastname@example.org @davidwilcox
- Drew Mackie email@example.com