by Wang Zhao [1]
In Belfast, Northern Ireland, a Service Design workshop to explore how people can design services for an aging population from a systems level approach was held on Friday 8th November 2019. The idea of system thinking, the system dynamics modelling method, and tools from Interactive System Dynamics were used by participants in the workshop. The author attended that event and observed how system dynamics helped the workshop to succeed.
Background
Adult social care
Adult social care is the health care service and support provided for adults who ‘need practical support because of illness and disability’ in the UK. (NHS, 2018) The provided service varies from help with daily living at home to a sheltered housing or care home. (NHS, 2018) Although the overall cost of these services is shared between the council and service recipient, public funding takes a big part in making them happen. (Full Fact Team, 2017) Between 1st April 2015 and 31st March 2016, “there were over 1.8 million new requests to local councils for adult social care”, most of which were from adults over 65 (Adult Social Care Team, 2016).
The situation
On the other hand, certain kinds of service seemed to be in shortage: as estimated by Age UK, in 2017 there were nearly 1.2 million people in England “who didn’t receive the help they need with essential activities”. (Age UK, 2017, p. 29) The balance between service provision and demand is also sensitive to funding cuts in recent years. Moreover, this service system will expectedly be more burdened, as the number of aged people rises and there become more requests for adult social care every year.
The challenge
In Northern Ireland, the challenge for service providers is at least three-fold: what resources are available, what kind of service do people need, and finally how to deliver the services to people. Moreover, the challenges are highly interrelated: a different design of service could have an impact on how such service is delivered, which in turn affects the utilisation of available resources.
The workshop in a nutshell
Service Design
“Service design is the activity of planning and organizing people, infrastructure, communication and material components of a service in order to improve its quality and the interaction between the service provider and its customers. […] The purpose of service design methodologies is to establish best practices for designing services according to both the needs of customers and the competencies and capabilities of service providers.” (Wikipedia contributors, 2019) The workshop in Belfast focused on the social care services and the related labour force and housing issue. The basic questions were what people in illness and disability need, how to design services to fulfil the demand, and how to deliver them.
Stakeholders
The event was held by Strategic Investment Board, a think tank-like company working closely with the public agency that oversees adult social care in Northern Ireland – the Northern Ireland Social Care Council (NISCC). People working in service delivery, service design, policy design, and in particular healthcare and housing were invited to participate in groups.
System thinking as a method was introduced to the participants to promote thinking of the problem on a systems level. For this purpose, members from the UK Chapter of the International System Dynamics Society were invited to talk about system thinking and the use of model as a tool to develop, exchange, and formalise ideas. They then participated in the group work as facilitators.
Agenda
1. Group and Topic
1.1 Creating groups
All participants (around 40) were divided into groups, each with 6 to 8 members sitting around a table. In each group there was a facilitator familiar with the agenda and the idea of system thinking, who was either from the System Dynamics Society or from the Strategic Investment Board. Stationary like sticky nots, markers, and paper sheets was provided.
1.2 Setting topics and expectations
Predefined topics such as ‘supports for people with mental impairment’, ‘people with disability’, housing/labour force issues in providing adult social care services were assigned to groups on a random basis. Before starting to work on their own, the agenda for group work was explained to all participants. Every step of the agenda was associated with an expected outcome. Large sheets of paper with the agenda printed on were distributed groups as both a reminder and a framework to put the outcomes.
2. Teamwork
2.1 Problematic behaviour
The group was first asked to come up with a problematic behaviour related to the assigned topic as a ‘reference mode’ – the change in a variable over time and sketch it down on the paper.
2.2 Variable elicitation
The group was then asked to come up with related things – or ‘variables’ – that have to do with the topic. Team members worked individually and put everything they got onto the sheet using sticky notes.
2.3 Variable categorisation and simplification
With about 30 variables on the sheet, the teams started to discuss and group the variables into a few categories by relocating sticky notes. There was no pre-conception about the categorisation, so categories emerged as the process went on. Group members had discussions on issues such as whether two variables were the same, how should a set of variables be named, and so forth. Some discussions went very deep as members with relevant experience shared insights or had debates.
2.4 Causal mapping
The group was then asked to identify a few causal relationships from the variables and draw causal loop diagrams. This created discussions as the members could perceive the causality relationships differently. Groups did not include all their variables but only those they thought the most important.
2.5 Storytelling and visualisation
Finally, the group was asked to tell a story about a virtual character based on the discussions they had and the causal model they developed. The story was preferred to be more vivid with details. For example, it could start with ‘John Smith is 70 years old and he lives in a community named …’ For the same purpose, the group was also asked to visualise the story by drawing a scene on the paper sheet featured by the virtual character.
3. Presentation
One group was selected to present and explain their final outcome to all participants. The outcome varies from group to group, but the one presented included almost all the expected components – a problematic behaviour, a set of variables, a causal map, a visualised story, and even a simple stock-and-flow structure. The elaboration was succinct due to limitation of time, but clear enough to show the group’s idea.
References
Adult Social Care Team, 2016. Community Care Statistics Social Services Activity, England, 2015-16. NHS Digital.
Age UK, 2017. The_Health_and_Care_of_Older_People_in_England_2017.pdf [WWW Document]. URL https://www.ageuk.org.uk/Documents/EN-GB/For-professionals/Research/The_Health_and_Care_of_Older_People_in_England_2017.pdf?dtrk=true#page=29 (accessed 2.9.20).
Full Fact Team, 2017. Adult social care in England [WWW Document]. Full Fact. URL https://fullfact.org/health/adult-social-care-england/ (accessed 2.9.20).
NHS, 2018. Introduction to care and support [WWW Document]. nhs.uk. URL https://www.nhs.uk/conditions/social-care-and-support-guide/introduction-to-care-and-support/ (accessed 2.9.20).
Wikipedia contributors, 2019. Service design — Wikipedia, The Free Encyclopedia.
[1] Wang Zhao is PhD student on System Dynamics and Data Science, University of Strathclyde, Glasgow, UK; The observation was sponsored by the UK Chapter of the International System Dynamics Society.