Designing better elderly healthcare with with Singapore’s public services

Many public services, from welfare to healthcare, are mainly intended for the elderly. One of the challenges of designing digital services is to create simple and effective public services for older users. Designers Italia asked Erin O’Loughlin of Experientia to explain what this means in practice, telling us about one of the most interesting international projects the Experientia team has worked on in recent years.

By Erin O’Loughlin (read it in Italian)

At its best, working in the public service sector results in innovations that influence good policy development, and change or evolve outdated or inefficient regulatory environments. Sometimes, this comes about as a side effect of a project, sometimes it’s the explicit project objective. As example of the former is the Airut Low2No urban development project in Finland. A team of architects, engineers, and user experience design consultancy Experientia changed long-standing regulations about timber buildings, when they designed a low-carbon emissions building for the new district of Jätkäsaari, and proved that new materials and technologies meant that multi-story timber buildings were no longer the high fire risk they once were. An example of the latter is Experientia’s work with the Singaporean public sector, on improving healthcare access and social services for Singapore’s rapidly ageing population. In that case, the findings of the research were incorporated in the Singapore Ministry of Health’s Action Plan For Successful Ageing. However, working with public agencies presents unique challenges, and it requires a particular approach to ensure that the relationship is collaborative and effective.

Experientia is a user experience design consultancy, and, as in the two above examples, it has worked with public services and government agencies on policy development and behavioral change projects, for clients like the ITCILO (UN), the European Commission, European municipalities, and the Italian Finance Ministry. The impact of these projects has often been far-reaching, improving the lives of citizens in a variety of ways. The Singapore: Ageing Gracefully project was a particularly far-reaching project, dealing with an issue that is critical to much of the developed world.

With populations in many countries rapidly ageing, there is increasingly urgency in ensuring that our public services support decent quality of life. When Experientia was asked to run a service design project on Singapore’s public health services, we started with investigating the daily challenges that elderly people face when dealing with the health system, and exploring their behaviors around health and wellbeing.

Singapore is a unique environment for any ethnographic research project. Although it’s a small country, it has a highly heterogeneous population, with diverse cultural backgrounds and a range of dialects supplementing the four official languages. Many of the older citizens find themselves facing a healthcare system which is increasingly run by English-speaking nurses and doctors, and dealing with services (e.g. transport, health, housing) that are run by separate ministries and have not been conceived with elderly people in mind. As an Asian country, the health and wellbeing sector is also particularly influenced by alternative health practices, with Chinese medicine being a strong presence in many people’s health practices. Within this rich framework, we selected 24 participants to interview and shadow, including elderly Singaporeans, their carers and social welfare workers.

If the rich cultural context of the research provided a particularly interesting element for the project, then the bureaucratic element provided a particularly satisfying one. The Singaporean government has a strong interest in design-driven innovation. Although this project was commissioned by the DesignSingapore Council, we were lucky enough to be able to run participatory design workshops with representatives from public healthcare agencies and government ministries, in which we shared our research findings, and co-created service concepts to support an ageing society. It’s always satisfying to see research and concepts being used beyond the direct lifespan of a particular project, and in this case our findings were incorporated into the Health Ministry’s ongoing Action Plan For Successful Ageing, were used as input for the 2016 Designathon, and inspired service concepts for the Kampung Admiralty elderly residency, a mixed-use building that welcomed its first residents earlier this year.

Following the ethnographic research in Singapore, we created 8 personas, representing the main characteristics of the research participants, and mapped their customer journeys through the healthcare system. These became a reference point when designing service and product concepts for elderly Singaporeans, helping to ensuring that concepts stay rooted in identified needs and respond to demonstrated behaviors.

The second project phase involved the aforementioned participatory design workshops. These were used to capture expert experiences, attitudes and innovative ideas about research findings. Through reflective and idea generation exercises, participants provided input on both problems and solutions. The initial service concepts were targeted to each of the research themes and showcased strategies, solutions, products and services that address current provision gaps. The participants included representatives from Singaporean ministries, such as MOH (Ministry of Health), HDB (Housing and Development Board), and NEA (National Environment Agency), healthcare-related industries including AIC (Agency for Integrated Care), AHS (Alexandra Health System) and NTUC health, and professionals from other design companies.

The challenges of working with public agencies

Experientia frequently conducts participatory design with research participants, as a valuable research tool to reveal attitudes and mental models, and stimulate ideation. However participatory design with public agencies is more challenging. In particular, the Singapore project involved a wide range and large number of stakeholders, each with their own goals and claims in the public sector, and with little or no familiarity with participatory design (PD) methods.

Firstly, our ethnographic videos and interactive map were important tools when presenting our insights. By positioning the findings very clearly as being directly from the research participants, we were able to reduce institutional resistance to any findings that might have been critical of the Singaporean system. The videos also allowed people’s unfiltered voices to come through in an engaging way, ensuring their voices were being heard directly when talking about such a sensitive topic as health.

One of the biggest challenges was overcoming the participants hesitation to participate. Many participants had not encountered PD techniques before, so we first ran ice-breaker activities that practiced ideation techniques with everyday problems that participants were familiar with. This allowed them to anticipate the kinds of activities they would experience during the workshop, and to see how design thinking techniques could be applied to any topic. Of course, our facilitators are also good at encouraging sharing and collaboration, and drawing out people who felt less confident.

A related challenge was conveying the value of PD to participants with little prior exposure to it. To combat this, we showcased the Airut urban planning project in Finland, showing how it had helped changed policy and won multiple awards. We illustrated how each PD tool had helped us to influence architectural choices and mixed-use services in collaboration with local people and companies. Seeing the path from PD to finished concept demonstrated the power and value of the approach.

Experientia’s facilitators additionally needed to be aware of sensitivities and hierarchies among the agencies. To address this, we worked closely with a local Singaporean agency, who informed us about local context, relationships between stakeholders, and how to frame our research themes sensitively. We also divided the participants into work teams with a mix of people from different agencies and disciplines. Participants created their own concepts and helped develop other people’s concepts. In this way, the concepts benefitted from a broad range of disciplinary expertise and perspectives. Then the “best” and “most feasible” concepts were voted on anonymously, leading to a hopefully objective identification of promising concepts.

From this, and other experiences, Experientia developed a brief framework for forming collaborative and effective relationships when conducting user experience design with public agencies. The consultancy should aim to:

• Situate the co-creation process: anticipate the participants’ value propositions, pain points and deal breakers. Prepare activities and arrange team compositions to optimize co-creation.
• Avoid assumptions: frame diverse expectations, insights and goals. Public sector participants might face more constraints than those from the private sector. Communicate often and deeply, so that facilitators are aware of potential sensitive topics or issues.
• Facilitate good process: Ensure that participants understand the activities. Gently encourage them to follow the processes while encouraging and stimulating discussion.
• Inspire change: model scenarios, connect stakeholders, plan actions. Explore options and scale.
• Excite: Use emotionally engaging media and tools to communicate and test ideas. Share.

This framework helped us to make a success of the Ageing Gracefully project, and, we hope, will become a guiding set of principles on many projects to come.