Designing for the social challenges of better health

Exploring new ways of working

Southwark is one of 33 boroughs in London. The Southwark Alliance provides a multitude of services to their 278,0000 residents.

The Southwark Rise project was set up in partnership with Engine as a platform for developing a multi disciplinary, cross service approach for connecting strategic policy making with the everyday lives of families in the borough. Working with a core team of policy strategists, Engine was asked to explore two related and complex areas; childhood obesity and the challenges of creating better life chances for children from the most deprived backgrounds.

The project was carried out with a view towards enabling Southwark policy makers, through the transfer of skills and knowledge to:

- build a more complete picture of the complex lives of families living with economic hardship; and

- become smarter in the way they identify and act on opportunities to support their residents.

Generating a 360 view of families lives in Southwark
Painting a rich and useful picture of the challenges faced by the most disadvantaged families is not easy. To begin with we needed to define the scope and audience of the research, choose the best approach and create the right conditions to support the approach.

A team of managers and policy staff from across different services helped to define key research areas during a workshop that explored complexity through the lens of a single family, including motivations and barriers to getting support and priorities and value systems.

It was important to understand topics such as employment, health, community, faith, and relationships in concert. To generate a deeper understanding of these interrelated topics we employed design ethnographies to study eight families in the borough.

This qualitative approach encouraged open and natural dialogue and enabled us to gain access to day-to-day lives through the use of comfortable (home) environments, extended engagement periods and objective observation. Informal stimulus materials helped to unearth perceptions of support, mindsets towards staff and services and permit conversations around sensitive or complicated issues inherent to health and family.

Stimulus materials: Area resource mapping

Collaborative service development with service users and health experts

Building on insights revealed through design ethnographies we moved to the conception of preventative health services that can support Southwark families in addressing the challenges of childhood obesity.

Though a series of collaborative design workshops we lead an action research programme involving a design team of 20 parents and frontline Council staff interested in the topic of childhood obesity as a dimension of public health.

Design activities challenged team members to look at problems as opportunities and supported them to generate services that involved new partnerships and approaches. A series of unexpected services were developed, evaluated, refined and modelled using tools such as service sketching, idea templates, customer journey mapping, desktop prototyping and voting. This revealed underlying values related to provision, desired service journeys and considerations for new and existing touchpoints.

Service sketches

From the many service ideas and propositions emerged a series of key areas of support around health. The image of a remarkably different notion of health support was defined, one that shifts the emphasis from providing support by health professionals to providing platforms that let residents support themselves in different ways such as:

- Support the exchange of information and experiences between people.

- Support individuals to create tailored solutions for themselves through resources that allow them to organise, manage and deliver themselves.

- Support the creation of new, combined and informal service roles.

These insights have provided the basis of the Southwark Alliances (Local Strategic Partnership) new work programme, which forms its approach to Total Place.

Making the case for service design in the public sector
Based on Engine’s work exploring new ways of working with Southwark and other organisations in the public sector, we have learned a great deal about the value of the particular contributions that service design practice can make.

Finding the root cause
The services developed by the team had seemingly tenuous links to childhood obesity. For the families, the root causes of unhealthy weight were various including: family finances, the home environment, safety and the neighbourhood. Public services have a very comprehensive remit and have much to gain from drilling down to solve root causes, wherever they may lie. Service design has a critical role to play in informing strategy, just as policy research might, and by engaging users in action research service designers can help connect insight with strategic projects.

Engaging a project network
Complex problems are best handled by groups as the knowledge, skills and other resources necessary to address them are often diverse. Fortunately organisations will always have their staff and users as sources of insight, but getting them involved requires support. Its about bringing in the right perspectives at the right time to create the capacity for creating solutions. Service design practice can play a leadership role here by sequencing these engagements and connecting them to a design process. Engine began the project by identifying and organically growing a project network of individuals, groups and organisations leading to the direct involvement of 70 people.

project network mapping

Giving people capabilities
For service providers in the commercial sector profit is the single bottom line. In contrast, reducing costs and building social capital are key drivers for the public sector. In this sense there is a greater recognition of the value of engaging service users in innovation through collaboration and delivery through co-production.

The Southwark Rise Project demonstrates the power of engagement and the need to design platforms not solutions to help citizens participate in delivering their own support. In the health sector such an approach lends itself to the imperative of co-production in improving health outcomes.

Through the hybrid practice of service design, health service organisations are able to create and relationships with users and staff that are more consistent, sustainable, generative, equal and geared towards continual improvement.

Reducing complexity
Complex problems cant be addressed all at once. What we offer is a way to break them down into understandable parts. By choosing an effective method of framing, such as the family and using a sequential design process that moves from insight to idea to action, we are able to understand and communicate the problem in a way that sticks like statistics but provides more lasting understanding. Service design has the power to bring people together around facts, experiences and motivations encouraging a shared view of the problem, which is incredibly valuable in siloed organisations.

Designing more than services
As service designers, our contributions go far beyond service creation to improving service capability and capacity that is embedded in the people and organisations that we work with.

Through the use of accessible methodologies and simple tools we provide useful frameworks for understanding the challenge and opportunities to build alliances both internally and externally coalescing in infrastructures of understanding. Of the twenty individuals involved in action research for the first phase of Southwark Rise, all twenty committed to further involvement.

Read more about our work with local councils here.