Authors:
Andy Dow, Rob Comber, John Vines
Like many countries across the world, the U.K. government has shifted to a strategy of digital by default as a standard in how public services are delivered. The notion of government as a platform has placed digital tools, mobile applications, and networked infrastructures as core to a new generation of scalable and sharable citizen-facing digital systems. Traditionally tedious paperwork, such as passport applications and intake forms for your doctor's office, are often now completed and delivered online. Heralding improved access to public and civic services and the delivery of more equitable care throughout society, the U.K. Government Digital Service has been a longtime proponent of human-centered design and user experience principles to make such online services as easy and effective as possible for citizens to use. At the same time, digital systems are now being discussed as a means of transforming how citizens interact with and fundamentally relate to the state, for example, through publishing open data that makes governmental bodies and agencies more transparent, automating freedom-of-information requests, and placing citizen generated content at the heart of public health initiatives.
Yet, as is often the case with technology developments, beneath the rhetoric of increased citizen choice and participation is often a motive to streamline public services and gain the associated benefit from cost and efficiency savings. In the U.K., the rise of digital government and governance is combined with a sustained period of austerity politics, where local government funding has suffered year-on-year cuts. Our joint research over the past five years has primarily been conducted in an area of public-service delivery, social care, that has been especially hard hit by state budget cutbacks. We've been working with local government departments and staff and, increasingly, charities and nonprofit community organizations, exploring the role that digital technologies and information systems might play in capturing experiences and stories from care service users and their families. The ambition of our work has been to develop tools and systems that allow diverse publics—service users; their families; nonprofit, for-profit, and state-funded service providers; and funders of care services—to collectively shape and improve care in ways that address the wants, needs, and aspirations of those needing it. However, while entering these spaces with an ambition to empower and give voice to groups of citizens who may not always have a voice, we have found ourselves continuously negotiating the tensions between this and the marketization of care, the simplistic cost-saving rhetoric surrounding digital systems, and a continuous focus on the measurement of outcomes rather than the qualities of care.
Insights
As human-computer interaction researchers and practitioners are becoming increasingly engaged in research in civic spaces, it is likely we are far from alone in experiencing some of these issues. The reduction in state-funded public services and the seduction of the power of digital transformation are not only U.K. or Western trends, but also global and globalizing. In this article, we discuss some of the challenges we have faced and outline how our thinking and practice have developed and helped us navigate the messy terrain of working inside, outside, and around local government. We, following others, suggest that working in spaces like these is inevitably to be concerned with the politics of design and specifically a contention with the currently dominant neoliberal politics of technology design. We argue that in designing within civic care, we must adopt and occupy a space that is middle out—what we have called "between the grassroots and the hierarchy" [1]. We address a liminal design space between the rigid hierarchy of local government and the growing and innovative scene of grassroots organizations and actors now tasked with collaborating and participating in the work of care service design, and the commissioning and delivery of care services for people with care needs. We acknowledge with this our own expertise and authority as offering a privileged position, one that we might be able to leverage and thereby do political work. We characterize the work we conduct in this space as middle out, both in how we ourselves work as middle actors in the understanding and design of what is needed, and in how, when the realities of top-down flows of decisions and funding are seen, the middle is what is left to work around and where we figure out how systems work in practice.
Designing Civic Technologies For Social Care
Our work, carried out in the context of social care in the U.K. Government legislation over the past 10 years, including the Localism Act in 2011 but also the Care Act and the Children and Families Act in 2014, puts the onus on local government to assess the support needs of individuals and ensure their well-being. Common across these acts is legislation directing local government departments to make greater use of digital technologies in order to ensure that needs are met, both at an individual level (i.e., through greater provision of assistive technologies) and at the level of communities (i.e., by using data related to service provision to map the availability of different care services in different locations). Our research in this space began when we were asked to support one of the nearby local governmental authorities in designing and introducing its Local Offer platform in 2014. At the time, the Local Offer was a newly mandated online service that, at its core, was to be a directory of local services available to people with special educational needs and disabilities (SEND). It was also mandated that each of the 400-plus local authorities in England needed to create such a directory through a participatory process. This was partly to ensure that the eventual platform was usable and legible to diverse members of the population, but also to ensure that the services on the directory spoke to the diversity of cultures, disabilities, and needs in the city. Furthermore, the eventual Local Offer directories needed to include some elements of service evaluation and feedback loops between citizens using the services, service providers, and their funders. As researchers, we were invited to join a working group that was driving the implementation of the platform forward, with the request to act as "critical friends." This became an opportunity to be participant-observers in a design process being carried out by a heterogenous group of stakeholders, including members of the public and of local government, social care service providers, and workers from volunteer and charity-sector organizations.
We address a liminal design space between the rigid hierarchy of local government and the growing and innovative scene of grassroots organizations.
What we observed in this project was, at first, a highly engaged and enthusiastic group of people, all of whom were deeply committed to not just delivering on what legislation required them to, but also to ensuring that the Local Offer was attuned to the specificities of a particular locality while creating a means for citizens to shape the future commissioning of care services. We saw a great commitment to bottom-up activism and advocacy around care, to ensuring state-funded services were responsive to more than just the medical needs of people with disabilities, and to changing attitudes within the local government about how services were funded and conceived. Over time, however, we also saw how the legislative requirements restricted the more innovative aspects of the Local Offer that the team was designing, and how the dreaded procurement processes of local government meant that buying pre-made systems, designed with different visions and purposes in mind, became more favorable. Furthermore, the cynicism of their public sector colleagues—who saw this as yet another box-ticking exercise that would be replaced by another initiative in the next election—meant it was hard to gain collective buy-in beyond the core working group and impacted the scope for innovative thinking in relation to the project.
Learning from the experiences with the Local Offer (which we reflect on further below, and discuss in detail in [1]), we set out to develop digital tools that were more in keeping with some of the initial ideas and values that inspired and motivated the Local Offer working group. We first developed ThoughtCloud, a mobile application and platform that was designed with a local nonprofit care and advocacy organization to gather opinions and experiences from care service users via audio and video clips. ThoughtCloud was created with the purpose of developing processes within care organizations where those receiving care would be able to share their stories and see them integrated into service-improvement and design processes. Our choice of audio and video to gather feedback was critical, as it provided a more appropriate channel of communication for many care service users compared with text input or, as most organizations were using, hard-copy forms. ThoughtCloud was designed so that staff and volunteers could set it up with questions and prompts for people to respond to, with the tablet often left in semi-public locations around an organization's premises or used at the end of meetings, sessions, activities, and workshops with service users. Through a secure backend, designated staff could then review collected feedback and annotate these with notes and keywords, or flag to follow up on them. The collected media, notes, and keywords could then be used by the organization's staff as part of reflective sessions where services are reviewed and improvements are noted for future developments.
Over the course of three years, ThoughtCloud was used extensively by our core partner organization and intermittently by a wide range of other care organizations. We observed a huge amount of enthusiasm for using handheld tablets with the application loaded on it to gather experiences from service users—as one of the members of staff we worked with told us, they loved "hoovering up" the feedback. Service users appeared to take great pleasure in talking to these devices, narrating what they had been up to during their day—and on rare occasion, directly responding to the questions ThoughtCloud posed to them. These "misuses" of the system were seen as a positive by the staff of the organizations we worked with, with these stories often offering glimpses into what people had achieved that day and the role their services had played for them. Yet we started to see a conflict: Lots of feedback would be gathered, but the opportunities to review and reflect on it within organizations were becoming infrequent. Increasingly, the clips of media collected from service users would be stored on devices and in the cloud but not viewed by those members of staff responsible for ensuring services are improved and developed. Indeed, we saw that when feedback was engaged with by staff, it was either initiated by individual staff members who wished to reflect on their care practice, or in response to needing to complete a report to a funder or write a bid for new funding. Rather than ThoughtCloud being used as a means to promote bottom-up participatory innovation within these care organizations, instead we saw it being used to support the top-down cherry-picking of opinion and feedback to suit the requirements of funding agencies.
Some of the frustrations over how ThoughtCloud was used inspired the design of our most recent system, Appraise. Appraise was another mobile application and platform, designed so that service users could collectively gather stories and experiences and then collaboratively make sense of these to create reports on services. Rather than designing with public sector management or care staff, as was the case in the previous projects, Appraise was designed with groups of young people with SEND who were already involved in service evaluation. These groups were formed on the basis that younger people with disabilities were often excluded from evaluations of public services and venues. Recognizing this, the local government funded a charity to facilitate this group in conducting a series of evaluations of local events and spaces, working as young ambassadors on behalf of their peers. Inspired by what we had done with ThoughtCloud, our collaborators saw an opportunity for digital tools to help with gathering material for these evaluations. Appraise, like ThoughtCloud, used audio and video, but gave more guided structure on what to do with them—for instance, by inviting a user to take photos of their day, to interview other service users and visitors, or to make panoramic videos and narrate responses to prompts over them. In group workshops, the ambassadors would come together and sort all this media they had collected, with the intention of creating themes related to their experiences that were evidenced by gathered material. At first the process drew on David Frohlich's Keep, Lose, Change method [2] but was later simplified to upvoting and downvoting; this made sorting through the increasing volumes of data that the ambassadors were collecting more manageable. Through this structured process, designed by the researchers to promote discussion and reflection around the material, the ambassadors then worked up reports on their collective experiences. The final reports comprised materials that the young people thought best reflected their experiences—including short pieces of text displayed alongside the photos, videos, and audio clips they had gathered. Reports did not contain explicit recommendations of how to solve specific issues, but rather offered a rounded picture of the ambassadors' experiences on which to draw for further reflection and service development—for example, capturing the positives and negatives from their experience or, in one notable case, highlighting access challenges resulting from poor signage. These summative reports would then be delivered to the organizations responsible for the events and services evaluated, and to the local governmental authority.
It is an intensely politicized space concerning citizens and their rights. It is also highly emotionally charged, since it includes family members and activists directly addressing challenges they face.
The progression across these two projects formed a natural trajectory from designing with management of local care services to working directly with care service users. Our goal in involving young service users in designing a tool to collect feedback about existing services was to support them with an outlet: They had space to say what they wanted about the services that interested them, in a way that was accessible and legible to them and consistent with existing forms of communication between them and their peers. In this respect, Appraise was a resounding success, resulting in a huge amount of positive engagement from our young ambassadors. Unfortunately, the data it generated was inconsistent with the reporting practices expected by the same local government that had called for its design. This mismatch did indicate a desire for new modes of feedback capture more in keeping with the ways in which young people increasingly communicate with one another—that is, through social media. As such, though the ambassadors were highly organized in collecting and discussing data about service provision, there was little motivation for service providers to act upon the data collected. As with the previous two projects, we saw some small achievements and wins. But there was also the looming feeling that the project had failed to reach its full potential in societal impact.
However, we did start to recognize that the ways in which we were approaching designing for civic care had changed. Increasingly, we became aware that we were occupying a space between, on the one hand, collectives of citizens and the bottom-up work of advocates, and, on the other, the increasingly neoliberal and top-down logic of public management. In other words, we had transitioned to working from the middle out.
Transitioning to Middle Out
The first step on our journey toward a middle-out orientation involved acknowledging middle-out spaces for what they are: instances of intersection between perspectives, flash points for debate and disagreement, literal meeting points where people gather, and opportunities for values and political beliefs to clash. At the intersection of HCI and urban studies, middle-out design has been described as "the process to draw on the collective knowledge of all actors to provide greater opportunities for more inclusive and collaborative community engagement processes. This approach allows for an integration of the objectives from top-down decision makers (government organizations, private enterprise) with those of the everyday people" [3].
As a definition, the above paints a rosy picture of what middle-out design could be; however, when it comes to the heterogeneous landscape of social care service delivery, the picture becomes rather messier. In forming our middle, we find a meeting point where the top-down powers, in our case of local government and public service workers, intersect with bottom-up, grassroots, voluntary organizations involved in service delivery and advocates for people with a disability. It is an intensely politicized space concerning citizens and their rights. It is also highly emotionally charged, since it includes family members and activists directly addressing challenges that they face in their day-to-day lives, where the decisions being made have direct repercussions.
The aspiration for middle-out design is to create opportunity for more inclusive and collaborative practice by welcoming the expertise of heterogeneous stakeholders, together, to the table. The work done then benefits from pooled knowledge and resources. In its ideal form everybody wins, and group members are able to equitably contribute their personal or professional perspectives. However, despite good intentions by everyone involved, in practice our middle represented a hierarchical space, since there was the presence of top-down management by the organizations of local government, with actions taken needing ratification by those in positions of power, often off-site. This was explicit in the Local Offer, where the top-down had both the power to set the agenda—they pulled everyone together to work on the project—and in the end to cherry-pick from the ideas put forward to deliver a minimally viable product on its own terms. But these issues also permeated our other projects, as reporting procedures and a focus on outcomes and short-term funding from the state heavily influenced the efficacy of our systems. Unfortunately, this is often how social care is delivered in England—with small pots of money allocated for specific projects that are often determined by the flavor of the month rather than the needs and aspirations of those who rely on social care.
The transition to taking our own middle-out perspective is most clear in our work on Appraise. Our decision to actively work on amplifying the voices of youth was an attempt to decenter or shift the middle in favor of more inclusive service design, evaluation, and delivery. In this sense, we used our own work and the design of digital technology as a new mediator in the transactions between the layers of service provision. And although our primary hope was to create a more relational space for the delivery of care, which we probably did not achieve, we began a shift in how we considered our own role as agents in the negotiation. We elaborate on the aspects of this thinking below, addressing: the responsibilities that we face as researchers in the mediator role, the dangers in becoming assimilated and trapped by the middle, and our obligation to be "in it for the long haul."
Becoming Responsible
Through our work on these projects, we grow more aware that collaborative civic design work means working across the spectrum of service provision, in a politically charged and value-driven environment. We have experienced a mixed landscape of public funding administered by local government (and, in some cases, from charitable trusts) resourcing a growing array of charitable, voluntary social enterprise and community-interest companies all competing for similar funds. Among these, universities and university researchers such as ourselves can play an important economic and social role [4]. If we take seriously the call for more civically minded universities and pay heed to the social responsibility of taxpayer investment in science, research, and education that supports many universities, we must accept that we have a responsibility to act in the public interest.
It is easy for notions about the bottom up and the top down to become artificial binaries or poles, when the reality of most engaged research is a negotiation between the two.
Let's consider the Local Offer. As it is produced through the local government process and national regulation, it becomes a site of different political and economic goals and values. From a neoliberal perspective, the Local Offer directory that we were working to produce becomes a tool for this market to use to self-organize and self-regulate. A proposed benefit of such a marketplace is that it allows for gap identification in service provision, theoretically not only in geospatial terms but also in terms of particular demographics, interests, and needs. The Local Offer provides coverage of services to the population that needs it. This is valuable. HCI researchers can support such efforts by optimizing matching, by improving visualization, and, as we anticipated in our work, by designing systems with the values of care and empowerment at their heart.
Conversely, the marketplace could allow for the consolidation of geographically similar services, the defunding of niche services, and increased competition in low-cost or high-value markets with an associated search for the maximum value offer at the lowest cost. These latter values of competition and efficiency are in direct contrast to the values of the charities, the employees of local government, and us as researchers. Care providers seek to maximize care—in quality, access, and match to needs—for all service users. They seek the possibility of working together, not against each other, to provide this care. The Local Offer directory could support these values; the initial work to produce the directory was guided by these values and principles. However, in the working out of what the directory should be and how it should be delivered, much of this enthusiasm evaporated. From our own frustration, and that of our societal partners, we began to question the ethics and responsibility of working with the local government. Do we continue to support the development of the system toward goals less in line with our own, and of many of our collaborators, but demanded by the procurement and management of local government? Or do we find and create sites of resistance? In answering such questions, it is easy for notions about the bottom up and the top down to become artificial binaries or poles, when the reality of most engaged research is a negotiation between the two. Hence, it is useful to think through what operating in these middle spaces means in practice.
Resisting Assimilation
Another common characteristic we find in the middle-out space lies in its proximal relation to the power of governing bodies, specifically in our case to local government in the form of a city council. When academics come into the orbit of government, there is a big risk: Their ideas will be adopted, partially, and their participation will cease. In the U.K., Simon J. Duffy's work on personal budgets is one such example [5]. Duffy, a disability rights and social justice advocate, conceived of personal budgets as a means to give recipients of social care control over the finances associated with their care needs, and to provide them with choice over what types of care they receive, when, and from whom. For a heavily institutionalized care system, as was the case in the U.K. until the turn of the millennium, these were radical ideas. Duffy's work was championed by the Labour government of the day but in practice was implemented through poorly designed systems and infrastructures. It has ultimately been used to promote private competition, to save on social care costs, and to further austerity. Duffy was forced to distance himself from an organization that he founded in order to halt the government's simplifying his ideas to the detriment of people with disabilities. Within HCI, project leaders have to be careful that design work, and the related collaborations and systems, are not being commissioned for similar reasons.
By the same token, there are already many examples of HCI researchers being drawn into the infrastructure of voluntary and charity sector organizations as resources to support the implementation and deployment of technologies [6]. However, as has been argued is the case with governmental funding around social innovation projects and community and volunteer initiatives, researchers working in civic spaces such as ours can become assimilated as part of the provision of care that must be the responsibility of the state. While it is important to conduct applied and action-oriented research in these spaces, we should be cautious to ensure that our work in itself is not seen as the care work that should be provided through other means. Importantly, our work should also not be allowed to provide more evidence for contracting the state, and withdrawing further already scanty resources. Furthermore, operating in these middle spaces requires resistance to the ways in which technologies designed for the civic good might be deceptively used to reinforce the dominant logics of how public services are funded and maintained. While our collaborators' use of ThoughtCloud as a means to support funding bids and reporting on outcomes is not inherently bad—indeed it led to valuable initiatives being refunded—it comes with the baggage of contradicting the bottom-up pull-economics and decentralized control envisaged by us and its other creators.
In it For the Long Haul
Reflecting on the failures of his own project, Simon Duffy was forced to conclude that government is incapable of innovation, that it was by its very nature a fixed hierarchy predicated on preserving the status quo. In one way that was its function, since change can be highly disruptive. In response, he advised social innovators: "Develop forms of innovation that are as distant as possible from the influence of government" [5]. By contrast, much of what we have seen in our work within care service provision has been a tumultuous rollercoaster of policy, funding, legislation, and on-the-ground work among a continually shifting landscape. In this environment, small and large providers appear and disappear with cash flows, initiatives, and shifts in legislation brought about with each political season, and working groups are formed and disbanded, leaving those with long-term needs in a sea of uncertainty. By turns, in our own work we have even become, over the course of the lengthy design work on Appraise, the thread of continuity preserving the integrity of a particular young people's group. As its leaders came and went, we helped it stay on track toward its goals. What we have observed is that there are often invisible continuities that smooth out transitions: social workers who move between the public and the third sector; motivated parents who spend decades fighting for their children and communities; young people participating in initiative after initiative to drive change for themselves and their peers, with little to show for their efforts. We believe that as middle-out actors with relative privilege in our professional positions, we can add weight to this continuity. We know that this has already been said. In their reflections on their work in participatory design, Suzanne Bødker and Morten Kyng highlight their years working on only the educational side of their work, not the intervention or the system [7]. More recently in this magazine, Nithya Sambasivan called out the kind of Band-Aid solutions that have the effect of exacerbating problems [8]. This should give us some cause for reflection as we enter into collaborations in and of the middle and, following Sambasivan, ask whether another technology is what is needed at all.
Finally, we assert that for those of us occupying a middle-out position, our role requires finding ways of working against the cycles of publication—and even graduation—and prioritizing long-term commitment as essential to responsible design and collaboration. This kind of obligation is not only a commitment to working on projects, but also to seeing and narrating the journeys made by citizens, by researchers, and by governments over the long haul. This means learning from projects like our own, which sometimes feel like they have failed to deliver, while mapping the configuration of a fraught and middling design space. It means learning from the work done by others in similarly politicized spaces. As Sara Heitlinger and colleagues have stated, when designers work with movements they should be "narrating and sharing the process through design research, thereby helping the resistance to grow and proliferate" [9]. It means taking seriously our responsibility as civic actors and reflecting on what is realistic in terms of our commitment, as well as what is practically achievable. It also means recognizing that while operating from the middle out can at times be restrictive as a space for innovation, restrictions often present us with the opportunity to reconsider how we carry out our work afresh.
References
1. Dow, A., Comber, R., and Vines, J. Between grassroots and the hierarchy: Lessons learned from the design of a public services directory. Proc. of the 2018 CHI Conference on Human Factors in Computing Systems. ACM, New York, 2018; https://doi.org/10.1145/3173574.3174016
2. Frohlich, D.M., Chong Lim, C.S., and Ahmed, A. Keep, lose, change: Prompts for the re-design of product concepts in a focus group setting. CoDesign 10, 2 (2014), 80–85; https://doi.org/10.1080/15710882.2013.862280
3. Fredericks, J., Amayo Caldwell, G., and Tomitsch, M. Middle-out design: Collaborative community engagement in urban HCI. Proc. of the 28th Australian Conference on Computer-Human Interaction. ACM, New York, 2016, 200–204; https://doi.org/10.1145/3010915.3010997
4. Goddard, J., Hazelkorn, E., Kempton, L., Vallance, P., and Goddard, J. Introduction: Why the civic university? In The Civic University. Edward Elgar, 2016; https://doi.org/10.4337/9781784717728.00008
5. Duffy, S. Government cannot innovate. In Kittens Are Evil: Little Heresies in Public Policy. C. Pell, R. Wilson, and T. Lowe, eds. Triarchy Press, 2016, 53–64.
6. Voida, A. Shapeshifters in the voluntary sector. Interactions 18, 6 (2011), 27; https://doi.org/10.1145/2029976.2029985
7. Bødker, S. and Kyng, M. Participatory design that matters—Facing the big issues. ACM Trans. Comput.-Hum. Interact. 25, 1 (2018), 4:1–4:31; https://doi.org/10.1145/3152421
8. Sambasivan, S. The remarkable illusions of technology for social good. Interactions 26, 3 (2019), 64–66; https://doi.org/10.1145/3319378
9. Heitlinger, S., Bryan-Kinns, N., and Comber, R. The right to the sustainable smart city. Proc. of the 2019 CHI Conference on Human Factors in Computing Systems. ACM, New York, 2019, 1–13; https://doi.org/10.1145/3290605.3300517
Authors
Andy Dow is a postdoctoral researcher at Open Lab working in digital civics in a health and social care setting. He focuses on designing with community groups, such as charities and social enterprises, to co-produce lightweight tools to capture the voices and opinions of care services users. [email protected]
Rob Comber is an HCI researcher and associate professor in communication at KTH Royal Institute of Technology. His research focuses on issues related to the democracy of technology, including social and environmental sustainability, social justice, and feminism, and to specific applications of computing technology, including civic society, food, and social media. [email protected]
John Vines is a professor in the Northumbria School of Design. His research concerns how people experience, appropriate, and use digital technologies in their everyday lives. He focuses on how technology is interwoven with issues such as independence and agency in later life, and how it could support informal and relational care for people of all ages. [email protected]
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The Digital Library is published by the Association for Computing Machinery. Copyright © 2019 ACM, Inc.
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