Innovations in cities are usually systemic in nature. Systemic innovations require changes in organizations, network relationships, technologies, and models of operation. Our focus in this article is health care innovations in the public sector where new services foster the quality and efficiency of services provided to citizens. The aging population, an increase of chronic diseases, new ICT solutions, and citizens’ increasing expectations has led to a situation where our health care system needs radical changes.
For example, the introduction of new ICT solutions makes it possible to connect more and more distant actors to the same service activity. However, at the same time, the service as a whole becomes complex and thus uncontrollable. From the viewpoint of the customer, care appears as a fuzzy process. Customer-oriented thinking and ways to coordinate services have been suggested as a solution. A change towards customer-oriented health care services requires a paradigmatic change and changes in multiple levels. In the Finnish health care system, the silos of organizations and professions, as well as expert-led health systems where customers are not considered as an expert in their own health, are significant barriers of implementing new customer-oriented services. It is essential to create a dialogue between organizations, professionals, and customers to promote system innovation and thus create high-quality health care services. For this, gamification, the use of game-like elements, and game-design principles in non-game applications are seen as potential tools for promoting dialogue and innovation.
Promoting dialogue–complexity theory, the societal embedding of innovation and gamification as methods
In recent years the idea to consider health care as a complex adaptive system has gained ground in research. CASS has collated and further developed the recommended managing principles of complex adaptive socio-technical systems (CASS). In CASS, individual actors self-organize and interact with each other thus changing the context and affecting the self-organization of other actors. This creates intrinsic unpredictability and uncontrollability in CASS. The management of CASS means trust and support to the self-organization of actors and build- ing of engagement to the shared purpose.
Another approach used in our research is the societal embedding of innovation. Societal embedding of innovation is a research and development approach that has been developed by VTT in different research projects since the 1990s. It has been used to enhance novel health care services and environmentally friendly innovations. It aims at facilitating and initiating new innovations in a multi-actor network. An important objective is to create a dialogue between different actors and give them the possibility to create a shared understanding of the elements of the solution. By opening up the perspectives of the different actors it aims to produce mutual learning.
Gamification can be seen as a promising approach for mutual learning. For instance, storytelling among a group of players assuming different roles, using visual aids such as playing cards and boards, can be adapted to game-like approaches. This allows systemic aspects of health care processes to be discussed from different perspectives in an inspiring setting, and coherent storylines involving different stakeholders to be created in order to concretize the often hazy interactions between different actors and actions. Games can also emulate complex interactions found in real-world service chains and in their management, providing a platform on which people can experience, discuss, and experiment with different future conditions and states.
In our research project MOSAIC, CASS, the societal embedding of innovation, and gamification have been studied in practical cases. In one of our cases, a substantial change in technical systems is introduced which induced also the need to change the process and operational culture. After the interviews of selected stakeholders and health care professionals, CASS is developing gamified solutions to support the management of complex care chains. One example of these development activities is a workshop where CASS applied a “role-switching game” in multidisciplinary teams aiming at improving the medical care process.
Integration of methods as one solution?
Typically there are no simple solutions to complex problems. CASS, the societal embedding of innovation and gamified approaches can be seen as valuable tools to understand, manage, and create a dialogue to foster change processes in complex health care service systems.