ON THE SAME PAGE process book

A project in partnership with:
Sykehjemsetaten
Oslo Kommune
Line T. Bogen, Rickard Jensen, Liz LeBlanc, Simon Søgnen Tveit
Systems Oriented Design Fall 2014
ON THE
SAME PAGEProcess Book

PROCESS BOOK //08.12.14
PROTOTYPING 29
THE TURN 19
WORKSHOPS 39
DELIVERABLES 51
RICH DESIGN SPACE 47
REFLECTIONS 55
INITIAL RESEARCH 05
BACKGROUND 03
PROCESS BOOK
TABLE OF CONTENTS

3
PROJECT GROUP
Employee representative:
Elisabeth Jørgensen
Special Employee consultant:
Janke Damslova
Quality control:
Inger Governess Kind
Representative for the Physic/Occupational therapy:
Ine Cecilie Ulven
Representative the Nurses:
Birgit Jensen
Nursing Assistant and representative for Union members:
Kjartan Goksøyr
Representative for area 2 (private healthcare):
Mona Kjekshus
Representative for area 1 (public healthcare):
Inger-Lise Kjos
Economy Dpt. SYE:
Bitte Thon
TOP MANAGEMENT GROUP
The director at Sykehjemsetaten (SYE):
Helge Jagmann
4 Directors from districts
Tove Stien (østensjø)
Tore Pran (Alna)
Kari Andreasen (Ullern)
Marius Trahne (sagene)
Dpt. Manager SYE quality, expertise and development
Heidi Englund
Director area 2, Private healthcare
Anne Berger Sjølie
Bærum municipality
Bente Nesset
The Central Council for the Elderly in Oslo
Wenche Hansgaard
The Union, Representing employees at SYE
Svein Matisen
Project leaders
Bjørg Torill Madsen & Bente Solvberg Sæve
The Top Management group ensures that
the development of the four “Health houses”
are coming through. They are also
responsible for the development of
concepts for the new “Health house” service
and the service that will be provided at the
long term facilities, “My home”.
They are also responsible for developing
the right competences.
City Council
Lead by the Mayor;
Fabian Stang
(Conservative Party)
The mayor is elected among the city
council members and the council's legal
representative. He signs on behalf of the
municipality in all cases where the authority
is not granted to other.
THE HIERARCHY WITHIN SYE
Director at SYE
Directors of
Area 1 & 2
Manager at
Institution
Head nurse
at institution
LOCAL MOVING GROUPS
While the project group ensures that the restructuring is carried out
properly - the actual moving process is lead by “local teams”.
The project leaders at SYE have the master plan and schedule for
the moves. Together with representatives from the institutions
involved - and the districts - the detailed plan for moving patients
and employees are developed and executed.
For a working document detailing one
of these moves, see map number 6.
This move also involves moving different staff members.
Gatekeepers:
Govermental Structure
Surrounding this project.
Oslo City Government
Lead by Stian Berger Røsland
(Conservative Party)
Among 8 committee leaders;
Aud Kvalbein,
(The Christian Democrats KrF)
councilor Health and Social Affairs
Prepare cases and make
recommendations to the City Council.
“Long term patients
have to move between
houses voluntarily.”
The project group is multifaceted
because of the huge change that follows
this restructuring process.
This statement came after a riot in the media,
caused by next of kins. In Oslo, patients
themselves can choose their longterm facility
(`Fritt sykehjemsvalg´). Some are more popular
than others. One of the most popular facilities
are being restructured into a health house.
When media wrote about this, Aud made her
statement and this caused a huge delay in the
restructuring process.
Reports to City Gov
6
“Decentralize power, give
the local authority more
control. Reduce bureaucracy.”
The City Council of Oslo:
“By April 1st 2014 we should have created four
”health-houses” in Oslo. These should take care of all
short term patients. By gathering all short term patients in
these facilities we will improve the services - get better
expertise on rehabilitation, decrease hospital admittance
and provide for elderly to live in their own homes rather
then being institutionalized in long term facilities.”
THE MISSION
PERSONNEL
STRUCTURE
PROJECT FOCUS &
‘ON THE GROUND’
Bjørg Torill Madsen & Bente Solberg Sæve
Brought in by the Director of SYE
Broke the mission into 4 projects
Short term: Health-house
Longterm: My home
New Price Model
The Move
THE MISSION
CITY COUNCIL
AND GOVERNMENT

4PROCESS BOOK //08.12.14
BACKGROUND
SAMHANDLINGS REFORM
SYE is in for a long period of change. As a
part of the strategy to meet the needs of
tomorrow, reforms from The Ministry of Health
and care are already set in motion. Due to
Samhandlingsreformen 2012, Stortingsmelding
25 (2005-06 - mestring, muligheter og mening.
Fremtidas omsorgsutfordringer), Omsorgsplan
2015, Stortingsmelding 29 (2012-13
Morgendagens omsorg) and Omsorgsplan 2020
-SYE is now restructuring their system of services
towards elderly care.
DIVIDING THE PATIENTS
Sykehjemsetaten in Oslo (SYE) is in a process of
restructuring their services towards elderly. Today
Oslo has about 50 mixed nursing homes. Mixed
meaning they house both long term and short term
patients. SYE has a plan to separate these two
groups within the nursing home system. The goal
being that all patients in need of services will be
taken care of in the most efficient and effective way,
according to the omsorg 2020 plan.
SYE will reach this goal by dividing the nursing
homes. From the spring of 2016 there will be four
short term houses in Oslo. The short term houses
will take care of all patients that needs rehab and
support to continue living in their own homes.
Oslo will also have approximately 50 long term
homes to take care of patients that no longer
manage to live in their own homes.
THE PLANS FOR CARE
Omsorgsplan 2020 and 2015 are strategies
developed by Helsedirektoratet that follows the
stortingsmelding 25 & 29, to meet the needs of
today, and challenges of tomorrow.
Short: Omsorg 2015 is about increasing the
number of 24hr care places, numbers of FTE’s
in the elderly care services, making a plan for
Dementia issues, and building better competence.
Omsorg 2020 is about tomorrow: new user groups,
new caring communities and networks, a national
volunteering strategy and policy for nonprofit,
cooperative-based and private service providers.
Omsorg 2020 is also addressing questions about
the surroundings for care services. Development
and implementation of welfare technologies and
developing future nursing and residential homes.
INTRODUCTION TO POLITICAL LANDCSAPE
4

INITIAL
RESEARCH

THE START
On the following pages we will take you through
our journy of doing research, developing the
communication tool product and facilitating
workshops .
As we took on this project, we had very little to non
experience with Sykehjemsetaten, SYE.
We did what were good at - went in with ears and
eyes wide open and dived into the organization.
We are very grateful to Bjørg Torill Madsen and
Bente Sæve who has been nothing short of stellar.
They have been opening doors all the way, and
made it possible for us to turn all stones we could
find in the large organization of Sykehjemsetaten.
SYKEHJEMSETATEN
INITIAL RESEARCH

BESTILLERKONTORET,
BYDEL ALNA
Today we had two hours to talk with Marit. After
our conversation last week with Bjørg and Bente at
Sykehjemsetaten we wanted to get a closer look
at what the work looks like from inside the bydel.
There are fifteen bydeler (districts) within the Oslo
kommune (municipality). The residents of these
bydeler access many of the health services through
the bestillerkontoret.
A few of our key take aways are:
1. Employees of bestillerkontoret check on patients
in person to assess what kind of care they need
after a stay in the hospital, or when transitioning to
home care or into a long term nursing facility.
2. These employees have high quality medical
training and practical experience in nursing,
occupational therapy, physical therapy, and other
specialties. They visit the homes multiple times
each week to check on patients.
3. Contrary to what we thought from our last
meeting, the evaluations are more than once each
week. The employees coming to check on patients
are not concerned that their residents are living in
the same area of the helse hus. They would rather
they be placed according to their medical needs.
4. Helse hus should not run like a nice spa, a place
to relax. Instead, it could be treated like an efficient
extension of the hospital. Patients need a place to
get back to normal and recuperate after a trip to
the hospital.
Last but not least, we asked Marit what her dream
for the helse hus would be. If she could have her
way, all she wanted was a home filled with“high
qualified staff that sees the whole patient, who is
a bit firm, but with a warm heart”. She wanted to
have a short term house that focused on goals and
getting healthy people back home.
INTERVIEWS
BLOG POST

HJEMMETJENESTEN,
BYDEL GRORUD
Yesterday we met with head of
hjemmehjelptjenesten in bydel (district) Grorud in
Oslo. She has worked in hjemmetjenesten since
2002 and knows the service in and out.
From her practice when she did home nursing -
through leading the cooperation processes when
the samhandlingsreform was introduced - and
now as the leader of the whole hjemmetjeneste in
Grorud.
We found that samhandlingsreformen resulted in
a much higher need of hjemmehjelp, as patients
are discharged from hospital much sooner than
before. Sometimes they are not finished with their
treatment, and are sent home with IVs that gives
antibiotics etc. This has lead to new tasks for the
home-nurses, and also increased the need of
highly educated employees in the hjemmehjelpen.
Over the last few years the number of nurses in
hjemmehjelpen has nearly doubled.
The different population in the districts of Oslo
demands very different help. From some districts
where the home nurses mostly care for elderly - to
the districts where the patients are younger. Like
kids with chronic diseases, drug abusers, people
with disabilities and such..
The meeting with Hjemmetjenesten opened our
minds to think about the whole spectrum of people
that at one point - or more permanent - is in need
of their services.
It is interesting to gain insight into the
complexities surrounding introduction of the
Samhandlingsreform.
“It is not“easy”to get admitted to a long-term care
facility. We have so many different services that
we can provide for the patient so that they can live
a happy and healthy life at home - for as long as
possible. Our experience is that living at home for
as long as it is safe is a good solution.”
INTERVIEWS
BLOG POST

PROCESS BOOK //08.12.14 10
11 SEPTEMBER BYDEL GRORUD
BENTE
1. Nothing is standard. Each bydel decides who
gets what care by whom
2. Communication is stronger and more open here.
3. Evaluation meeting is not enough time to give
accurate vedtak
4. Opinion of private/public varies by district and
demographic
5. Amount of public housing has huge impact
6. Many have been working 20- 25 years
7. Different employees have different strengths.
Holistic view, or get it done
8. Hospitals, family, and politicians want more room
in the nursing home. Patients and districts want
them to be cared for at home
9. If you haven’t worked in home care, impressions
aren’t great.
10. Miscommunication is an epidemic
11. Want primary person for each patient. But
sometimes that’s not what the patient wants, or it’s
dangerous, or it’s impossible with 24hr care
12. It’s easy to think things are going well but they
only see employees a few times per day
13. Technology is working, they work with device to
control
HJEMMETJENESTE

AHUS
At Ahus we met with Bjørn, one of the advisors as
the dept. for samhandling.
Samhandling = cooperations. Here between
hospital and municipality, but also between
hospital and many other connected actors... We’ll
concentrate on the connection to bestillerkontoret.
We have now learned that the Bestillerkontor is sort
of the glue between different care-facilities and the
patient. Either the hospital, your GP or you yourself
reach out to the bestillerkontor - so that they can
evaluate your need for help/care.
If the hospital is the one noticing the bestillerkontor
about a patient that needs help - this can happen in
two ways.
Common for these two approaches is that they
have to make contact with the bestillerkontor
within the first 24 hours after patient is admitted to
hospital.
If patient is known in the health care system - there
is already a journal and a file following the patient.
If not - Ahus makes a new case - and via GERICA
this is sent to the bestillerkontor.
Samhandlingsreformen had a huge impact on
the flow in the hospital. Now patients are sent
home much sooner than before. The responsibility
of rehabilitating patients are moved to the
municipalities. When the reform was set in action
- departments at the hospital was emptied over
night - as the care facilities in the municipalities and
districts had to take over the responsibility. With this
reform the weight shifted in the system. I think we
will have to dig deeper into what impacts that has
on the health&care systems in the districts...
Bjørn also had a suspicion that the GPs are
gatekeepers, that they don’t know enough about
the system. Due to hospital diseases and risk of
“getting more dependent on nursing”the advisors
at the hospital also think that home care is the
better solution.
INTERVIEWS
BLOG POST

12 SEPTEMBER
BJØRN & BENTE
1. Patients get better care at home (even
research says so)
2. Still not ideal communication between Ahus
and bestillerkontoret
3. Positive reaction to changes. It gives common
communication.
4. Reform about increasing collaboration so
patients get the best care
5. GP’s are gatekeepers who don’t see the
whole picture
6. 2012 effect- hospital is empty
AHUS SYKEHUS

23 SEPTEMBER
TERESA
1. There has been an increase in patients, a
bigger turnover and more work in general for
nursing homes after samhandlingsreformen.
2. Becoming a health house requires a
higher number of full time employees, yet the
number of beds remains the same.
3. About 90 % of the current employees at
Solvang will be moved to other nursing homes
as a direct consequence of competence
following the patients.
4. There will be no unskilled nurses at health
houses.
5. Personal information concerning the
patient, such as eating and sleeping habits
are included in the reports in the Gerica
journal.
6. Restructuring Solvang, all long term
patients are given the choice of either moving
internally to a different ward, or to another
nursing home. The majority chooses to stay at
Solvang.
SOLVANG SYKEHJEM

3 OCTOBER
KRYSTYNA
1. Bestillerkontoret visits and evaluates every 2
weeks
2. Normal stay at a short term facility is 2-3
weeks
3. Patients with dementia can seem calm and
balanced in hospital, but act out in nursing
home.
4. First evaluation of patient consists of a cross
disciplinary team.
5. Regular meetings for special case patients
include Bestillerkontor, patient, next of kin and a
representative from the nursing home
6. Some patients have scheduled visits allowing
them stay for instance two weeks in a nursing
home followed by four weeks at home.
HONEY
1. A long term nurse can stay at a health
house if that nurse acquires the necessary
competence
2. There is unclarity as to what competence is
needed for short term vs long term patients.
3. The potential possibility of staying at your
facility renders the nurse passive as to whether
or not to apply other places.
4. Practical elements that change when
switching workplace, such as proximity to home
or kindergarten, play a smaller role than losing
colleagues and patient relations.
LILLEBORG SYKEHJEM

RICH DESIGN SPACE
THE FIRST MAPS

CONNECTING THE DOTS
After our tour around Oslo, doing interviews and
gaining general insights about SYE, we got ready
for our first milestone meeting at school.
We reorganized our rich designs pace. Pulled out
all our larger and not so large maps - and started
connecting the bits and pieces so that we could get
the overview to connect the dots.
In the mess of connections we found some
interesting areas for design directions. For example
we discovered that the Bestillerkontoret is actually
the hing between many of the actors providing
health care services.
We had also been playing with the thought of
developing systems for the dynamics in the coming
helsehus. And we were looking into the SYE
structure.
At the milestone meeting at 15th
of September we
presented four design directions that we wanted to
pursue.

4 INITIAL CONCEPTS
DESIGN DIRECTIONS
1 HELSEHUS DYNAMICS
Structure within the short term homes.
2 BK EVALUATION PROCESS
Getting the decition for level of care right, on
the first try.
3 KEEP PATIENTS AT HOME
Combining comforts of home with medical
care.
4 THE SYE STRUCTURE
Hierarchy & logistics in the municipality.
Impact Radius
Ripple Effect
Horizontal
Effect
Vertical Effect
Implementation
Barriers
Evaluation
Process
HIGH
HIGH
HIGH
HIGH
TECHNICAL
ORGANIZATIONAL
Keep Patients
at Home
TECHNICAL
CULTURAL
MEDIUM
MEDIUM
HIGH
MEDIUM
Helse Hus
Dynamics
ECONOMIC
TECHNICAL
SMALL
HIGH
HIGH
MEDIUM
Organizational
Structure
ORGANIZATIONAL
CULTURAL
HIGH
HIGH
MEDIUM
HIGH

THE
TURN

OUR CALENDARA PLAN FOR THE SEMESTER
R
SATURDAY SUNDAY MONDAY TUESDAY FRIDAY SATURDAY SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY
| |Systems Oriented Design (SOD) |Autumn 2014
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Milestone presentations
AHO WORKS EXHIBITION
09:00 - 16:00
Big & Small
Auditorium
Final
Presentations.
Invite your
project
partners.
Exhibition is part of the
evaluation.
(price for best
exhibition)
09:00 - 16:00
Big & Small
Auditorium
Exhibition
space
presentation.
Exhibition is part of the
evaluation.
(price for best
exhibition)
Exhibition
Setup
Exhibition
Setup
WEDNESDAY THURSDAY FRIDAY
MONDAMONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY SUNDAYMONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY
SATURDAY SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY MONDAY TUESDAY WEDNESD
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY
09:00 - 16:00
Group Room 4&5
Elevator Pitch.
Implementation.
3 posters.
(Pecha Kucha
Format - 20 slides
and 20 seconds
each slide)
09:00 - 16:00
Tegnesal 9
Rich Design
Space and 3
elevator pitch
posters.
09:00 - 16:00
Reverse
Archaeology
Presentation.
The future systems
landscape.
09:00 - 16:00
Tegnesal 9
giga map
presentations
of future
systems.
Proposed
Day
Stakeholder
Workshop
Making DeliverablesConcept DevelopmentInsight Work Testing & Iterations
WEDNESDAY THURSDAY
Decision
Day:
Narrow
Down Scope
Decision
Day:
Individual
Problems
Defined
Decision Day:
Final
Deliverables
Determined
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 2
IMMEDIATE NEEDS
After an intense period of doing interviews with
bestillerkontor, home help, leaders at different
nursing homes, avdeling for samhandling at Ahus
and nurses in nursing homes, we presented four
design directions at the first milestone meeting.
These directions was a result of our research,
mapping and analyzing potential areas where
we saw a need for change and innovation.
When presenting these for the project leaders at
SYE, two things became clear.
They were not custom to the designerly approach
and our methods for identifying an intervention
point.
And as Bjørg Torill Madsen said;
We went to a second meeting with Bjørg and Bente
at SYE where we presented our design directions
again. We had a discussion about these - we
agreed on that, in addition to our intent on pursuing
the ideas we had, we would do a session at SYE
where we visualized their Excel Sheets with all the
numbers for the move.
Starting this work we thought this was going to be
a straight forward job. However - this is when we
really understood the complexity of the restructuring
process.
While we were working in the SYE office we started
sitting in on the meetings where Bente Sæve and
leaders of the coming Helsehus were planning
moves.
We started illustrating their conversations. Made
time lines and floor plan-structures on big sheets.
And as soon as the participants in the meeting
could relate to the drawings we made, they
instantly started using them to point to - and the
illustrations became a way for them to very visually
construct their communications, which led to a
consensus regarding what they were talking about.
They could all of a sudden follow each others
chains of thoughts in the discussions.
“But what
about right
now?”- Bjørg Torill Madsen

THE EXCEL SHEETS
This is the columns and numbers that met us when
mapping at SYE. No wonder Bente and Bjørg
Torill are struggling explaining the project to other
stakeholders.
VISUALIZING THE MOVES

VISUALIZING THE MOVES
September October November December January
2015 2016
February March April May June July August September October November December January
October
2015
27 1714 9 22
Hoveseter Smestad Sofienberg
7 5
Romsås Grunerløkka
3221 6 917 17 5 16 17
Majorstua Kingosgate
28
Rødtvet Ammerud
2023
FurusetMadserudLambertseter Lillohjemmet Akerselva
17
Akerselva
Vålerenga
29 927 26 10 19 20178
8
13961513
Moving Patients
& Staff Between
Nursing Homes
HOW TO READ THIS MAP
The top portion also shows staff that will need to move in order to fill
the needs of the new patient population. The bottom portion shows
the different type of patients that will be relocated. This lower portion is
based on a time line over the next 14 months.
For example:
Akerselva, a newly long term facility is
moving 17 regular short term patients
spaces to Lilleborg, a new short term
home, or Helse Hus. They are also
receiving 8, regular long term places
in return. Akerselva will send 14.26
FTEs to Lilleborg to assist with this
new patient population. Akerselva will
receive 8 FTEs from Lillohjemmet
because they cannot send patients
to Tåsen, because it is privately held.
MAP LEGEND
POINTS OF INTEREST
Lambertseter
MovingStaffMovingPatients
Langerud
Abildsø
Furuset
Ammerud
Rødtvet
Romsås Madserud
Smestad
Majorstua
Lillohjemmet
Vålerenga
Sofienberg
Kingosgate
Grunerløkka
Akerselva
41
28
33
51.6
1.75
13
14
3.9
14.26
7
24.26
7
44.66
24
6.4
9
8
Lillohjemmet
8
RYEN SOLVANG TÅSEN LILLEBORG
LILLEBORG
Akerselva 14.26
Short Term Patients Long Term Patients
Facilities
Staff
Ordinary RehabRus Ordinary Intensive Care
Unspecified Specialty
UDI
Direction of the move:
Origin Destination
Number of
Patients or
FTEs
17
Public Long Term Home
Private Long Term Home PRIVATE SHORT TERM
PUBLIC SHORT TERM
A
A
B
BB
A
Romsås is becoming private and the Oslo Kommune wants to keep substance
abuse treatment competences within the public sector. This means that the
employees with this special training must also move into Ryen before the
privatization is finalized.
B
Tåsen is private so employees will have to find a new place to work after the
short term patients leave. They will have to move into a different quadrant of the
city to find work at a short term facility, as there is only one health house for each.
D
C C C C C
C
These matches may seem equal, but remember that short term and long term
patients require very different needs. Between Grunerløkka and Lilleborg they
switch the correct amount of FTEs to match the patient move. The other four
are between public and private homes, which makes it difficult to move staff.
D
While the moves have individual deadlines over the next 14 months, the patients
and employees could be moved at any time before their date. The markers here
are spread out in the month prior to their deadline. For instance, a move that
should happen before June 1 2015 looks like it will take place in May 2015.
E
E
FTEs may look easy to trade back and forth, but this does not yet take into
account the different competence such as rehabilitation, physical or ergo
therapies, nurses, or non-medical staff.
Note: There are some exceptions to this moving system. Some patients are moving between long term facilities due to
special medical needs. These are not listed on this version but will be added later on in the project. This map reflects the
knowledge we have as of October 14, 2014 and is subject to change.
THE CITY OVERVIEW
This is the excel sheet from the picture on the
previous page. We also added the move of
employees. The map created great enthusiasm.
The city overview map answered to the original brief
Sye came with to AHO. They wanted us to help
them communicate their moving plans.
When presenting this map for the whole
projectgroup we threw out a couple of ideas
building on this map. For example we suggested
that this could be an online informationservica
accessable for all employees in SYE. Or it could be
a part of a newsfeed, like a blog, where everything
about the move could be presented to employees.
Our research had shown that information is an
issue. Employees were caught between either
getting no information - leaving them confused and
worried, or too musch information - leaving them
uncertain about what is the right info, and who to
trust?
We had some ideas on how to execute these ideas.
However, during the following week we came to the
realization previously mentioned;
One thing was the issue regarding information to
employees. An other pressing issue was that we
understod that the level of confusion during the
plannig meetings led to confusion about what
was actually appropriate information to give to the
employees back at the nursinghomes.
As we developed the communicationtool we left the
ideas on making a“newsfeed”.

MAPPING AT SYEVISUALIZING THE MOVES

SHIFTING DIRECTIONS
After Rickard and Line had a tutoring session with
Ted and Kaja at school -
we got some guidance to how we could form
this project. We have done interviews with many
different actors and stakeholders - they all have
different agendas, wishes for the outcome of our
work and opinions on what is important in the
restructuring process. So - as the restructuring
process is already started - we have decided that
our project and deliverers for this SOD course will
consist of several part-deliveries that we make
through out this semester.
Instead of focusing on making a service or product
we will see the“process as the result”.
Through our systemic approach we will facilitate
workshops, visualize SYEs wicked problems,
enable moves to go smooth- and so on. Methods
and“results”of these interventions will be our
delivery. Our result after this course.
Oh. and in the beginning of this month LiveWork
was announced the winner of the SYE preDIP..
During the last months we have gained LOADS
of insights. We decided to try and sum up the
research and present it at the RSD3 symposium.
We spent two days on the 9th and 10th of October
to go to SYE. There we mapped the moving
between nursing homes - on the way to establish
the four health houses. Bente Sæve answered a lot
of questions. We got an even better overview. The
maps were presented at the RSD3.
Next up is creating a communication-tool.
While mapping at SYE, we sat in on some of their
strategy meetings regarding moving beds and
patients. As we were illustrating their conversation,
the participants in the meetings started to point
to our drawings/maps as they were discussing. It
became very clear that by pointing to illustrations
they were able to be more clear - and on the same
page - in their discussions. Less confusion - more
consensus.
THE TURN
BLOG POST

SOD SYMPOSIUM
RSD3 took place last week and we took this
opportunity to put a pause in our work. We had
gathered so much new information from the
mapping sessions and needed to take some time
and gather what we knew. We also decided to
show our work in a slightly different way than has
been done in the past. It is typical for SOD students
to put up their maps as they have been working
on them. While this certainly shows the richness
of their process, it makes it difficult for anyone
who is not familiar with the project to understand.
We wanted to create one display that showed
the complexity of our project in a way that was
accessible and approachable. We also wanted to
get into digital space to make everything as clear as
possible. Almost all of the information we showed
was new to us (within the last week) so it was also
helpful for us to see how it connected together.
Each project from the SOD class had the same
introduction poster. We placed a small key below
ours to explain all the other elements in our
exhibition. The main map in the center shows the
moves of patients and staff over the next fourteen
months. To the right is the governmental hierarchy
and structure around this whole initiative. On the
table, from left to right, is a model of Oslo and
the actors, an animation showing the moves in a
geographic setting, and a zoom in to just one of the
moves. Showing how all these pieces fit together
helped us clarify where we are in the project.
We are not sure if the guests of RSD3 understood
it without us, but it certainly helped us put a flag
down in our process.
THE TURN
BLOG POST

CLEANING UP AND CONNECTING MAPS
SOD SYMPOSIUM

THE TURN
AFTER MAPPING
We started this project with a classic designerly
approach. We did broad research in order to get to
know the landscape we were going to work within.
Our mission was to find possible intervention points
where we could use design processes to develop
a concept that we would present at the end of the
project.
But as we have mentioned, after first milestone
meeting we took a pause from that, to focus on
what Bente and Bjørg were requesting.
After the intense mapping days at SYE we took a
moment to reflect on where this work had taken us
- and realized that we wanted to pursue the track
we were on.
On the right hand side we have listed the 4 most
important reasons why we left the first four design
directions behind.
CHANGING THE DIRECTION
1.
2.
3.
4.
One of our directions was about the
dynamicsin the new helsehus. We actually
knew that a designfirm in Oslo, Live|work,
was going to make the concept for this
service as SYE had set out a competition
for this. We obviously did not want to do a
project that would be done by professionals
after all. so with this in mind we left that
direction.
We wanted to take care of the employees.
The big picture was that they were excited to
be a part of making a better future for elderly
care in Oslo. They were just confused due to
the malbalance of information.
The projectgroup at SYE had immediate
need for organizational help in their
meetings.
We saw the opportunity to create something
that would mutual benneficial.
We could use our skills as designers to
develop a useful product for SYE. We saw
that vi could make an impact.

PROTOTYPING

HELPING
COMMUNICATION
We have been sitting in on many meetings at SYE.
In these meetings Bente Sæve, and the respective
leaders of the nursing homes involved, are planning
the move of beds, patients and employees.
We have been following the move between Abildsø
and Ryen, and Kingosgate and Lilleborg especially
close. We have also been shadowing other
move-meetings, regarding other nursing homes,
and we have discovered sort of a reoccurring
pattern.
First a rough sketch on how the meetings are
organized;
1“The prep”
For each move there are a series of meetings
starting on a high level in the hierarchy.
The project group at Sye, with union-people,
formidlingen and representatives for different
groups of employees, are initiating a first meeting
for to start planning move and establishing of
“helsehus”.
In this first meeting the leader of the nursing home
that is becoming a helsehus is invited.
Union-people and representatives for employees
are continuously following meetings where
employee related issues are addressed.
2“The coupling up”
After“prepping”, the institute leader for the
exchanging nursing home is invited to the meeting
no. 2. Here the two leaders have their first sit-down
to talk about the move, and exchange of patients
and employees. In this meeting Bente Sæve is
giving a brief on the status of the project. Tentative
dates for move are discussed.
No. of patients and beds are updated and placed
in right dpt. at new destination.
3“The protocol”
Then comes a meeting where the parties sign a
protocol where they agree on terms reg. the move
of staff.
During these meetings there are constant
discussions on MANY other issues;
- furniture
- improving buildings
- employee needs
- frustrations towards the change
and so on.
3.1 3.2 3.3 ...
More meetings to prepare for an easy transition.
The meeting no 3s, we call them. When it’s time
to discuss employees and FTE’s were touching on
the real complexity in this project of restructurig.
The move should follow certain principals. When
opsticles occur it may require new meetings and
planning“back at home”- in the respective nursing
homes. Which means delays and more meetings.
OUR OBSERVATIONS
- there are a lot of numbers to be straight about.
- there are a lot of building related stuff to
remember. names of departments/floors/rooms.
- all the participants in the meetings have their own
notes.
- some make small sketches in own book while
discussing/explaining.
- some gesticulate in the air...
- everybody forgets, from time to time, exact
numbers and so on.
- often confusion about what is actually being
discussed at the time.
- misunderstandings.
- repetition due to confusion
PROTOTYPING
BLOG POST

BLOG POST
PROTOTYPING
HELPING
COMMUNICATION
The Communication tool“version 1.0”:
In the brief from SYE they expressed a need for
making their project more visual, in a way so
that they could easier explain it to others, such
as politicians. While sitting in on a meeting, we
started visualizing their conversation. And started
understanding what caused the most of the
confusion and time-consuming discussions.
As everybody in the meetings are following
their own notes in their own books they tend to
misunderstand and talk passed each others when
discussing number of patients, employees, fte’s.
We came to realize that if we could facilitate their
discussion by illustrating it - we could save time,
confusion and frustration.
Not only did the projectleaders at SYE have
problems communicating and explaning the project
“outside”of the projectgroup. They even had some
problems communicationg between themselves in
their own meetings.
So we thought we coud test som mappingmethods
that we learnd in one of our SOD lectures.
We tried to draw up a timeline for moves. And
structuring floors and dpts. in the nursinghomes.
First step was a super easy visualization - floors
and dpts drawn on paper during a meeting at SYE.
Instantly all the people around the table lifted their
eyes from their notes and started pointing to the
“common”sheet - where everybody could follow
what was being discussed.
This has come to be one of our most important
maps, as this was the beginning of the
communication tool prototyping.

PRODUCT DEVELOPMENT
After reflecting on the SYE meetings where we
visualized their conversation, we went back to
school and tried to develop what we have called
“the communication-tool”.
Here’s a 5 step sum up on the iteration.
1ST
VERSION
(Top left picture)
As we had the idea of having placeholders for beds,
employees and patients - we made some hundred
pieces... We really wanted to show the complexity
in the large number of people involved. We wanted
it to look“huge”. The picture is from first iteration
at school. We tried to use the tool ourselves and
realized it was too many bits and pieces.
So we cut down on number of pieces and made
them from acrylic plates. These chips we brought to
SYE to use them in the meeting between Abisdsø
and Ryen.
It could have gone better:
-Wrong level on meeting, this was the first meeting
where they had an overall discussion about the
move. The tempo was to high for our tool, which
was too detailed.
-The tool had to many components - hard to use.
-The discussion was about human relations and
rough numbers of how many patients were moving
from Abildsø to Ryen.
So we narrowed down number of pieces. Made the
tool look nicer - and tried again.
2ND
VERSION
(Bottom left picture)
We decided to skip most of the chips. Didn’t work
last time. Here we tried a super simple version with
just the two nursing homes in question, which was
Abildsø and Ryen.
-Right level and right discussion in meeting.
-Less parts made it easier to use.
-More visual and less physical pieces this time.
-It became too messy though, because it had to
little structure and inconsistent coloring.
-High level of us facilitating the use of the tool.
PROTOTYPING
BLOG POST

4TH
VERSION
(picture below)
To up the game we brought an acrylic board to this
next iteration so that we could draw - and erase
fast. It looked kind of cool. And it was fun to use -
but documenting and updating the map after the
meeting was not that easy. And since you need a
whiteboard marker to write on it we unintentionally
excluded participants to contribute to the common
worksheet. But - as we started thinking about how
this tool should be used in the future - we thought
that adding a big board to the package was’nt
necessarily such a good idea. So we left the board.
3RD
VERSION
(picture above)
Better setup, sketch of floor-plans made the
tool easy to use fast. Reintroduced some
“subject”pieces in an atempt to guide the
conversations towards ether patients, employees,
supportfunctions etc.
Clear & straight lines symbolizing patients moving.
Easy to add details, though on postits
Very visual!
Tool made it easy for those who came in late to
catch up. Over all pretty happy about this iteration.
Could wish for a little bit more structure though.
BLOG POST
PROTOTYPING

5TH
VERSION
After the previous iterations we cleared up our
layout and presented this last version of the
tool. Now being a plotted sheet with pre made
structures and room for the participants to fill in
new notes and numbers.
This was a“no2”meeting. First meeting with both
institutional leaders.
Hilde from Kingosgate and Gerd from Ryen. The
meaning is to create a feeling of ownership to the
project from both inst.leaders - and for them to get
of on the right foot in planning the move of their
patients.
We took a few minutes in the beginning of the
meeting and told them that during the past few
months of sitting in on their meetings - one of our
key findings is that visualization is golden!
If the participants in the meetings can see what
they discuss - the communication runs so much
smoother. No need to repeat as much - and high
level of consensus all the way.
This time we had decided to skip the acrylic plate.
It is not as useful as it is a “cool feature”.
And the“users”seems more comfortable drawing
straight on paper.
Gerd really took charge and used the tool for what
its worth. I think we can say that the idea is good.
Now it’s a matter of how we actually present this
tool to the end user.
PROTOTYPING
BLOG POST

LAST TOUCH
PROTOTYPING
Good thing is that it is not too much to tweak
in order too make this tool usable without us
facilitating.
The two most important notes, given our time
scope, from last iteration on the tool:
It needs an illustration on the connected LT home
on same sheet. So that patients going from ST to
LT is also in the map.
And. The no 3 meetings may need more rounds. It
is obvious that the matching patient+competence
move is very complicated.
PROTOTYPING
BLOG POST

37
CREATING OWNERSHIP
The tool has progressed a lot during this project
and more and more information goes directly into
this common worksheet.
This version of the communication tool enables the
participants to get an overview of where all patients
and employees that are moving into the Helsehus
are coming from and what floor they are moving
into.
There is also floors of the long term facility that
the Helsehus people are moving into. On top of
this they have one area on the sheet available for
adding general notes and one for things that needs
to be followed through.
Our plans of getting the project group to adopt this
way of working is almost complete. From the first
time we used the worksheet up until now, the level
of facilitation from us has continuously decreased.
Now they are using it even without us there.
The picture above is actually taken when Line
stopped by at the end of a meeting. Bente has
been facilitating the use of the tool all by herself.
That was a great testimoni to get as we were
entering final production mode back at school.
FINAL VERSION
PROTOTYPING

WORKSHOPS

WORKSHOP AT SOLVANG
They have a regular meeting with Helse Hus
employees. We were allowed to hijack this meeting
and use part of it for our workshop. We wanted to
use this time to get the employees to start thinking
about the future. They have been so focused on
the move and all the work that will take. So we
decided to get them to envision all the benefits for
the employees, patients, family members, and for
the system as a whole.
We asked each group to think of ways this new
system could benefit their target. If it would greatly
affect this user group, the post-it went in the middle
of the circle (see next page,top left picture, on the
wall). If it was more of a secondary or minor effect,
the post-it was placed on the outside of the circle.
This was a bit of a challenge for our participants, as
they were not used to thinking about the Helsehus
in this way. We provided some prompt cards with
questions to get them to think about specifics.
After they presented their tasks we asked them
each to choose one. We then asked them to
get in groups of three and discuss why they had
chosen this particular benefit or change. We made
a template to fill out. This template asked them to
imagine that this benefit already exists, and then
“look back”and imagine how it came to be. This
helped them talk about specifics like barriers and
team members who would need to be on the
project. We wanted them to discuss this with each
other, but it was difficult to encourage that. Mostly,
they wanted to think it through themselves, then
chat afterwards.
Our last task was just to place their new project
pages on a time line. On one end is 2015 and the
other is 2020. We wanted to know when these
projects would likely be complete. We also asked
them if the projects would be“nice to have”or
“need to have”to try and see how they viewed
changes. In reality, only one was“nice to have”.
This group really does want to make a lot of
necessary and impactful changes.
At the end of the workshop, the whole group broke
into a discussion. It was clear from this last section
that they wanted to discuss with each other. Before
the workshop started they had their update on
numbers of patients that had been moved, and
more on the logistics side. We brought this with
us into the planning for the next workshop, we
decided that we should leave time for ventilation
about the changes that are under way.
WORKSHOPS
BLOG POST

30 OCTOBER SOLVANG SYKEHJEM
WORKSHOP 1

WORKSHOP 25 NOVEMBER AHO

WORKSHOP AT AHO
In the beginning of the semester, we asked to have
a big workshop. We knew it would take some time
to organize and schedule but had no immediate
plans for what we wanted to get out of it. We also
figured we’d get about 20 participants, maybe 30
tops. A few months later we had our workshop. It
was drastically different than we anticipated.
For starters, we had about 50 people instead of the
20 we’d assumed. the task we had them perform
was quite standard, but the workshop itself took a
fair amount of planning and coordination.
The task was as follows:
1. Participants were divided into ten groups before
they arrived. They each sat at their tables and we
given a blank journey for a patient.
2. Each group was assigned a patient, some
groups had the same patient. In an envelop was a
description of a patient, as well as their immediate
medical needs.
3. We asked each group to map out the patient’s
journey: Where would they go? Who would the
see? who was present when a decision was made?
4. Once they had completed their journeys, we
asked them to open another envelope. This
contained a twist to the story: What if the patient’s
wound does not heal? What if they suddenly lose
a lot of weight? We wanted to see how they would
rearrange a journey when something goes wrong,
something that may not be anyone’s fault. Groups
with the same patient had different twists, to see
how one journey could start the same, but end up
in very different places.
5. Now that they had a journey (nearly two journeys
in some cases), we asked them to label some
highlights. These included“When did the patient
feel most supported? Least supported?”,“When
did the employee feel like they were in control? Out
of control?”, etc.
6. The last task was to write on an anonymous card
what they thought was the biggest challenge. We
also had them note their one wish for this systems/
journey. We wanted to keep this anonymous so
people would be more free to criticize the system.
7. Each group presented their journey to the whole
workshop.
All in all, we felt this workshop went very smoothly.
We kept ourselves to a strict clock and managed to
get everything done that we needed to. Although
this particular workshop was about patient
journeys, our main goal was communication. We
are happy to collect the journeys are read about
the challenges that exist. This is more than relevant
for our work. But we also wanted to do something
else. We wanted to encourage open discussion and
dialogue between nursing care workers who do not
work side by side. There are changes coming for
all of them. This is a time where they need to feel
supported and encouraged. We wanted to show
that they are all in this together.
WORKSHOPS
BLOG POST

AHO WORKSHOP

INSIGHTS REINVENTING
THE RICH DESIGN SPACE
Here we are coming towards“the end”and we
rolled out all our maps and reinvented our rich
design space. Through this project we have
surrounded us with the maps we have been
working on, and actively used them as source of
information.
As we are in this systemic approach - we are
reviewing our own system of notes and knowledge
- to make an insights book of it!
RICH DESIGN SPACE
BLOG POST

DELIVERABLES
INSIGHT BOOK
Contains all our gained insights.
It has a map attached to visualize all this.
We made this book because we did not want all tis
valuable insights to get lost and disapear, as this
can be useful for the project Live|Work
PROCESS BOOK
Contains the story of our project, told in puctures,
small articles and through our blog.
MAPS
City owerview map
Hierarchy map
Insightsbook map
All the maps that are templates used in the
communication tool
THE COMMUNICATION
TOOL
A digital package of all templates
A user manual for whom leading the meeting
An introduction folder for the institutional leaders
involved in meetings

REFLECTIONS

THE PROCESS
The system oriented approach has led us on a
journey we haven´t experienced before.
We have had an interesting course of this project,
with the main focus shifting two times due to our
search for interventions points with big impacts.
The initial brief was to help the project group at
Sykehjemsetaten communicate their moving
plans to stakeholders affected by the restructuring
process taking place in Oslo.
However our focus for the first month was on
delivering a“shiny”concept
at the end of the process, basically neglecting the
brief.
When presenting the four directions we thought
this project could take, our partners were mildly
interested, because as we soon would understand,
they had pressing needs related to the moving
process.
We turned our focus towards the communication
issues Sykehjemsetaten had, which was what the
original brief was all about. We thought that helping
them with this would lead to them let us go back to
working on the“shiny”concepts.
That never happened, because we found
something that we could do right now that would
have an immediate impact on both the moving
process and most likely on the coming work
that Livework would do. It would have that effect
because it is the people being affected by the
moving process that are going to adopt or reject
the new concepts Livework will deliver.
Making the current process go as smooth as
possible is therefor essential.
THE PARTNERS
Our partners this semester, Bjørg Torill and Bente
Sæve from Sykehjemsetaten, have been absolutely
fantastic. They have opened every door we wanted
to look behind, giving us access to people all
over Oslo. They are very opened minded though
precise about their opinions, which is exactly what
a designer wishes for.
It´s also very inspiring to work along side them
because they have big plans for Sykehjemsetaten.
They want to change from being a traditional
hierarchical organization to a more dynamic
one, with empowered leaders throughout the
organization.
THE OUTCOME
We have two main contributions from this
project, which are the insight documents and the
communication tool.
The insight document is a delivery that we hand
over to the service design consultancy Livework,
who are now developing the concepts for the
services that will be offered in the Helsehus and
“Mitt hjem”.
In these documents we have gathered various
insights from across the landscape we were in the
first month and a half. Some of these will be highly
relevant to Livework´s project, while others might
just be curiosities.
The communication tool is the innovation we have
done in this project and it is a very specialized
tool, to be used when planning moves of patients
and employees in order to become Helsehus
respectively long term facility (“Mitt hjem”). We
mean that the impact of this“small”intervention will
have a mayor impact, both on making the moving
process run smoothly but also for the changes that
will continue after the separation of patients.
The restructuring which is going on in Oslo right
now will take around 2 years in total, with around
20-25 separate moves, and every thing that helps
the progression of the planning for these moves are
crucial.
Also, this restructuring process is something that
is most likely going to take place in other cities in
Norway soon (they´re are looking to Oslo to see
how it goes first), so the communication tool can
play a small but important role in if this strategy
becomes national or not.
CREATING VALUEREFLECTIONS

4
ON THE
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Process Book
Sykehjemsetaten
Oslo Kommune

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