Bringing Citizens into Health Planning

Bringing Citizens
into Health Planning
II Output Report
September 2014
Bringing Citizens
into Health Planning
II Output Report
September 2014
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Bringing Citizens
into Health Planning
II Output Report
September 2014
Index
I. Project Overview
4
II. Introduction
7
III. Methodology
9
IV. Outputs
12
a. Local policies in favour of citizens’ healthy lives and wellbeing
13
b. Social Innovation 18
c. Social Enterprise
23
d. Patients Empowerment
24
e. Neighbourhood Networks
25
V. Closing remarks
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VI. Conclusions
28
Annex 1: Meeting Agenda
Annex 2: List of participants
29
Annex 3: Meeting pictures
Annex 4: Glossary
Annex 5: Bibliography and web references
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I. Project Overview
URBACT (http://urbact.eu) is a European exchange
and learning programme promoting sustainable
urban development. It enables cities to work
together to develop solutions to major urban
challenges. It helps them to develop solutions
that are new and sustainable, and that integrate
economic, social and environmental dimensions.
URBACT projects yield and share good practices
and lessons learned with all professionals involved
in urban policy throughout Europe.
URBACT II 4D Cites Project (http://urbact.
eu/en/projects/innovation-creativity/4d-cities/
homepage) aims at determining key factors of
innovation in Health that promote local economic
and social development by developing integrated
policies. The project brings eight European cities
together as shown below in the map:
Figure 1: Igualada (Catalonia, Spain), as the Lead Partner, Leeds (UK), Eindhoven (The Netherlands), Jena (Germany), Tartu (Estonia), Plunge (Lithuania),
Baia Sprie (Romania) and Novara (Italy).
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Bringing Citizens
into Health Planning
II Output Report
September 2014
The work approach by all eight city partners
tackles 4 main dimensions for the development
of Local Action Plans for innovation in health:
the health sector itself, business, knowledge and
training, with the citizen dimension at the centre.
Local governments, in this work, are the principle
stakeholders for promoting and harmonizing local
policies across these dimensions for an integrated
approach towards the local health system.
Our 4D Cities project addresses each dimension for
the development of each local government’s Local
Action Plans through trainings, exchanges of best
practices, research, and transnational workshops.
The results are captured in 4 thematic reports,
with the perspective of each being that of a
Quadruple Helix. The picture below represents
this 360 degree approach and the components
involved.
Figure 2: 4D Cities Project is conceived in a 360º perspective that places the patient as a key stakeholder at the centre of the Health system.
4 Dimensions’ Interactivity within a local context.
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Each thematic output report presents results and
conclusions issued from this sharing and learning
process at the transnational meetings. The first of
this series of four, focused on the private Business
Sector and the economic opportunities that a
city can promote when endeavouring a Health
innovation strategy at local level .
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The present Report focuses on the Citizen as the
centre of attention from the medical and policy
perspective and the interactions with the rest of
the relevant health stakeholders that can have a
positive impact both in terms of individual health
and of collective wellbeing. Reports on the Health
Sector and the Knowledge and Training Institutions will be issued after the present one.
Because of the trans-disciplinary, or multisector, necessities involved in creating innovationbased and integrated local health systems many
topics overlap one another in these four Reports.
For example, when presenting the benefits of social
entrepreneurship in the healthcare sector, it can be
approached from both the health perspective and
the business perspective: indeed, some of these
benefits have been brought forward at different
meetings. In sum, the overlapping of material makes
it impossible to treat some subjects solely in one
report or only at one specific meeting.
Nevertheless, it is the aim here to put the focus
on the issues tackled regarding the Citizen as
the centre of attention from the medical and
policy perspectives, and as such, to report on the
progress being made by each local government in
developing its Local Action Plan, where the enablers
or barriers to health system innovation can be
identified, shared, and acted upon.
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This Report is the second of a total of four thematic
Reports issued from the transnational meetings
that the 4D Cities project partners held in 2013,
each showing continuity or overlap with the others,
as mentioned above. The content included in the
present Report especially refers to the experiences
and knowledge shared and discussed in the second
transnational meeting held in Baia Sprie
(Romania) in June 2013.
This Report is divided up into 5 main sections.
The first is this brief project Overview, which is
then followed by the Introduction which explains
in more in detail the Quadruple Helix approach
and its relevance to 4D Cities, together with the
broader contextualization and conceptualization of the work. Following this is a brief review of
the methodology and tools used for analyzing
each partners’ assets, capacities and competencies. Much of this part was already shown in the
Business Report (which serves as the backbone
document for all the Reports) so only a summary
of them is given here. In continuation, 5 sections
are dedicated to the key Outputs so far in this
Thematic area.
Rounding out the Report are some closing remarks
and conclusions and a series of 5 annexes, which
include the 1) the Baia Sprie meeting agenda; 2)
the list of participants; 3) pictures taken during the
sessions; 4) a glossary; and, 5) a short bibliography
of documents and references used for the report
and shared with the project partners.
See URBACT II 4D Cities Business Opportunities of Local Health Innovation. I Output Report Februrary 2014 at http://urbact.eu/en/documentsand-resources/documents/?project=1890
Bringing Citizens
into Health Planning
II Output Report
September 2014
II. Introduction
From the point of view of the 4D Cities project
on Health innovation with economic growth, the
Quadruple Helix approach refers to including the
patient and by extension, the community (neighbourhood, citizens, entrepreneurs…), as the 4th
dimension of a public-private-knowledge collaborative partnership. A synthesis of this follows:
and also those that positively affect employment,
education and training, sports, social care, etc.
Quadruple Helix (QH), with its emphasis on
broad cooperation in innovation, represents a
shift towards systemic, open and user-centric
innovation policy. An era of linear, top-down,
expert driven development, production and
services is giving way to different forms
and levels of coproduction with consumers,
customers and citizens. This also sets a challenge
for public authorities and the production of
public services .
· The shift of the local Health sector’s conception
that places the professional as the focus of
health services towards placing the citizen at the
centre;
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With this notion in mind, Business, Knowledge,
Public administration and the Citizen interact with
varying intensities of engagement with the common
objective of both economic development and
the wellbeing of the people. The Quadruple Helix
approach is particularly relevant in the 4D Cities
project since the person is placed at the core of
the innovation process, not only as a beneficiary
but as a co-creator of the service. Thus, we
do not simply refer to citizens as “patients” but
to the different dimensions of citizens as “users”,
“consumers”, “relatives”, “workers”, “tax-payers”,
“innovators”, “social entrepreneurs”…
While the person’s health is the centre of the 4D
Cities project approach, the local government
is the driving force behind shaping the context
and sustainability of that health care development,
provision and improvement. With a “bird’s eye view”
of the local health stakeholders, the leading policy
makers can forward integrated policies that support
public health interests as well as economic interests
Accordingly, and with the focus put on the Citizen
dimension of the project, the starting points
addressed during the 4D Cities’ debates and
working sessions included:
· The role of the local government and policies in
support of this change of view and model;
· The potential of engagement of the citizen in
the increasing scale from being informed on to
design and co-create health services;
· Social Innovation as a valid tool to be used to
facilitate the patient-centre approach.
Given these common starting points, the partners
representing Igualada (Spain), Eindhoven (The
Netherlands), Jena (Germany), Leeds (UK), Plunge
(Lithuania), Tartu (Estonia) and the team and
local support group representatives of Baia Sprie
(Romania) shared their vision, policies and best
practices on the Citizen Dimension over two
intensive work days in Baia Sprie in June 2013.
· Igualada introduced the Health simulation
concept and project, which recreates real
scenarios such as home healthcare, hospital,
primary care, emergencies and pharmacy to
allow professionals and patients confront new,
unexpected and stressful situations in a safetyensured environment with no risk to people.
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Exploring Quadruple Helix. Outlining user-oriented innovation models. Arnkil, R., Järvensivu, A., Koski, P., Piirainen, P. Final Report on Quadruple Helix
Research for the CLIQ project Co-financed by European Regional Development Fund, INTERREG IVC Programme.
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· Plunge described its Public Health Bureau
project, a connection between citizens and public
health institutions as a means to survey groups
of citizens, to inform them on health topics and
monitor and improve peoples’ health.
· Tartu presented its Innovation 4 Welfare project
and the health innovation support group that
followed from this INTERREG project. The focus
of Tartu’s health strategy is based on innovation
via the interdisciplinary cooperation with the
Tartu Science Park, the University and patients.
· Baia Sprie focused its presentation on the role
that the citizens –being they patients, business
leaders, doctors, decision makers– play in building
a common project of reopening the regional
Hospital. They also presented the case of a Social
Enterprise that is currently generating employment
for physical disabled people while also decreasing
the costs of local public care assistance.
In all cases, including inputs from Jena, Leeds, and
Eindhoven, different levels of citizens’ engagement
were evidenced. Although the social component
exists in each presentation, the common need for all
partners was –and remains– the need to be able to
plan and measure the social value gained by ways
of citizens’ involvement in health projects, as experts,
testers, patients, etc. This Report will explore further
the developments on this important topic.
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What is of added value to the 4D Cities project
and URBACT II is the partnership’s discovery and
engagement with issues and opportunities that
are emerging, as of this writing, beyond what was
initially set out in the project’s work programme.
These include:
· The importance of the promotion of healthy
life styles and self-responsible attitudes;
· The need for including comprehensive perspectives for preventive health measures;
· The importance of data collection for understanding emerging trends and immediate needs;
· The importance of being able to gauge Social
Return on Investment and of using asset
based assessments;
· The need to recognize and/or seize the gamechanging opportunities that Social Innovation
represents for Health Systems and all stakeholders involved.
In the next section, we describe the methodology
for our work.
Bringing Citizens
into Health Planning
II Output Report
September 2014
III. Methodology
The way the 4D Cities project works is at two
levels: local; and, in network.
At the local level, each partner undertakes self
assessment SWOTs and in-house analyses of problem-solving capacities and overall competencies
using the 4D Cities guidelines and Local Support
Group working frameworks of URBACT.
At the network level, the partners share experiences and Best Practices; exchange knowledge of
current relevant initiatives and opportunities; get
training to widen the horizons of possibilities in their
respective Local Action Plans; and, learn from one
another regards tactics or measures to promote
with stakeholders in order to achieve Local Action
Plan objectives.
So far, the 4D Cities partners have held four
thematic gatherings to analyse and learn from
each other’s experience and best practices on the
4 thematic topics of Private Business Sector;
local Health Sector; Knowledge and Training
Centres; and, the Citizens. Members of the Local
Support Groups and experts on different issues
related participated. Again, the overlapping nature
of the topics has led to the sharing of a number of
interesting and complementary projects that have
helped to identify the possible intensification or
improvements of the interactions between the
project stakeholders. Visits to the most relevant
assets and facilities of each hosting city have
complemented these international meetings. The
table below shows the thematic meetings:
Table 1: Calendar of 4D Cities Transnational Meetings
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As explained in more detail in the Methodology
section of the Business Report, 4D Cities
developed three main tools for capturing the
complex relationships between the 4 drivers within
the local context of health innovation policies.
The first is the 4D Cities Mapping , which is a
register of the policies, tools and actions that
have enabled each partner to collaborate with
local health actors for defining the health project
objectives in their respective cities. The utility of
the mapping exercise is to offer cities a wider range
of actions and tools to develop their Local Action
Plans (LAPs) with a Quadruple Helix approach.
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Key here is the role and work of Local Support
Groups in the development of the mapping, and
by extension, the further development of the
4D Cities project. Local Support Groups include
universities, community neighbours, business associations, hospitals, care centres, patients, among
others. Depending on the local project’s focus
and each partner’s network, the composition of
these Local Support Groups will vary. In any event,
though, what is essential is the set of interactions
promoted and established through these Groups,
which, in turn, helps the city council obtain a richer,
more comprehensive overview of the city’s profile
and its population groups and health system needs.
Examples that now constitute 4D Cities Best
Practices have been shown and discussed by the
partners at the Thematic Meetings.
The second tool is a matrix of sector
engagement , which is derived from the abovementioned mapping activity. This contains a
breakdown of the basic competencies and
knowledge requirements called for in engaging the
public for developing integrated, Quadruple Helixbased Local Action Plans. The matrix shows the
levels of stakeholders’ involvement as a series of
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small actions that range from the simple to the
more complex – from information provision on
through to consulting, involving, partnering, and
real, citizen-focused empowerment.
Finally, the third tool is an internal instrument
to assess regulation and funding capacities
of partner cities which has been used to
develop the Matrix of indicators although it is
in itself an informative document too. A survey
distributed to project partners identified policy
competences, funding capacities and level of
policy integration regarding the 4 dimensions,
e.g. regulation capacity in Health, responsibilities
on the promotion of direct investment, capacity to
fund or co-fund for new studies and curricula at
the local level, etc.
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Using these tools has allowed partners to better
contextualize each one’s own project’s work and
outputs. The use of the tools has allowed the
partners to look beyond their current situations and
environments and come to detect new, emerging
issues on the topics. It is therefore important for
this Report to show some of these emerging
issues at this point as way of:
1) encouraging the thinking of “value chain”
approaches for developing Local Action Plans,
in consideration of the different stakeholder’s
needs and potentials;
2) highlighting the roles each stakeholder can play,
in particular each local government, in achieving
health systems drawn from innovation and
social innovation in ways that benefit the entire
community. Clearly, local governments can be
enablers and facilitators of such innovation and
social innovation. What’s more, they themselves
can also be direct beneficiaries of the economic and
social returns of their own policy investments.
See 4D Cities Concept Map. Tools, practices, policies of local governments to promote citizens’ centred health and innovation with an economic
growth at http://urbact.eu/en/projects/innovation-creativity/4d-cities/homepage/
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See 4D Cities Matrix of Sector Engagement at http://urbact.eu/en/projects/innovation-creativity/4d-cities/homepage/
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See abstract of the assessment exercise in the Summary Table of Political Competences for Health Innovation at http://urbact.eu/en/projects/innovation-creativity/4d-cities/homepage/
Bringing Citizens
into Health Planning
II Output Report
September 2014
A short list of some of the emerging issues
includes:
· E-government and 2.0 platforms
· Health as a “source” for job opportunities and
social enterprise
· Asset-Based Assessments
· Patient Empowerment
· Corporate Health Management
Indeed, as each partner develops its own Local
Action Plan, we can see that each partner - and
the 4D Cities network itself - is involved in a kind
of learning process. Work at the local or at the
network level is not about creating static realities:
environments change, stakeholders and relations
evolve. For the project, then, in the next 12 months,
important questions will need to be addressed:
· Given our expectations, goals and capacities, what
else can be done to advance our Local Action Plan?
What can we integrate from the experiences of
others? What can we share?
· What can I do within my possibilities, according to
local government political capacities and responsibilities? How can I be a catalyst for change?
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IV. Outputs
This section outlines the key shared knowledge and
experience regarding the Citizens dimension of the
4D Cities project as they were discussed. It clearly
shows the influence of the emerging issues in the
discourse about 4D Cities’ work and opportunities.
The following therefore shows a) what can be done
–with the interest of generating more sustainable
and rewarding relationships for the development
of Local Action Plans; and b) what is being done
by the Partners –with the interest of promoting
the transferrable and adaptable practices of
stakeholder interactions and integration to other
cities in the partnership and to other stakeholders
in the greater community of the European Union.
The key findings, the new learning involved and Best
Practices are described in continuation, including
–where relevant– the background information to
the case or challenge to the city and the perspectives of the stakeholders. Five focus areas
comprehend the findings:
1. Local policies in favour of citizens’ healthy lives
and wellbeing
2. Participation and Social Innovation in Health
Innovation projects
3. Social enterprise
4. Patient empowerment
5. Community support networks / Neighbourhood
networks-Volunteers
The first section presents Citizens at the
centre of the health system. It’s about health
and wellbeing. About the shift from a reactive
approach to health to a more preventive one.
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About promoting healthy lifestyles and selfresponsible attitudes towards one’s own health.
About overcoming health inequalities. About
tackling health as a comprehensive issue from
this prevention perspective involving work,
for example, with school children –informing
these young people about the rewards of healthy
diets and habits, about addiction prevention,
and a host of other health-related topics, where
local governments have vested interests that
call for far-ranging, future-oriented, and smart
investments in tomorrow’s adult citizens.
The second focuses on the role of Social
Innovation encouraging and getting active citizen
participation in the design, development, testing
and assessment of Health Innovation projects. Of
particular interest here is the increasing use of
e-platforms tools and e-governance.
The third shows how social enterprise can be
a source of job creation and opportunities while
contributing to meeting the evolving needs of health
care and other social care related local demands.
The fourth is about patient empowerment. It’s
about ways for involving the patients in their own
treatments –from the diagnosis, treatment choices
and care to the management, safety and protection
over all data.
The fifth focus area deals with community
support networks / neighbourhood networkvolunteers. About how, where, when is it possible
for citizens to get together to achieve goals – in
this case, to act jointly to improve the local Health
system within the wider “eco-system” of relationships and systems that comprise the entire
community’s services.
Bringing Citizens
into Health Planning
II Output Report
September 2014
In dealing with each of the outputs in these 5
areas, we should mention one overarching concern
–Social Return on Investment. Given the
importance and consequences of investments in
education, innovation, social enterprise, and patient
empowerment, the question remains: “What is the
Social Return on Investment for any such initiative
on behalf of a more integrated Health policy?”
Or maybe the better question is “How can we
even begin to calculate the return of the social
investment by a local government in the area of
health?” As mentioned earlier in this Report, this
issue of calculating benefits versus investments
poses one of the main challenges to 4D Cities’ work
in the future.
a. Local policies in favour of citizens’ healthy
lives and wellbeing
When talking about Citizens we need to bear in mind
the multiplicity of roles that the same citizen
can adopt. Citizens can be approached and can
participate as potential health services beneficiaries,
tax payers, patients, relatives, neighbours or parts
of other collectives with specific interests: young,
elderly, disabled, families, teachers or workers.
Furthermore, when addressing the Citizens
dimension of the project we include a wide range
of collectives: patients as individual users, patients’
associations (for specific diseases), relatives who
care for the patient, communities (neighbourhoods, networks,…), voluntary and social organizations; and finally, the citizens as the ultimate focus
of public policies, whichever role they take.
Importantly for 4D Cities, the Citizen dimension also
brings into the discussion the term “assets”. Indeed,
while it is clear that local governments should aim
at a citizens’ improvement of their wellbeing, not
only making the local health system more efficient
but also promoting policies conducing to better
habits and preventive attitudes, this can only be
done with the cooperation of a number of Health
sector stakeholders including –but also going
beyond– health professionals. The key here is to
activate local assets towards a more responsible
and efficient health system. And it is here where
the local government is ideally positioned - both
strategically and tactically.
As co-owners and co-managers of the local health
care, local governments can play a major role as
promoters of long-term innovation strategies
that comply with patients’ satisfaction and improve
citizens’ wellbeing. By collecting and analysing info it
can understand population up close and immediate
needs and demands and promote timely collaborations between local government services in
favour of healthier habits of the population.
At the same time, Health policies are not entirely a
local responsibility. However, cities can be influential
in achieving healthier populations by undertaking
local policies and measures in related areas and
seeking local and supra-local interactions and
allies. For instance, cities are better situated to
leverage a wide range of information collecting
and processing tools –assets– to anticipate local
health needs and the services required for quality
care services.
For 4D Cities, the concept of a health asset
opens up a wide range of possibilities for actions
for citizens and communities: from becoming
pro-active co-producers of health and wellbeing
to empowering communities to control their own
futures, creating services, funds and buildings in
support of healthy populations –young and old.
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“A health asset is any factor or resource which
enhances the ability of individuals, communities
and populations to maintain and sustain health
and well-being. These assets can operate at the
level of the individual, family or community as
protective and promoting factors to buffer against
life’s stresses.” Antony Morgan, associate director,
National Institute for Health and Clinical Excellence
(NICE), 2009
An asset can be any of the following:
· the practical skills, capacity and knowledge of
local residents
· the passions and interests of local residents that
give them energy for change
· the networks and connections –known as ‘social
capital’– in a community, including friendships
and neighbourliness
· the effectiveness of local community and
voluntary associations
· the resources of public, private and third sector
organisations that are available to support a
community
· the physical and economic resources of a place
that enhance well-being.
The asset model is not new. In 1986, the World
Health organization held the First International conference on Health Promotion in Ottawa,
and among the elements of the first Charter is
the statement “Health promotion is the process
of enabling people to increase control over, and
to improve their health…) . Although it is not new,
it is still highly relevant for 4D Cities. The process
turns citizens-patient passivity on its head, brings
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the citizen in on the design and implementation
of products and services, and challenges local
governments and health services to recast their
relationships between commissioners, providers,
service users and communities .
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Asset models tend to accentuate positive capability
within individuals and support them to identify
problems and activate their own solutions to
problems which they themselves identify. They
focus on promoting health generating resources
that promote the self esteem and coping abilities
of individuals and communities, eventually leading
to less dependency on professional services .
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And this is what 4D Cities has been doing: identifying
public policies to meet citizens’ expectations of
quality Health services through a different, more
asset-model approach. This, also in recognition of
two important mind shifts in how “to do business”:
· Given the recent trends of moving from
reactive to preventive approaches to health
and given the economic constraints due to
high costs of medicines and other treatments,
local governments are beginning to understand
that these costs can be decreased if good
investments are made in the social area.
· Health professional staff and councillors have to
be willing to share power: instead of doing things
for people, they have to help a community to
do things for itself. Local solutions rely on
the community’s multiplicity of knowledge and
know-how. Engagement and commitment are
rooted in very specific local circumstances. That
said, the values and principles of asset working
are clearly transferrable, can be replicated city
to city. Leadership and knowledge sharing are
key to embedding these ideas in the mainstream
of public services.
Health in Scotland 2009. Time for a Change. Annual Report, 2009. See also Assets Alliance Scotland Event. Report, 2010
Adapted From Jane Foot and Trevor Hopkins, What Makes us Healthy, 2012.
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Health in Scotland 2009. Time for a Change. Annual Report, 2009. See also Assets Alliance Scotland Event. Report, 2010
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Bringing Citizens
into Health Planning
II Output Report
September 2014
The above brings us to the Thematic Meeting in
Baia Sprie (Romania) in June 2013, where the 4D
Cities’ partners tackled the measures to address
the issue of healthier styles of life, starting with the
information provision to reach different population
collectives and ending with more citizen-empowering approaches.
The consensus was that the City Council can carry
out three types of actions (and here it is worth
noting how many different kinds of “assets”
were being addressed and activated):
1) Give response and solutions to people’s demands
through an ad hoc organization or through work
with experts on data collection and analysis. Data
treatment gives information on trends and future
expected problems, as Àngels Chacón –project
coordinator for the lead partner city of Igualada–
very simply put it “if you know the number of births
at a given year, you can predict the number of kindergarten seats needed”. Beyond this, information
has to reach citizens in their own environment or
context and has to respond to the actual needs and
demands of them.
At another level, local governments should aim for
the improvement of citizens’ wellbeing, not only
making the local health system more efficient but
also promoting policies that lead to better habits
and preventive attitudes. But this would also require
means for assessing and quantifying these impacts;
and this, by extension, would involve calculating or
gauging the social return on investment.
More than simply informing the population, local
governments can develop ways to monitor the
outputs and the outcomes to make sure that the
investments in information provision is well-spent
and effective.
Providing information on training and monitoring
groups of patients with chronic diseases through
local programs is another means for generating
positive impact on the population’s health and the
efficiency of the health service.
2) Foster healthy habits and ways of life. Here,
the discussions focused on children in schools,
about healthy diets, about re-educating children
on the Mediterranean or other healthy diets and
healthy food. It was highlighted the need to start
educating from the early age. The fostering of
healthy habits also should address young people,
teen-agers, which can be achieved via youth associations and clubs. Emphasis here would be about
not only prevention (alcohol and drugs), but the
need for exercise, which also applies to the adult
population. Here, the assets of primary health
centres and sports clubs play an important role.
And local creativity, too. Promoting local health
activities such as popular sports competitions is an
easy-to-use resource that puts together any idea
with sports: for example, swimming or running
for a cause or a collective of people has become
increasingly common in many cities.
The need to do more to keep elderly people active
and social was discussed. Activities for the elderly
in Civic Centres (neighbourhood social centres)
were highlighted in that it has been observed that
when old people feel more accompanied, they
do not need/use medical services so often. Their
mental wellbeing remains positive. These activities
can include informing and training the elderly on
the use of new technologies, which would a) enable
them to follow up and monitor their own health,
and b) help them stay engaged, communicating and
interacting with peers, relatives and carers through
such tools.
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This also brings up the issue of Health Inequalities: inequalities in life expectancy, in illness and in
health and wellbeing. There is now a “clearer understanding of the links between mental wellbeing
and physical health and the contribution that
social determinants make to our health” . There
is need for re-enforcing the links between social
conditions and health and the need to create and
develop healthy and sustainable communities in
order to reduce health inequalities for populations
of all ages.
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From Sir Michael Marmot’s review, Fair Society Healthy Lives, 2010
3) Involve patients in the Health System as “active
patients”. The discussions dealt with the political
competences for undertaking initiatives in the
Health sector. Because not all competences reside
in the local government, it is sometimes necessary
to “lobby” before the relevant department of the
regional Government to get the funding or the
strategic support. Given the fact the public administration has lots of plans and work on its table
and limited resources, the partners recognize that
there is a need for the local government to clarify
strategy and act as a unique driver. Then make clear
what the local project is, who are they doing things
for, and why they want such improvements made.
It is about how to get local governments on board
for creating the conditions for a healthy living
and Health self-responsibility.
Bringing Citizens
into Health Planning
II Output Report
September 2014
On this topic we show two initiatives that show the
multi-levelled development of healthier population
strategies.
Joint local policies towards healthy lives, Igualada
Igualada is undertaking a series of projects and activities aimed at a healthier population. One of them
includes social events organized by the city council, in particular the promotion of population health and
wealth – in this case, a night urban running (Igualada Urban Running Show) that couples a popular night
outing for exercise with the capacity to go shopping at the stores expressly open for the Running Show.
Information to population groups through the Health Bureau, Plunge
The Public Health Bureau (PHB) is responsible for the public health at local level in the city of Plunge. Among its
responsibilities are health promotion and surveillance, child and young healthcare, community involvement in
public health activities, and implementation of the local public health program. PHB’s activities include information,
prevention and health monitoring programs; development of health services and facilities for children and
young; tackling health inequalities, etc. To plan its work, the PHB collects and analyses local community health
data regarding environmental, social and economic factors that affect health of the citizens.
Currently, the PHB has a total of 15 agreements signed with different health actors, ranging from the
Health Education and Disease Prevention Centre, the Police, the business school, the district health facilities,
the kindergartens, the Plunge Social Service Center, etc. Through these agreements, the PHB is able to
facilitate public health projects, provide information about healthy lifestyles, organize events,
seminars, etc., and collect useful data and spread materials on healthy style of living.
The PHB, managed through a municipal board and a health committee of the municipal council represented
by the Mayor, the Deputy Mayor, the Director of the Municipality Administration and a Municipality Doctor,
monitors the health of population via a survey that scholars fill in each year. This is a very rich and interesting
source of information but the challenge is how to use the information in a better way. In this sense, health
equity impact assessment is a tool for policy development. While health inequalities is still an issue in
Lithuania, capacity building and awareness raising activities continue.
17
b. Social Innovation
First and foremost, from the 4D Cities perspective,
the role of the public sector in Social Innovation –in
Health Innovation– is crucial. Without attempting
to cover all aspects regarding Social Innovation,
the following section presents the main discussions
and learning exchanges that took place in Baia Sprie
on the topic, and points to relevant documents and
possible ways ahead for the project.
Social innovations are new solutions that simultaneously meet a social need and lead to new
or improved capabilities and relationships and
better use of assets and resources. In other
words, social innovations are good for society
and enhance society’s capacity to act.’ (Tepsie)
Social innovation deeply changes the way to
approach public policies. All partners agreed
in Baia Sprie that it is more about the ‘how’ than
the ‘what’. The approach adopted by municipal
authorities to stimulate innovation is an innovation
by itself. Here we must think again of the “assets”
available to municipal authorities: how assets
are motivated; how they multiply; how they
inter-link; and, what they, in turn, give rise to when
mobilised or empowered. This is one reason why
Social Innovation often leads to the creation of
new organizations rather than new services from
existing ones. In sum, and in the long term, in Social
Innovation, the new “attitude” is as important as
the new contents created. The potential impact of
Social Innovation on Health systems is a paradigm
changer regards the design, development, delivery
and quality assessment of the system.
But what is the purpose of the innovation and
Social Innovation as it refers to Health systems?
How is it possible to measure the results of Social
Innovation (and this refers back to the Social Return
on Investment and cost-benefit analysis issue)?
Social Innovation does not happen without a
closely surveyed process. It comes about through
a controlled participatory design process, and
always in teamwork. This is done to facilitate the
formulation of ideas form different perspectives
for open and critical analysis, where the ideas get
sorted out and filtered according to pre-set criteria.
The selected criteria may have internal or external
contexts, such as economic aspects, competences,
opportunities, resources, etc… Social Innovations
are characterized by being:
· Critically driven by an extra motive: a social
mission, and the value they create is necessarily
shared value, at once economic and social.
· Open rather than closed when it comes to
knowledge-sharing and the ownership of
knowledge;
· Multi-disciplinary and more integrated to
problem solving than the single department or
single profession solutions of the past;
· Participative and empowering of citizens and
users rather than ‘top down’ and expert-led.
· Demand-led rather than supply-driven;
· Tailored rather than mass-produced, as most
solutions have to be adapted to local circumstances and personalised to individuals .
10
10
18
Guide to Social Innovation EU, 2010, European Commission
Bringing Citizens
into Health Planning
II Output Report
September 2014
What is important for 4D Cities partners to
understand and integrate in the work is, that to
become an enabler of social innovation, one needs
to shift from:
· Random innovation to a conscious and
systematic approach to public sector renewal;
· Merely managing human resources to building
innovation capacity at all levels of government;
· Running tasks and projects to orchestrating
processes of co-creation, creating new solutions
with people, not for them;
· Administrating public organisations to courageously leading innovation across and beyond
the public sector .
11
Normally, Social Innovation is an iterative process
(see image below), where Human Resources, time
and money are factored in, as selected ideas go
from ideation to prototyping to implementation to
finally scaling up.
1. Ideas
2. Prototyping
& piloting
4. Scaling
3. Implementation
11
For the partners familiar with the Logical
Framework approach, this process is familiar.
Through brainstorming and provoking, the analysis
of contexts and stakeholders’ needs, the prioritizing of tools, and the smart, impact-oriented selection of channels of communication are
all common results of the iterative techniques
used in Logical Framework approaches, which
can be applied in designing and deploying a Social
Innovation initiative.
Social innovation is to some extent risky, as change
involves risk, and more so with the stakes so high.
Health systems involve so many different assets
and stakeholders’ interests. A change in one affects
another, with unforeseen consequences always a
factor. Thus, it is essential for decision-makers to
be highly and constantly informed and aware of the
needs and changes that could take place prior to
starting action –and do take place during each stage
of the actual iteration– so as to be able to mitigate
risks and find appropriate remedies. After all, what
looks like a good solution today may not turn out to
be so good a solution in a future scenario.
A good idea that the city of Leeds exposed during
the debate around Social Innovation is the balance
that should exist among the roles that actors and
stakeholders play in a local health project: business,
health professionals, citizens and politicians. It’s
advisable to “exchange roles”: “Politicians should
think of themselves as enterprises, businesses as
civic organisations, and citizens as engaged and
empowered stakeholders”. In this way, empathies
and understandings can be created, and the clarity
of the vision for Social Innovation can be improved.
Roles and responsibilities of Local Support Groups
can act as filters or brokers of information once
the initiative starts, to prevent everybody doing
everything and needless duplications, too.
From Christian Bason, as published in the Guide to Social Innovation EU
19
Most of all, throughout the process, decision
makers have to be both a) proactive in creating
the conditions for participation, involvement and
co-creation; and, b) reactive in responding to
specific demands of people.
Indeed, and as was discussed at Baia Sprie, the local
government has to change its role towards the
citizens. People want to be listened to and to see their
problems solved. The local city councils must deal
with citizen’s constructive, innovative suggestions
as much as if they deal with citizen’s complaints.
Leadership is called for to effect this change.
From the social point of view, the health and
wealth strategy of a government is a long-term one
that needs meaningful community engagement,
bottom-up driven thinking and prioritizing for
investments. But as some partners stated in Baia
Sprie, it is not a matter of money but of will. And
to change mind sets is not easy. A new discourse
over the rewards or returns of Social Innovation
may be needed. The partners will remember that
Social Innovation is not the objective in and of itself,
but a tool. In other words, it is not about arranging
meetings with neighbours or inviting international specialists at big conferences to talk about
what should be done about Health systems in their
respective cities: it’s about adopting new behaviours
and working in new ways to get things done.
But this can only be possible with all stakeholders’ implication and participation through concrete
managerial tools. In this respect, the partners
underscored the importance of going beyond
just asking or surveying citizens about topics to
also involve them, get their feedback, during the
decision making process.
12
20
For this, it was clear at the meeting: the local
authorities need to work with citizens in
an organised and controlled process. Local
government representatives need to meet and
organize working sessions with interest groups,
community representatives, users, patients and
other stakeholders in an open but guided process
so as to facilitate dialogue and people’s contribution and feedback focusing on the area of interest.
One set of tools for such organized and
controlled processes for the 4D Cities project are
e-platforms and the way these facilitate e-governance and e-health. For the project, these tools
are of growing interest. And, to our benefit, there
are both EU 7 Framework Programme initiatives to
benchmark, such as D-Cent, and other platforms
on e-participation .
th
12
E-platforms, though, represent a two-side
challenge. On the one hand, it is about education
and training –to be able to ensure users are
aware of the tools and have the wherewithal to use
these tools to participate in a meaningful way; on
the other hand, it is about the partners (and their
cities’ stakeholders) avoiding the pitfalls of other
well-intentioned, top-down, institutionalized
e-participation efforts that fail shortly after
starting up.
E-based citizen initiatives have evidenced that they
can have more success, if they stem from a focused
problem or protest that motivates real and deep
engagement. Despite the degree of the importance
of the problem or the protest at hand, the process
of e-participation in Health innovation is nevertheless expected to be slow and will depend on many
other factors besides the mere existence and technological quality of channels and tools.
See http://ec.europa.eu/information_society/apps/projects/factsheet/index.cfm?project_ref=EP-06-01-021 with examples on Sweden,
Estonia and Iceland.
Bringing Citizens
into Health Planning
II Output Report
September 2014
In the first place, the use of communication technologies does not stop the needs for real, physical
interaction between citizens and health system
professionals. In addition, citizens may lack the
interest and robust political knowledge to formulate
their ideas and critique in a format suitable for
legislative or technical proposals. On top of this, the
motivation among civil servants to participate in
direct e-participation processes can be somewhat
low and not always encouraged or rewarded.
In sum, though the public administration is
responsible for the design of a broad strategy for
Health and to make clear where it is heading to
in the mid and long-term, it also needs to keep in
mind – and listen to and learn from – the targets,
end users, of its very own public policies, that is,
the citizens.
With this big picture in mind, public administrations need to identify the needs or opportunities for science and technical innovation and
Social Innovation by working hand in hand with
the citizens in open, transparent and trust-building
ways. The key is to be able to balance bottom-up
and top-down approaches in the process of
interacting with citizens, based on the principles
and basic “rules” of Social Innovation that can help
guide local governments and stakeholders in the
process for open consultation and co-creation for
innovations in Health systems.
Two 4D Cities initiatives are a result of this new
“mind-set” for innovation:
Best practice: Baia Sprie
In the case of the 4D Cities Health project in Baia Sprie, the aim is to create a feeling of “ownership” among
the citizens over health initiatives by mobilizing the population towards a common objective. Here, the
hospital is part of a broader strategy that has to do more with integration - a completely new approach. It
is not only about decentralizing but about creating greater ownership over decisions and local ambitions.
This attitude already exists towards the local Church. The idea that one can have a similar approach towards
ones’ own health. This proves the changes happening in the environment that can favour innovation and
Social Innovation lead by a committed leadership and municipal team.
D-Cent is an Europe-wide project creating privacy-aware tools and applications for direct democracy and economic empowerment. Together with
the citizens and developers, D-Cent creates a decentralised social networking platform for large-scale collaboration and decision-making: http://
dcentproject.eu/
21
Best practice: 4D Health, Igualada
In the case of the 4D Cities Health project of Igualada, the Mayor assigned the project to the Department
of Economic Promotion not in the Health Department. This is a fundamentally different way of approaching
possible improvements in a city’s Health system. Changes are being encouraged based on research that also
requires innovation and society participation. The message that the objective is to “move forward” and “do
something new” is spreading throughout the stakeholders’ networks.
With the support of the local coordinator of the URBACT Local Support Groups, Igualada has endeavoured
an exhaustive mapping and a series of consultations with each and every local health stakeholder. The
individual meetings allow them to know in detail what are the activities they do; the services they offer;
which are their problems and difficulties; their territorial scope; devices; human resources; evolution; overlaps
with other organizations and areas; challenges and leadership; proposals of collaboration with other ULSG
members; etc. This analysis is a key starting point to know the problems and challenges of every stakeholder
before putting them to work together with the other members.
Taking into account the analysis of the stakeholders and the analysis of the healthcare sector as well as
patients’ expressed needs, some areas have been prioritized for work. In that regard, working groups will
be set up so as to go more deeply into the contents and co-create concrete actions and measures to be
implemented.
The extensive group of stakeholders that are active for the project in the City include:
· High schools, the Public Healthcare Consortium, the local delegation of the College of Pharmacists, the
Consortium for Social Health (CSSI), primary care centres.
· Association for psychically disabled children and young; work centre for people with psychic of physic
disabilities; private foundations for people with disabilities; association of patients with rare diseases; the
Red Cross; healthcare foundations; a residence and health care assistance; social organizations working
on volunteering projects; some related to the health care area; old people associations.
· The business association; the Association of ICT companies, the Chamber of Commerce,
· Igualada City Council – Economic Development Department
22
Bringing Citizens
into Health Planning
II Output Report
September 2014
c. Social Enterprise in Health
There is a major role to play by social enterprises in
the health sector, offering social health care services
that support elderly and chronic ill people to live
healthier, more active and social lives, improving
their condition. This becomes even more relevant
for health system strategy makers when publicprivate initiatives between social enterprises and
the local government can ease pressure on local
demands for social services.
Social enterprises, and their leaders –social
entrepreneurs, offer delivery mechanisms for
their products and services that can bring also
added value. Micro enterprises, user-led organisations, mutuals, and co-operatives are examples
of the different types of enterprises that cover
social and economic needs, including those in the
Health sector.
In the health and social care sector, social
enterprises seek to involve patients and staff in
the design and delivery of services, giving more
control over their healthcare and helping to
improve quality and tailored services to match
patient needs more closely.
It also delivers services in a more flexible and
less bureaucratic manner than traditional delivery
models. The localisation of the social enterprise
model enables services to be tailored to the needs
of the local population and hence contributes to
improvements in the health and wellbeing of the
whole local community .
13
For 4D Cities partners, the challenges exposed
included: a) how to create favourable fiscal and
legal environments for social enterprises and
social entrepreneurs to emerge and prosper; and,
b) how to create the most adequate conditions for
13
strategic partnerships between the government
and these private sector initiatives, as well as with
non-profits and other entities…
For many social enterprises achieving scale
remains one of the most important challenges
facing entrepreneurial approaches, and many
remain small and local. Those that have achieved
scale have done so through strategic partnerships
with governments or the companies. Therefore,
support from the public sector can be of great
importance to boost this sector.
One kind of strategic partnership involves
companies that integrate, or that fully employ,
disabled people. On the one hand, these human
resources represent employment generated at
the local level; on the other hand, costs for social
and care assistance from the public budget are
decreased. The partnership works: occupying
disabled people in a productive/commercial activity
alleviates social and healthcare costs and increases
the wealth and wellbeing of citizens.
Other strategic arrangements involves tax
benefits or other incentives, e.g. improved
corporate image, CSR, and each country has its
own regulations for social initiatives of this kind.
However local governments may pursue the
stimulation of social enterprises through local
policies. A local government may support and
encourage the development of services which help
people live independently by investing in social
enterprises: older people, people with a learning
disability, people with a physical disability or
sensory impairment, people with a mental health
need, etc.
From Social Enterprises in Health and Social Care - What Are They? White Paper. Oackley Consulting http://www.oakleigh.co.uk/Homepage
23
Best practice: ASSOC Baia Sprie
In Romania a total of 40.000 people work for social enterprises (6% of population). For stakeholders in
Baia Sprie, disabled people need to be seen as potential labour force, not as a problem. ASSOC, Petru Mare,
successfully integrates disabled people into the labour productive market.
d. Patients’ Empowerment
Patient empowerment comes through a collection of
means and conditions that makes the patient a central
piece of a new system. At the Citizens’ Thematic
meeting the partners exchanged views, practices
and knowledge based on literature and experiences.
In brief, patient empowerment involves:
· A patient’s opinion and input has to be
ensured through the existence of feedback
mechanisms: follow up contacts, surveys, etc.
· A patient can be provided support for his/her own
independence through building self-management skills and by creating the appropriate
environment. Here, the self-care support may
come from expert patients themselves or from
qualified trainers. A host of related training and
support services to follow-up on the training
and environment can be created, which would
generate income and employment.
· A patient has to become the owner of his/
her data and history. In this model, patient
data and information records are established in
partnership with professionals. This allows for
the patient to better understand the medical
condition and helps him/her become part of the
14
24
Connect. Patients and the power of data, The Young Foundation, 2011.
decision-making about the care plan together
with the medical and care professionals. Patients
often know better than anyone else what they
need most. As such, this new model respects
patients’ preferences and choices for their
health, e.g. living wills, personal budgets and
expenses, treatments…
In this respect, some entities like the Young
Foundation have studied patient-empowerment and
envision the health system moving in the direction of
a more cooperative multi-actor approach, including
evidence + value-based decision-making processes
that help match supply with market demand and
patient need, in particular, regards the development
and use of ICT innovation solutions .
14
Patients’ data collection and treatment in the new
models of Health Services (where patients are the
owners of their history) require development based
on clear collaboration principles and regulations.
Bringing Citizens
into Health Planning
II Output Report
September 2014
e. Neighbourhood Networks
This section presents the support networks through
community and volunteer engagement that some
4D Cities partners discussed in Baia Sprie but also
in other meetings, namely the Health one in Leeds.
Partners could learn about the wide range of
neighbourhood capacities, potentials and support
mechanisms (assets, in other words) and highlighted
a number of findings and opportunities for building
on, or helping to create, these networks in local
neighbour communities . These are described in
continuation:
15
· Neighbourhood community work through
volunteers in cooperation with health care
services helps dependent and elderly people
to keep active, motivated and healthy, which is
part of any positive preventive health care plan.
To support these volunteers means understanding local capacities to engage people, being
able to match different profiles of volunteers
for different kinds of activities. It would mean
matching Human Resource capacity and will,
possible apprenticeship opportunities, etc.
In this respect, it was assessed in Leeds, the
following 4D Cities transnational meeting, that
the culture of volunteering is diverse in different
European countries, and that it is sometimes a
challenge to involve volunteer work, according
to Mick Ward, Head of commissioning of Adult
social care in Leeds City Council, you have to
give a volunteer something in return, being it
knowledge, training or other type of compensation, if you want to keep him/her engaged
and committed.
· Neighbourhood networks provide a wide range
of services besides health care: recreational and leisure time activities, etc.. These help
15
16
people of all ages – including the elderly - so
that they can stay involved in their communities
to the younger generation by way of advice
and support on behalf of healthy lifestyles.
Neighbourhood networks also offer additional
services such as support at home or to those
recently discharged from hospital.
· Local clinics and specialists may prescribe
activities instead of drugs. Exercise and
socialization improves elderly people’s lives.
The prescribed services mobilise communities
and networks to support people on their terms.
Services are co-designed and co-delivered
by patients, enabling them to meet not only
bio-medical needs but wider social, physical
and mental wellbeing goals .
16
· Regarding sustainability, a variety of support
and income generating sources from public
agreements, charities, lotteries, and regular
payments of users and payment of particular
services (transport, outings,…), always according
to local possibilities and each city’s cultural and
economic profile. Indeed, community support
networks improve people’s lives and have
proved to be cost-effective through saving
public resources. Supporting these networks
from the local government has proved to be
highly efficient in terms of social return.
· There are also opportunities for Corporate
Social Responsibility from local companies
allocating time of their staff. Plus, there are
opportunities for developing collaborations
with training centres, which may result in
agreements for students to do internships in
areas such as social work, nursing, teaching, etc.
See Networks that work, partnerships for integrated care and services, Nesta, UK 2013
For Social Prescribing see More than Medicine, New services for people powered Health, Nesta, UK, 2013
25
Neighbourhood Network, Armley Helping Hands
Armley Helping Hands is part of a network of over 30 organisations throughout Leeds whose aim is to
provide facilities for educational, recreational and leisure time activities with a view to improving quality of
life, promoting independence, safeguarding older people and reducing social isolation.
The network, which nowadays has more than 1.800 volunteers and 22.000 users, was initiated on 1992 by
a social worker and it was after replied by the municipality.
The main aim of the charity is to enable older people to live independently within the local community,
give older people and their carers the opportunity to “have a choice” and establish services and activities
within the local community to reduce social isolation, improve mental and physical wellbeing and develop
community partnership and engagement.
The network deals with very isolated people with mental and health problems (such as dementia). Provides
preventive services and promotes arrangement activities to avoid social isolation: lunch clubs, indoor activities
to promote health, swimming groups, healthy eating, computer sessions, etc. They also can monitor the
members in their homes since they pick them up at home and can see if there is deterioration, or problem.
Support provided promotes independence, health and well-being, active living, mental stimulation,
community partnership, recreation time, access to education, improve the quality of live, give older people
a voice in their community and community partnership.
Representation of older people and users on the Board of Trustees and Management Committee is of 95%.
Shared resources include technology: computer training, use of skype, email, etc. Due to this intensified use of
technology there is a company that develops communication systems through image that has made an investment
in the city occupying 1000 people now. The products are designed in interaction with older people.
A College neighbouring the Centre offers assistance by the young students (hairdressing, training in computer
activities, etc).
It is worth noting here a relevant EU funder project
called WILCO. This project aims to examine, through
cross-national comparative research, how local
welfare systems favour social cohesion. Special
17
26
See the project here: http://www.wilcoproject.eu/
attention will be paid on the missing link between
innovations at the local level and their successful
transfer and implementation to other settings .
17
Bringing Citizens
into Health Planning
II Output Report
September 2014
V. Closing remarks
One might be tempted to think that empowering
the patient and supporting citizens in a new
health model that makes them more self-responsible of their health condition could translate into
watering down the public responsibilities of good
and quality healthcare services.
Better acknowledgement of patients’ real needs
should translate into better services, tools and
procedures to meet them. This in turn facilitates
mutual trust between people and public practitioners, citizens relying in decision makers and
public services.
However, the user-centred approach does not
mean passing the responsibility onto the patients,
full stop. On the contrary, it is about creating the
conditions to enable a more direct participation and
involvement of citizens and patients in a context
of new service organization and provision. This is
achieved by informing, training and effectively
incorporating people’s opinions and feedback into
local health policies.
Social Innovation, as a tool, facilitates this
consultation and empowerment of citizens,
encouraging their participation in the design,
development, testing and assessment of Health
Innovation projects.
27
VI. Conclusions
nd
In this, the 2 of 4 Reports on Local Health
Innovation, we have seen what has been done –and
what is being done– by the 4D Cities’ Partners in
5 main focus areas focusing on the Citizen as
the center of attention with other stakeholders
from a medical and policy perspective: 1) Local
policies in favour of citizens’ healthy lives and
wellbeing; 2) Participation and Social Innovation in
Health Innovation projects; 3) Social enterprise; 4)
Patient empowerment; and 5) Community support
networks/ Neighbourhood networks – Volunteers.
As in all the Reports, the Project used three main
tools to capture the complexities of the relationships between the drivers within and across these
5 focus areas, which offers a 360 Quadruple
Helix vision of the situations in each community:
a) a mapping, or register, of the policies, tools and
actions that enable each partner to collaborate
with local health actors for defining the health
project objectives in their respective cities; b) a
matrix of sector engagement based on diffusion
and social innovation theories; and, c) an internal
project instrument to assess regulation and funding
capacities of partner cities.
What was found using these tools is a two-stranded, common thread running through the 5 focus
areas mentioned above as each Partner develops
its own Local Action Plans. The commonality is none
other but the constant and dynamic calculus
between investments and benefits regards
stakeholders’ implications in creating or supporting
health innovation up and down the value chain.
Along one strand are the challenges of being able to
quantify or qualify now in terms of Social Return
on Investment the costs and returns for health
innovation design, implementation, evaluation, the
28
effects on local community assets, and the local,
tactical, practical questions of ”how” to do and
measure all this.
Along the other strand is the set of emerging
issues that are shaping the future, each issue
poised to impact on new value chains and stakeholders’ relationships: e-government and 2.0
platforms; health as a source for social enterprise
and job creation; asset-based assessments for
making better long term future planning; patient
empowerment that puts the citizen/patient in the
center of health innovation; and, the place and role
of corporate health management.
This Report highlighted the partners’ proposals and
experiences in top-down and bottom-up open
consultation and co-creation for needs-based
health innovation. Such experience presents a
diversified set of actions in: a) social enterprise,
b) volunteer and community support groups; c)
the nurturing of a citizens’ preventive approach
to health care and overcoming health inequalities; d) Social Innovation to meet the evolving
needs of health care and other social care; and, e)
the empowerment of patients in their interface
with health care from the diagnosis and treatment
stages to dealing with care management, safety
and protection over all data issues.
Whether we are talking about patients’
empowerment, neighborhood support groups,
integrating the disabled into the work force or
citizens co-designing and co-delivering their own
health services, the local government remains the
driving force behind shaping the context and sustainability of a community’s health care development,
the key actor shaping the top-down and bottom-up
balance for sustainability and progress.
Bringing Citizens
into Health Planning
II Output Report
September 2014
Annex 1: Agenda of the 2nd Transnational
Meeting, Baia Sprie
URBACT II
2nd TRANSNATIONAL MEETING
IMPLEMENTATION PHASE
18-19 JUNE 2013, BAIA SPRIE
OBJECTIVES OF THE MEETING
· To learn about patients and local communities’
involvement in the co-creation of health care
and health delivery systems, through partners’
local best practices and experts.
· To learn about Social Innovation tools and methodologies from field experts.
· To participate in exchanging and peer review
activities to: discuss key focus points in social
innovation practices related to health care
services as well as to identify legal and political
framework constraints and opportunities.
PREPARATION BEFORE THE MEETING
· The 4 “expert” partners prepare and share their
best practice reports.
· All partners read the 4 reports of the experts
on citizens’ dimension.
· All partners prepare questions according to
own interest focus points to be raised at the
meeting.
· To identify particular lessons learnt to be
eventually assumed and incorporated in
partners’ Local Action Plans.
· To agree on thematic topics to be further
developed and analysed on the citizens
dimension.
· To hold a Steering Committee meeting to
nd
evaluate the 2 Transnational meeting and
suggest changes for the following.
29
DAY 1 - TUESDAY 18TH JUNE 2013
9:00-9:30
9:30-9:45
9:45-10:00
10:00-10:30
Welcome and introduction of
Baia Sprie
Mr. Dorin Pasca,
Mayor of Baia Sprie
12:30-13:00
Tartu case study
Siim Espenberg
13:00-13:30
Questions & Doubts
Who is who
Round of quick personal introductions
13:30-15:00
Lunch break
15:00-16:00
Managing Social Innovation
Mr. Joan Josep Rotger, Managing
Partner at Invenies
16:00-17:00
Social Innovation in the Health
Services
Case analisys
17:00-19:00
Trip to Barsana
19:30
Dinner
Revision of meeting objectives
and ULSG work update
Mireia Sanabria, Lead Expert
Baia Sprie case study: Local
Health System and Citizens
Implication
Zoltan Molnar, USLG Coordinator
Iulian Furnea.
10:30-11:00
Igualada case study
Dr. Enric Macarulla, 4D Health
Project Director, Surgeon and
Director of the Teaching and
Research Department, Igualada
Hospital.
11:00-11:30
Coffe break
11:30-12:00
Baia Sprie case study: ASSOC,
Social NGO
Florian Salajeanu, President of
ASSOC, former State Secretary
Minister of Labor and USLG
member
12:00-12:30
Plunge case study
Zaneta Piepaliene, Head of
Strategic Planning and Investment
Department
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Meeting Venue
Mogosa Hotel, Baia Sprie
www.mogosa.ro
Bringing Citizens
into Health Planning
II Output Report
September 2014
DAY 2 - WEDNESDAY 19TH JUNE 2013
9:00-9:30
Introduction to the working
session
9:30-10:15
Group work. Session I
Partner’s group meetings for
questions and peer review
10:15-11:00
Group work. Session II
Partner’s group meetings for
questions and peer review
11:00-11:30
Coffee break
11:30-12:00
Flea market session
4 tables set for partners’ free
exchange: go around to discuss
specific interest points, share and
exchange opinions, contacts, etc. 12:00-12:20
Individual work
Each partner prepares a 5 minutes
presentation of lessons learnt and
topics to be further developed in
the business dimension
12:20-13:20
Presentation of partners’
lessons learnt and group
agreement on topics to be
further studied.
13.20-14:00
Evaluation and Next Steps
14:30-15:30
Lunch
15:30-16:00
Trip to Merry Cemetery,
Sapanta OR The Potter’s
House – Les Daniel
19:00
Dinner
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Annex 2: List of participants
Eindhoven
Marieke van Beurden, Project Leader, Brainport Development NV
Baia Sprie
Dorin Pasca, Mayor
Szakacs Levente Istvan, Projects Implementation Unit, City Council
Bogdan Breban, Projects Implementation Unit, City Council
Claudia Breban, Director County Council Maramures, City Council
Iulian Furnea, External expert, advisor for 4D Cities project
Zoltan Molnar, Medspria Medical Unit Manager
Carmen Tarnovschi, Executive Director, Centrul de Afaceri and ULSG member
Petru Mare, Executive Manager at NGO ASSOC
Igualada
Àngels Chacón, Project Coordinator
Enric Macarulla, Thematic Expert
Núria Cañamares, Communication Officer
Jena
Marco Röhl, Business Development
Leeds
Plunge
Susan Tuck, Senior policy officer
Tartu
Siim Espenberg, Chief Specialist in Business Development
Social
Innovation
Expert
Lead Expert
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Zaneta Piepaliene, Head of Strategic Planning and Investments Department
Ceslovas Kerpauskas, Deputy Director of Plunge District Municipality Administration
Joan Josep Rotger, Managing Partner, Invenies
Mireia Sanabria, Invenies
Bringing Citizens
into Health Planning
II Output Report
September 2014
Annex 3: Meeting Pictures
Working sessions at the Baia Sprie 2 Transnational Meeting of the 4D Cities Project
nd
Picture 1: Meeting debates.
Picture 2: Working groups session.
Picture 3: Working groups session.
Picture 4: 4D Cities photo family.
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Annex 4: Glossary
· Social Innovation:
· Social innovations are new solutions that
simultaneously meet a social need and lead
to new or improved capabilities and relationships and better use of assets and resources.
In other words, social innovations are good
for society and enhance society’s capacity
to act.’ (Tepsie)
· Social innovation ‘must be structurally aimed
at meeting social need (social challenge);
must involve a new or significantly improved
product, process, marketing method, and/or
organisational model.’ (Selusi)
· Social innovation is a process where civil
society actors develop new technologies,
strategies, ideas and/or organisations to
meet social needs or solve social problems.
(SPREAD)
· Social enterprise:
An organization that applies commercial strategies
to maximize improvements in human and environmental well-being, rather than maximizing profits
for external shareholders. Social enterprises can
be structured as a for-profit or non-profit, and
may take the form of a cooperative, mutual organization, a disregarded entity a social business,
or a charity organization. One of the key differentiating characteristics of social enterprises
is ownership. They can be owned by users or
customers, employees, the wider community,
trustees, public bodies, or a combination of these
different groups. Many social enterprises in the
health and social care sector are partnerships
with organisations from other sectors such as
voluntary and community groups -or ‘third sector
organisations’. This is because the third sector
organisations often have better relations with
patient and staff groups and expert knowledge
in specific areas or types of care.
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· Social Return on Investment (SROI):
SROI It is an analytic tool for measuring and
accounting for a much broader concept of value
beyond the financial one, relative to resources
invested, taking into account social, economic
and environmental factors that a conventional cost-benefit analysis does not consider. It
provides a consistent quantitative approach to
understanding and managing the impacts of a
project, business, organisation, fund or policy.
· Asset-Based Approach and Assessment:
An asset based approach makes visible and
values the skills, knowledge, connections and
potential in a community. It promotes capacity,
connectedness and social capital. Asset based
approaches are concerned with identifying
the protective factors that support health and
wellbeing.
Assets can be described as the collective
resources which individuals and communities
have at their disposal, which protect against
negative health outcomes and promote health
status. Although health assets are a part of every
person, they are not necessarily used purposefully or mindfully. The Asset-based assessment
is the identification, mapping and acknowledgement of such assets in a community.
· Health Inequalities:
Health inequalities are preventable and unjust
differences in health status experienced by
certain population groups. People in lower socioeconomic groups are more likely to experience
chronic ill-health and die earlier than those who
are more advantaged. Health inequalities are
not only apparent between people of different
socio-economic groups –they exist between
different genders and different ethnic groups.
(The Institute of Public health in Ireland)
Bringing Citizens
into Health Planning
II Output Report
September 2014
Annex 5: Bibliography and web references
· Exploring the Quadruple Helix.
Outlining user-oriented innovation models.
Arnkil, R., Järvensivu, A., Koski, P., Piirainen, P.
· The Reengineering Revolution. Michael Hammer
& Steve Stanton. Harper Business, 1995.
Comments. (Specially chapter 7).
· Health in Scotland 2009. Time for a Change.
Annual Report, 2009.
· Knowledge for Action. Chris Argyris.
Jossey Bass. 1993.
· Assets Alliance Scotland Event. Report, 2010
· Social Innovation Europe
http://innovationforchange.org/
· What Makes us Healthy,
Jane Foot and Trevor Hopkins, 2012.
· Fair Society Healthy Lives,
Sir Michael Marmot’s review 2010
· Guide to Social Innovation EU,
European Commission, 2010,
· Social innovation research in the European Union.
Approaches, findings and future directions,
Policy review. Directorate-General for Research
and Innovation. Socio-economic Sciences and
Humanities, 2013
· Connect. Patients and the power of data,
The Young Foundation, 2011.
· D-Cent Project http://dcentproject.eu/
· WILCO Project http://www.wilcoproject.eu/
· Innovation Unit
http://www.innovationunit.org/knowledge
· http://geniusyork.com/
· European Urban Knowledge Network
http://www.eukn.org/E_library/Practice_of_
the_month/Practice_of_the_Month_Active_
Ageing
· http://www.patientsknowbest.com/
· Networks that work, partnerships for integrated
care and services, Nesta, UK 2013
· More than Medicine, New services for people
powered Health, Nesta, UK, 2013
· Innovating to the core. Peter Skarzynski.
Harvard Business Press, 2008.
· Blue Ocean Startegy. W. Chan Kim & Renée
Maubergne. Harvard Business School Press,
2005. (Specially the chapter about innovation
at New York Police Department)
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