Social Services for Disabled People

The Swedish pilot in social services for disability is a Wave A pilot and aims at preparing organizational infrastructure for a more systematic co-creation with the service user. It is an integral part of national policy and local municipal service reform in Jönköping city.

The aim of the pilot is to further advance the municipal disability services, especially (legally stipulated) so-called personal assistance services, so that they would be of greater relevance and value to users with various disabilities or functional impairments. We aim for a service provision that better accommodates both service provider and user perspectives and resources, and thus contributes to increased user abilities to participate in society and user health and well-being on a daily basis.  The assistance that service actors and users achieve together in dialogue should be perceived as meaningful and manageable by the user.

Such service improvement requires systematic and long-term work including raising professionals’ and user awareness of co-creation and developing such abilities, sometimes also with the help of ICT tools.

This requires improving some service provision routines based on the feedback from its users (co-designing service improvements). More importantly, it means motivating and supporting first line managers and personnel in their roles as co-creators of service value rather than self-reliant service providers. In this sense users are rather seen as citizens with rights and capacities.

Read more about the pilot from our blog (in Swedish).

Schedule

The piloting service improvement work has been ongoing during 2018 and 2019. Its implementation and development will continue in one form or another as part of the overarching organisational service quality management strategy year 2020 and onwards. Insights are already being shared and disseminated through interactions and meetings in various internal platforms and at national workshops with other municipalities.

Geographic area and target groups
The pilot targets citizens aged 18-65 that have chosen municipal Disability Care services in the municipality of Jönköping. Only the citizens that chose the municipal services (in competition with private service providers) are the targets of the piloting service improvements.

Collaborators
Managers at all levels in Social Services and in Disability services in Jönköping municipality, pedagogical support unit (TSM); decision making unit, front-line managers and their personnel in personal assistance services, and local organizations for users with disabilities. Other related service areas within the municipality of Jönköping (Housing assistance, Daily Activity Services, Integration Services, etc.) that are involved in some parts of the pilot.

Pilot actions
The piloting activities have targeted several general areas of service improvement that affect all municipal personal assistance serve users.  Following improvement areas have been identified based on user voices and perspectives in which improvement actions have been undertaken:

• Improving communication to the users about the co-creation in service provision on and how that may happen. This required also improving communication between service providing teams within municipal organisation.
• Improving communication between PA service authorities and implementers.
• Improving the way service team meetings with the first-time user are conducted (pilot actors went on to improve meeting routines with all users).
• Enhancing co-creation possibilities in documenting service implementation; providing technical infrastructure.
• Developing common professional approach and clarifying co-creation principles in disability care (based on user-friendly and health-promoting ethics).

Tentative results

Results so far indicate rather successful adoption of improved service routines among first-line managers in disability care (personal assistance) services.  We also see indications of deeper understanding among first-line managers of how they can utilise their own and available organisational resources to advance co-creation with users in service personalisation. First steps have been undertaken to adjust support on organisational level such as personnel training and technical, administrative assistance.

Observations
A major lesson is probably that that changing mindsets is a crucial element in opening service improvement for user influence. For this purpose, researcher-led joint dialogues with entire first-line manager group in PA services have been rather fruitful for making sense about “the why and for whom”, “the what” and “the how” in piloting service improvements.

Another lesson is that while user voices and insights have been useful for introducing some improvements in service provision routines, advancing towards more systematic co-creation in service personalisation on a day to day basis is much more time and effort demanding. It requires not least effort from first-line managers in coming to terms with their (new) role as health promoting co-creation leaders in relation to their service personnel.

Thus, while attempts to bring in user voices, especially those with cognitive impairments, for co-initiating and co-designing general service improvements was rather successful (given large variations in disabilities that makes search for common needs more difficult) the ambitions to establish service improvements based on those voices have been much more challenging. It seems not enough to work with first-line managers, they need to continue entrenching the new professional approach (ethics) on co-creation to their personnel. Jönköping case exemplifies how such change can not be forced upon responsible managers and how they are challenged to improve their coaching and leadership abilities and methods.

All their advancement is however constantly challenged by external factors such as severe personnel shortage and rotation among personal assistants and managers, This brain drain takes much energy from building and sustaining a new co-creation friendly professional culture in concrete organisations. Of course, budget deficits also slow down organisational adaptation capacities.

Perhaps more unexpected for CoSIE insight is that using social media in co-creation has not proven very useful in Jönköping case, other than for reaching out to users in the geographical area. Social media was seen to be less well fitted for counterbalancing power inequalities among the most vulnerable user groups. Most fruitful service improvement conversations require establishing trust and relations to the dialogue partners from public service for the user to open up without fair of being misused. This requires organisational readiness and capacity, why face-to-face focus group interviews worked out so well. On the other hand there are interesting pioneering activities and innovations inJönköping in open service provision data creation that have great potential for co-initiating and advancing service improvements.

Future
User participation and influence in service development becomes more an more entrenched as paradigm in Disability and Social services ion Jönköping municipality, also legitimised by current national legislation and supervising agencies. We have almost no doubts that at least some of already introduced piloting service improvements will live beyond the CoSIE time frame as part of the new organisational quality management strategy.

Most importantly entire municipal organisation has been committed for the past 5-6 towards increased user importance in improvement personalised services. The choice and the commitment to this, and some earlier pilot, prove sustained municipal interest and abilities to invite users to dialogues om improving services on more systemic level. That too points to an ongoing paradigm shift.

Learn more form lived experience stories gathered in the Swedish CoSIE pilot

CoSIE partners involved:
Jönköping municipality
Karlstad University

Read more about the pilot from CoSIE Blog
Co-creation through Change Leadership

Contact
Inga Narbutaité Aflaki, inganarb@kau.se