This is a CTP of initiative: Living Labs - Living Lab Eindhoven (Netherlands)
This critical turning point (CTP1) was part of the first project that was labelled as living lab project in the city of Eindhoven. The project was developed in the neighbourhood Doornakkers in the East of Eindhoven and it aimed to improve the awareness and ability of residents to improve their health and to keep on living in their own houses longer, rather than going to a nursing home or an elderly home.
For more information see:
https://english.brabant.nl/smart-care/smart-care-projects/living-lab-eindhoven.aspx
This CTP is about the moment that the project team started to realize that this project could only work out well if the people in the neighbourhood Doornakkers are truly engaged and connected. This took place at the end of 2010. This became clear when many critical factors of the project were already defined; the idea behind it was clearly defined, the objectives were set, there was a project team formed including public and private actors (in which Gaby Rasters was one of the representatives of the municipality of Eindhoven) and there was a project plan. However, it got clear that a true collaboration with and engagement of the residents in the neighbourhood was not yet realised. The main target group of the project were elderly people and many elderly people in Doornakkers are of Turkish origin and among others, due to language barriers it was a real challenge to reach them. N.B. Gaby Rasters stressed that this CTP can be considered as a ‘typical’ CTP that also takes place in other comparable projects.
This CTP is a mainly a moment of realisation that the traditional approach of developing a government- subsidized project with a clear project plan that is to be implemented by public and private partners is not enough, but should be complemented by a different way of working, which has three dimensions:
Gaby Rasters realised that the project in Doornakkers could only become successful if they would really put a lot of effort in trying to understand the needs of the target group of the project. She also realised that the project team did not have the right person on board to do this by themselves. This resulted in the start of an intensive cooperation with a lady who knew the neighbourhood very well since she was working in the social welfare sector at neighbourhood level in Doornakkers. She developed intensive relationships with the (elderly) residents and she could also reach the residents of Turkish origin, since she herself was Dutch with Turkish roots, she understood the culture, spoke Turkish and managed to build trust. She got paid for her efforts and she joined the project team and functioned as an intermediary, somebody who connects between the project team and the residents. It was clear from the beginning that this endeavour of engaging the residents would and could only work if it was genuine. The interest that the project group and the intermediary showed was serious and for real. It felt as a revelation for the project team that they now had somebody on board who had enough time, who had the network and the right skills to fulfil this task. They realised you need somebody who enters the houses of the residents, this is the only way that you can start to understand how people live, what challenges they face, what priorities they have and only by this intensive approach you can develop the sensitivity that you need when you want to develop a project that is for and with citizens.
It was also realized by Gaby Rasters that even though this critical turning point applies to the Doornakkers project, every project at neighbourhood level has a moment where the project teams realizes that it can only get successful if citizens are engaged; if their needs and priorities are understood and addressed and if there is a business case that assures sustainability and continuation of the project.
This CTP was co-produced by the Doornakkers project team that operated within the larger living lab eHealth project team, the residents and the intermediary and it showed the challenges of co-production. The project in Doornakkers was actually a sub-project of the Living Lab eHealth project in Eindhoven which is a cooperation of a number of partners that are active in developing and delivering services in the field of living, housing, health and social welfare and wellbeing. This Living Lab project aims to introduce and test services in this field that are based on the demands and needs of the users. The services are ICT based and intend to improve the quality of life and the independence of residents in selected neighbourhoods. The Living Lab is an initiative of the Municipality of Eindhoven and it is facilitated by Brainport Health Innovation. In addition to the municipality and Brainport, the Living Lab e-Health Eindhoven project has the following partners which include companies, non-profit and (semi)-public organistions: Close the Gap, Ons Net Eindhoven, Helpt Elkander, Top Support, Tunstall, Van Egdom Security, ZuidZorg and Woonbedrijf (Palet, 2010).
All partners in the project team (N.B. this refers to the Doornakkers project team) realised and sensed that it was critical to engage the residents, since they are eventually the end users and the target group. The companies and the other project partners were comfortable with a more classical line of thinking that is ‘supply-driven’; meaning centred on their own ideas of what they had to offer. However, they also had a clear ambition and intention to deliver tailor-made solutions to their end-users. This dual awareness resulted in a process of a slowly increasing realisation that they could only be successful if they would manage to truly engage the end-users of the ICT based health services. This realisation came in the Doornakkers project, but was also applicable to other sub-projects within the eHealth Living Lab. They found out in the Doornakkers project that their ambition was best realised by first engaging with intermediaries, such as the area coordinators that are employed by the municipality and work in a neighbourhood where they function as linking pins between local residents and entrepreneurs and the professionals who work in neighbourhood based and focused projects. Then the project team decided to hire somebody with the primary task to engage with the residents, the (potential) end-users, to build trust and to develop a better understanding of their needs. This went very well, but it also showed how difficult it is to assess the needs of the residents. You can ask what people want and what they need in terms of ICT based and health-related services, but often people do not know this exactly and it is even harder when it concerns services that are new and when it relates to health challenges that are not (yet) known or that people might experience in the future. Gaby Rasters addressed this: “It is extremely complex to go into a neighbourhood and then collect the needs of the residents, many people do not know their needs and they cannot easily answer questions about their needs. Just think about how such a process is for yourself. I would also find it hard to express what I need.”
This CTP naturally emerged. It was a natural and sequential flow of events that happened within and around the project and as Gaby Rasters expressed it: “It all went very organically and developed itself.” Therefore it is hard to point out events that were related to it and or evoked by it. However, there is a certain pattern of events that is typical and that contributes to the emergence of a CTP such as this one in Doornakkers. This pattern is evoked by the policy context that was conducive to the co-existence of technology-driven and people centred developments. Therefore it is natural that projects have a clear technology focus but also that there comes a moment of realisation that it cannot become successful without citizen engagement.
The policy context in which the Doornakkers project was developed was favouring a focus on health care and ICT (technology) and on citizen participation and engagement. Gaby Rasters observes that at European level policy-makers work on scenarios that describe potential futures. Those scenarios are mainly inspired by the potentials of high-tech and not low-tech and they are not primarily informed by the needs of people. She explains that on the one hand this pushes some national and local public policy towards a ‘technology-bias’, rather than ‘people-centred-bias’. On the other hand at European level but also at national level there is policy-push towards citizen’s-based-, user-centred- and co-production approaches targeting the neighbourhood scale, so this ‘people-focus’ co-exist with the ‘technology-focus’. In the Netherlands there is historically a long tradition of area-based work at the neighbourhood scale and this is promoted by national subsidy schemes since 2003. The neighbourhood Doornakkers in Eindhoven was targeted in the most important national subsidy schemes (Platform31.nl, 2016). Additionally Eindhoven can be characterized as a city of technology (Ruijsink & Smith, 2016). Both at a European and at local level it is observed that technology driven and people-centred approaches co-exits and sometimes the approaches seem conflicting. For example, the technology focus can be leading in projects and then the focus on people moves to the background or is put ‘on hold’, often this is not a conscious process. However, in much contemporary policy documents, including in Eindhoven, the ambition to develop high-tech solutions and to be human-centred are combined.
The municipality of Eindhoven set-up a partnership with private, non-profit and (semi-) public organisations and they successfully applied for a provincial subsidy in the field of ‘Smart healthcare’ (Brabant, 2009), an example of a subsidy scheme that aims to connect technology-driven and people centred approaches. This resulted in the living lab project in Doornakkers. The neighbourhood Doornakkers was selected because it seemed logical from the perspective of the existing policy agenda that focused among others on health and citizen empowerment (Rijksoverheid.nl, 2008). In line with the ‘general tendencies’ and the policy environment this project combined technology (ICT) and people. It also ‘fell in the trap’ of initially being mainly concerned about the technology but this was complemented by ambitions of user engagement and tailor-made solutions. So it was natural that the project team realised that focusing on technology was not enough (the CTP). The latter happened because there was a context in which paying attention to citizen participation was more or less something natural for some key actors involved (including Gaby Sadowksi) as well as at a more abstract level.
At the side of the residents there was an important incident that contributed to the realisation that the project could be important for them. During one of the first meetings with citizens one of the residents was testing self-help equipment for measuring blood-pressure and it appeared that she suffered from a high pressure without knowing it. This incident actually facilitated the further engagement of the residents.
There was hardly any contestation around the CTP. The project team agreed with the need to engage the end-users. It was however not easy to realize it and nobody seemed to have the right combination of skills, time availability, position and character that allows somebody to gain trust and respect from the citizens. Hence it was agreed to hire somebody that fulfilled the role as intermediary between the citizens and the professionals. This was perceived as a relief by the project team. This might be explained as follows: everybody in the project team agreed that citizen engagement was necessary, but nobody wanted or could bear this responsibility.
At neighbourhood level there was very little resistance either. But the engagement did require a very strong investment of time and of energy of all directly involved actors. The project team agreed that there was a need to go out and talk with people and that they needed to organize meetings and it made estimates of the required time investment. Talking to people face to face seemed crucial and it was much appreciated, but it also required much more time and commitment than expected. Also it appeared rather naturally in the process that there was need for more meetings than what was planned initially.
One of the reasons that engagement requires more time investment and commitment than the initial expectations is because professionals in the project team and the residents of the neighbourhood have different expectations and mind-sets. The professionals are already familiar with the project and they tend to forget that residents also need time to simply understand and get used to new ideas and new possibilities that are created within the project. Additionally there is usually some scepticism when a project team comes in a neighbourhood. As Gaby Sadowksi expressed it that it is only natural to then think along the line: “What do they want from me? Can I trust those companies? Aren’t they simply interested in making money? What is my benefit?”
Eventually both the project team and the residents were really proud to be part of project that focused on experimentation with ICT applications in health care. The project also positively contributed to social cohesion and created more mutual understanding between residents and professionals.
The CTP did not come as a surprise. It was rather a critical moment that was forced into the project by Gaby Rasters. She was convinced that it was extremely important to commit and engage citizens. This is a result of her background in area based work at the neighbourhood scale as well as of her passion for community engagement. She managed to push it through because there was a general favouring context (see ‘related events’) and she was persistent. Gaby Rasters mentions that her team members said: “Oh, there she goes again, Gaby with her residents”. It then was mainly a matter of doing it at the right time and this timing was mainly intuitive.
Gaby Rasters also realised that there was a need to work on a business case. She even identifies this as part of, or probably even another critical turning point. The living lab project in Doornakkers relied on subsidy and it is rather common that subsidized projects do not sustain because there is no business case: there is no (realistic) plan on income generation after the subsidy stops. During the project the citizens were informed that they could get free services for the pilot-phase only, but this message might have been overshadowed by the heat of the moment. Gaby Rasters expects that there is a rather low willingness (and maybe even ability) to pay for the services among the citizens. She however did not push as hard for this as she did for the citizen engagement. She also anticipated on it, but in the case of the citizen engagement her passion, knowledge and energy allowed her to materialize it as a critical turning point in the project and in this case it did not happen.
The European Network of Living Labs (ENoLL) explains what living labs are as follows: “Living labs are defined as user-centred, open innovation ecosystems based on a systematic user co-creation approach integrating research and innovation processes in real life communities and settings. In practice, living labs place the citizen at the centre of innovation, and have thus shown the ability to better mould the opportunities offered by new ICT concepts and solutions to the specific needs and aspirations of local contexts, cultures, and creativity potentials” (ENoLL.eu, 2006). Gaby Rasters stresses that the user and citizen engagement are indeed intended, but she expects that most projects have challenges to realize this engagement since the beginning of a project. But projects would benefit largely if citizen and user engagement starts earlier. Besides this, the engagement process is also much more difficult than often hinted: it costs energy and time and it is not easy to find out what people want since they often do not know it themselves. It can only work if all people involved are willing to open up. If the commitment is not genuine it is sensed by the people and it will result in resistance. The professionals need to show that they really care about the residents. It does not work if professionals take an approach of ‘check the boxes’ and simply organize engagement activities because it is a formal requirement for project funding. Despite the challenges, it is critical since you can hardly develop meaningful projects without it.
In the municipality, many project ideas originate at strategic level without engaging other sectors or departments. In the process of among others choosing where to do a neighbourhood based project and what to focus on, such as the living lab project in Doornakkers Gaby Raster sees possibilities to improve the co-production process. The municipality has area coordinators in all its neighbourhoods and they have much knowledge and a well-developed sensitivity about the needs of the residents in a neighbourhood. Those coordinators are also called ‘eyes and ears of the neighbourhood’. It would have made a lot of sense to include the area coordinator of Doornakkers (and of other neighbourhoods) more actively in the selections process of the neighbourhood, so this means that co-production could start in an earlier process of the project.
Currently a considerable amount of (semi-public and public) projects that are operational exist because there is subsidy available. This is not a very sustainable situation and it does not encourage project teams to take responsibility or to respond to the real needs in the society. Rather there is a risk that the subsidy becomes the main motivator behind a project. This can be addressed in various ways. First there is a need to increase the focus on business cases. The attention for citizen participation and engagement was championed by Gaby Rasters in the Doornakkers project, but the business case was not championed by anybody and it rarely is in subsidized semi-public and public projects. But it is a lesson of this CTP that a project needs team members who can champion the business case because they are passionate about it. Secondly projects need to move beyond the level of pilots and experimentation. In order to achieve this there paradoxically is a need to experiment more. The experimentation should focus on governance and finance. This includes questioning of and experimenting with issues such as: what resources do we need, who has access to those resources, who can and should decide over them, what benefits and value can we generate, for whom, who gets which share of it, who is responsible for what, who should be responsible, how can we achieve shifts in commitment, who can take risk and who cannot, etc.?
References
Brabant.nl (2009) https://www.brabant.nl/applicaties/regelingen/445_subsidieregeling_slimme_zorg_noord_brabant_2009_2011.aspx
ENoLL.eu (2006) European Network of Living Labs (ENoLL), http://www.openlivinglabs.eu/FAQ
Palet, Oktober (2010) Slimme Zorg en participatie van specifieke gebruikersgroepen Handleiding voor een effectieve aanpak.
Platform31.nl (2016) http://www.platform31.nl/wijkengids/2-de-wijkaanpak-door-de-jaren-heen
Rijskoverheid.nl (2008) https://www.rijksoverheid.nl/binaries/rijksoverheid/documenten/rapporten/2008/02/01/het-wijkactieplan-doornakkers/wapeindhovendoornakkers.pdf
Ruijsink, S. & Smith, A. (2016) Transformative Social Innovation: European Network of Living Labs: summary report. TRANSIT: EU SSH.2013.3.2-1 Grant agreement no: 613169
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