Ezio Manzini's picture
Collaborative care. A new generation of services

The Challenge: 

The Question: 

Can collaborative care services help us to overcome the care crisis?

The Problem: 

the demand of care is growing and becoming more complex while traditional and modern offers of care are less capable of coping

The Solution: 

spreading the burden of care over more people while loosening up the boundaries between caregivers and care recipients

Channels: 

Since the beginning of human history, care has been exchanged (given and received) inside homogeneous, durable and relatively closed groups of individuals. 

Families, clans, village communities, urban neighborhoods ... 

In the past century, in parallel to that, care has also been delivered by dedicated institutions: hospital, kindergartens, elderly residences...  

Today, for several reasons, the demand on care is growing and becoming more complex, while both the traditional and the modern offer of care are less and less capable of coping with it. In our fluid, hyper-individualized societies, families, village communities and urban neighborhoods are weakening (if not totally disappearing). Individuals, given their life structure, have less and less practical possibilities to take care of others (even when, in principle, they would do it). 
Care institutions, which were supposed to substitute the traditional community’s and individual’s care, have fewer and fewer economic resources (and often political will) to do it. 

The gap between the growing demand and the shrinking offer of care is the basis of the present care crisis: a lack of care that is practical (the caring system do not succeed in coping with the care demand) as well as psychological (the sense of loneliness deriving from the lack of sense of care throughout the whole society). 

To overcome this crisis brand new care systems have to be imagined and enhanced. A first step is to better understand caring activities, considering their nature and diversity. 

The practical/organizational side of care is particularly important because care is more than exchange of information and knowledge. Care requires proximity and action: doing something for each other, taking time and being committed.

Care activities. Care activities are quite diverse: they can be performed by whoever could be willing to do it (as shopping for groceries for somebody who is temporarily sick); they can require a lot of time, attention, and assumption of responsibility (as taking care of the daily life necessities of somebody seriously ill); they can require timely actions by highly specialized experts (as performing surgery in very specific moments). And so on.   

In general terms, these differences are characterized by a set of main parameters: 

  • Time: duration, frequency, flexibility, …

  • Space: virtual, hybrid, only physical, …

  • Competences: normal everyday life socialization, specific diffuse knowledge, specialized expert knowledge, …

  • Responsibility: very low; low, high, very high.

Different care actions should be attentively analyzed and mapped using these parameters. Intuitively, we can already say that different care activities could be delivered by different actors in different modalities. 

To imagine a new care system, we should recognize all the potential caregivers and consider them as resources. Either as effective care resources (when they are already active). Or as potential care resources (when they can be activated under certain conditions)

Care resources. In principle, everybody can care for someone else. He or she can do it in different forms (depending on his/her expertise and time availability), but all of them require attention. In turn, given that attention is a limited resource (each person has a limit in his/hers capability to give attention), this is true also for his/her capability to care. Care (both the expert and non-expert one) is a diffuse but limited resource. 

Presently, care systems are built on a mix of three main resources:

  • Institutional care givers (based on professional actors)

  • Third sector and charity organizations (based on both professional and nonprofessional actors)

  • Traditional care communities (as families, village communities, urban neighborhoods ).

We know that, for different reasons, all of them are in difficulty to cope with the growing care demand. Therefore, the issue is to reshape the system in order to permit to new potential resources to emerge and become effective resources. 
 
Mainstream and countertrends. We have said that, in principle, everybody, depending on his/her time and expertise, could give some forms of care. But we can observe that today, in the contemporary societies, this care potential, clashes with the dominant culture and practice. In the name of individual freedom and convenience, our culture tends to assume a careless approach to everything and everyone (the throwaway society extended from things to human relationships). And: a mainstream practice of living that makes it difficult to introduce care activities in the daily life (due to work constraints, to the evolution of families and to their being scattered in different places).

Therefore, given the present structures of family and work, few people can commit to offering care, especially if this requires continuity, high responsibility and duration in time.

Nevertheless, several examples tell us that there still are several people who could and would dedicate some time/energy/attention to well-defined caring activities - if and when an appropriate enabling system would permit them to do it in an easy and flexible way.

This limited but diffuse caring availability is the potential resource that the socio-technical innovation should be capable to transform in an effective resource.  

In other words, thanks to an appropriate socio-technical innovation, it should become possible to cultivate and harvest the limited individual caring resources of broader groups of subjects. That is, to catalyze and coordinate existing but not used care resources could be the key to overcoming the crisis of care in contemporary societies.

Hypothesis and vision

Hypothesis. If the close (social or institutional) organizations of the past cannot cope with the dimension and complexity of the present demand of care, they must be opened. That is: the care activities must be divided in smaller/lighter tasks, and allocated to a large number of actors, each one giving what he/she is capable/willing to give. 

Vision. Open care is an ecosystem of care-related interactions, characterized by being distributed among a large number of individuals, groups and institutions, with different competence, responsibility and commitment:  from the highly specialized actors and institutions to family members, friends and neighbours with no specific knowledge and limited time availability. 

Viability

Social preconditions and enabling systems. To be viable, open care requires two main social preconditions:

  • The existence of a large number of other actors (relatives, friends, neighbors) willing to care for someone, even though they have practical limits (in terms of time and resource availability).

  • The existence of dedicated and specialized actors capable of intervening when their competencies are (really) needed.

Given the previous social preconditions, the open care potentialities are made real thanks to the existence of a technological and organizational system capable of catalyzing  diffuse resources, coordinate them and give their action the needed continuity. More precisely, this enabling system should:

  • match different demands with different offers (in terms of competence)

  • give different care actions coherence and continuity (from the point of view of the care receiver)

  • promote and support both relational and the highly effective ones (i.e. the most specialized, professional interventions).

  • be organically part of a larger systems: the ecosystem of interactions that represents what today we can refer to as a local community. ​​

Social innovation and open care

The open care viability is based on the existence of a whole stream of social (and socio-technical) innovation that is already moving in a similar direction. 
In fact, in the complexity of contemporary society we can find several promising cases (some of them are still social prototypes, some others have already reached a more mature stage). For instance:

  • Circles of care: groups of citizen facing the same problem (as: diabetes, allergies, obesity, … or simply the old age) who mutually support each other, with the supervision of a team of doctors and nurses (a well-known example is the Circle in UK: http://www.participle.net/ageing ).

  • Networks of care: coordinated networks of family members, friends and neighbors, who share and coordinate their efforts to care for a person with serious problems (a well-known example is Tyze in Canada http://tyze.com )

  • Intergenerational cooperation: organizations that supports the encounter of young and elderly people mainly around the theme of collaborative living (a well-known example is Prendi a casa uno studente (Take a student at home), in Italy: http://www.meglio.milano.it/pratiche_studenti.htm )

  • Collaborative inclusion: organizations of migrants and residents collaborating to produce both migrant’s inclusion and social values, for both the migrants and the whole community (an example is:  Dine with us, in Belgium: http://dinewithus.strikingly.com )   

Considering these diverse examples, we can observe that they present three common characteristics: (1) some care activities are delivered by non-professional actors; (2) the overall care burden is shared between different subjects; (3) specialized interventions are asked only when they are really needed.  

These examples are interesting because they give us an idea on how open care components could work. Nevertheless, in my view, they are not yet the full representation of the open care vision.

To better approximate it, two steps should be taken:

  • To rethink each one of these service ideas adopting the radically open approach that characterizes the Open Care research.

  • To consider the whole socio-technical ecosystem, and to improve it in order to give all of them and a multiplicity of similar ones the possibility to flourish

Comments

OpenCare as a Wikipedia-type system

Alberto's picture

Very interesting, @Ezio Manzini! Here's the money quote: 

In principle, everybody can care for someone else [...] in different forms [...], but all of them require attention. Given that attention is a limited resource [...] care [...] is [also] a diffuse but limited resource. 

This vision of care activities reminds me of Wikipedia. Wikipedia is quite a coherent object. It's also very decentralized in scope and authorship; and tasks are allocated across contributors by self-selection, without central control.

Contributors are extremely diverse in their interests, experience, and in the time they contribute to Wikipedia. Some Wikipedians, like me, might fix a typos or repair a broken link here or there, and only very occasionally enter a factual information. Others take full stewardship for entries that are important to them. Others, still, make tens of edits a day. A lot of Wikipedia's advantage comes from the fact that it can use effectively small contributions. 

Open care might be the same. A mature open care ecosystem, I propose, is one where the natural human impulse to care and help can be easily translated into a contribution. One, in other words, where, if you can only contribute 30 minutes, you can, and your contribution will make a small, but tangible difference. Works?

 

social ecosystem

Simonedb's picture

my two cents to a great thinker...

by profession I deal both with institutions and corporations and, as a citizen, with society and all the issues. each of this world have needs and questions but also resources but, despite rhetoric or good will, they just negotiate on few elements (budgets, regulations..) as counterparts. 2 by 2. if we mange to make the "system" work differently we would easily gain - low costs - a much better impact and effect ..helping the social brain to work in a more complex way, which is not harder.

with this open care project we try to do something like that, making several forces co-operate and… if I  can sponsor a bit my part...having housing at the center (also with a good platform) can aggregate actions towards families networks as the center of policies, buildings, peer to peer care, local micro welfare we can enhance a social innovation

 

 

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