Aims and scope
The ‘Proactive service provision for disabled people’ project started out in 2018 and was implemented in 2020. The objective of the project was to automate the process of application for disability in an effort to reduce personnel resource costs (as application review is a very time-consuming process for physicians involved in the review) for the Social Insurance Board and simplify the current application system for users. Currently, individuals first apply for disability and only then they can start applying for various support services from various organisations such as rehabilitative services and aids (e.g. wheelchairs). After handing in an application to register their disability status, the experts in Social Insurance Board will evaluate the level of disability based on medical information available in the health information system. However, it provides no immediate access to other services, which require additional applications. These services have different dates of expiration, which requires individuals to keep track of when a service expires. Applying for disability by itself therefore pertains no value and the application process for various services is fragmented between different organisations and levels, which makes it increasingly difficult for users to perceive the opportunities available for them. As a result, there can be confusion whether service provision occurs through the Social Insurance Board or whether it is a service of a local municipality. This creates excessive administrative burden for an individual to keep track of all services separately.
The redesigned service makes use of the national Health Information System, Social Insurance Board Information System, X-Road for information exchange, Delta document management system and Excel for data processing and analysis. It is focused on backend processes, where the Social Insurance Board based on existing data has redesigned data processing and analysis, enabling proactively to commence the application process for support services the new applicants are qualified for. As a result, a parent of a disabled child has to submit a limited number of applications, as the Social Insurance Board makes use of the information they have access to. During the initiation of the new service process, the parents have to provide consent to the Social Insurance Board to process and use the personal health data of their disabled children for analysis. Following the provided consent, the Social Insurance Board initiates the disability evaluation and additionally support services aimed towards the child based on the info from their health data.
The innovation makes use of the national digital infrastructure that is irreplaceable within the Estonian context. In the field of evaluating disability levels and providing certain support services, the Social Insurance Board possesses a monopoly position thus owning the key digital solutions. They are the sole providers of the necessary data used to conduct the evaluation of the disability level and connected support services.
Main collaborative innovation conditions
New ideas emerged directly from interactions between different organisations and individual actors who were actively encouraged to provide their perspective within the project framework. Each individual in the project team was encouraged to write down their ideas, which then were deliberated amongst all project team members in an effort to complement it or propose an alternative. The ideas proposed were then prioritised according to importance, effect or feasibility. The deliberation was strongly shaped by the inclusion of the Estonian Chamber of Disabled People, who provided input from their systematic collection of feedback from the disabled community. The Estonian Chamber of Disabled People possessed extensive experience due to years of systemic accumulation of information and feedback from disabled people. The Social Insurance Board possesses a monopoly in the delivery of key services to disabled people in the Estonian context, which gives them expert knowledge of existing processes and the necessary resources. Both the Social Insurance Board and the Estonian Chamber of Disabled People conducted interviews with the target group to enable an overview of the user perspective that was accommodated into the redesigning process, thus incorporating a user-oriented approach. The results were infused through a methodology using empathy cards (i.e. cards that represented the feelings of the respondents), which helped to make the mindset of the user the focus of the project.
The Estonian Chamber of Disabled People was involved as a user representative organisation, and has been a key actor within the field for a long time. Also, members of the target group were involved differently in different phases of the project. Initially in an effort to map user perspectives during the phase of problem analysis, several interviews were conducted with members of the target group. This enabled to better perceive the issues they face, thus moving the focus from back-end perspective towards users. During the piloting phase, 50 children and their parents tested the new service process.
Implications and lessons learned
The innovation process strongly differs from traditional attempts to redesign a service as it emphasises user-centricity and pro-activity. The conscious approach to consistently deviate from organisation-centric mindset and orient towards a user-oriented solution has resulted in stark differences with standard procedures. A user representative organisation was actively engaged as an equal partner in efforts to design a service that offered maximum benefits for the applicants.
Despite the ambitious approach by the relevant actors, the innovation and collaboration process did face several barriers. These were not predominantly the result of actors’ attitudes or negative stances, but the result of limited available resources, which impeded their opportunity to participate to the extent desired. Duality of roles and competition between the Ministry of Social Affairs and Social Insurance Board between organising service provision in the field further complicated the process. Concurrently, there are separate initiatives within the field to bring about change in service provision for disabled children, which causes actors to distribute their resources. This inhibits the opportunity for actors to collaborate to the extent desired, as the limited resources for both NGO’s and governmental actors result in individuals being overloaded with different tasks, which affects their ability to participate.
There were certain key factors which enabled success. The Social Insurance Board is in the middle of reforming outdated services as part of an organisation-wide initiative, which has enabled the agency to provide the necessary leadership support to accommodate the changes. Additionally, it is important to highlight the role of the Government Office, who has been leading the innovation programme that enables different government actors to experiment with a novel service design framework. This has enabled the actors a framework within which to approach the collaboration process, which was very smooth considering all the different problems (e.g. limited resources, time, incompatibilities with the legal framework, etc.) that the participants faced. Individual actors were motivated to contribute additional resources to ensure the positive result from the collaborative arrangement. Another key success factor was the role of the project manager. She was not an established member within the Social Insurance Board due to which she was uninhibited by the established organisational legacies. As a result, she brought a mindset to the project, which proved crucial in bringing about change, as she held an alternative perspective, which allowed for the reconstruction of the established work routines.
This project exhibits the importance of personal motivation, use of novel service design methods, openness towards change and importance of a strong project manager, which enabled the project to successfully reach this stage.
 For instance, the Estonian Chamber of Disabled People has published guides and manuals that highlight crucial information for the disabled community and communication with the government. Different guidelines are gathered on the following website: https://www.epikoda.ee/mida-me-teeme/trukised. An example of such guidelines (which was linked to the processes that the collaboration in the current case tries to streamline) can be found here: https://epikoda.ee/media/pages/mida-me-teeme/trukised/478472131-1567066576/epik_kasiraamat_2019-est-koos-low.pdf
To read more about the case study, see D7.1 – Practices of external collaboration for service delivery. Comparative case studies on external collaboration in eHealth partnerships report.
About the Authors
Steven Nõmmik, Tallinn University of Technology
Veiko Lember, Tallinn University of Technology