-
1
Moving towards Person-Centred Innovation for Ageing Better Draft
by David Wilcox and Drew Mackie : February 13 2015
Summary 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 hadnt 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 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 doesnt 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
... gather resources 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. Its 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 dont have the resources to do that, or any leverage to
achieve much change. We do, however, suggest some modest ways
forward.
-
2
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. Weve worked on the basis that if people cant talk about
issues in relatively straightforward terms, then they wont 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 whats 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 Funds 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.
-
3
The provocations and challenges The provocations and challenges
are detailed here. After a first round of discussion, we summarised
the provocations as:
1. There isnt 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. Whats important is
enabling people to choose how they engage).
2. Government is concerned that many older people are not online
- but there are limits to what government can do. (People will
engage with whats interesting and useful to them, and use devices
that most suit their needs).
3. Everyone needs Internet access but beyond that, no one size
fits all. (Cost is a barrier, and then personalisation is
important).
4. Computer courses and basic skills training dont 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 peoples needs).
5. Simpler interfaces are needed for computers and mobile
devices - not just more functions. (Older people should be involved
in design).
6. 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).
7. Digital social innovations in services are not scaling.
(Theres too much focus on the tech, and not enough on what it does,
together with a lot of re-invention).
8. 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
peoples inclination to cooperate and use whats already
available).
9. 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).
10. 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 :
1. Promote greater understanding of ways that technology is
changing the world that we all live in
2. Influence current digital inclusion programmes towards an
approach that recognises the importance of familiar technology,
mobile devices, and personalised routes towards adoption.
3. Encourage and support organisations in the ageing field in
the use of social technology
4. Facilitate conversations and stories that make it easier to
develop inclusive discussion of digital inclusion and
innovation
5. Make better use of existing assets - research, practical
experience and innovative projects that could be scaled.
6. Promote ways to introduce innovation into the Big Lottery
Funds 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.
-
4
Ideas platform 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: http://goo.gl/TD5xxf and also embedded in the exploration
site.
Mapping 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 dont know what assets and collaborations you may
be looking for unless you know the problem or opportunity. More
here about mapping.
-
5
Mapping ideas 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
-
6
London Borough of Southwark map from workshop
Reality check 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:
Culture
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. Theres 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
Technology
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.
-
7
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 peoples 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 dont know whats
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 individuals
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. Theyve 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 thats 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.
New frameworks 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.
-
8
The exploration into tech and ageing better suggests that we
need other additional frameworks to complement this landscape
view.
-
9
Grey Cells 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.
Image original here
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.
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 persons 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.
-
10
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 wont 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.
-
11
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:
Theres 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. Theres 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.
Tackling social isolation in a locality: in this workshop a
semi-fictitious partnership plans how to use digital technology to
promote wellbeing and tackle social isolation without special
funding: austerity innovation. Full report.
The games generally use a system of cards that include personas
to start discussion around peoples needs and interests
-
12
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.
Locality Labs 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 Funds 82 million programme, and the
apparent lack of digital innovation or provision for sharing of
knowledge.
Summary of blog posts
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 whats 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.
-
13
Next steps 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 [email protected]
Drew Mackie [email protected]