How Design Methods Improved the Working Environment and Reduced Sick-Leave by 50% in Norwegian Nursing Homes

From 2019 to 2024, Siri Moe Megaard and Elin Skogstad?of Norwegian Design agency Halogen worked with the Programme for Inclusive Working life in Nursing Homes.??

Their brief was to empower the staff in ‘test’ nursing homes across 4 regions of Norway to understand and improve their working day, using service design methods, and create a tool for all nursing homes to use.??

The Challenge??

• Staff in the long-term care sector in Norway face a heavy workload, physically and psychologically. Burn-out causes significant numbers of staff to be on long-term sick leave impacting remaining staff’s workload and motivation, continuity and quality of care. 40% of the absences could be linked to the working environment.?

Insight Methods Used?

• Shadowing: Observing health care over time; writing down the subject’s activities; asking why about the activities. Summarising the findings and capturing positive and negative experiences at each stage of a working day.?

• Probes: Self documentation; reflection; analysis. Health care workers used post-it notes to document good and bad experiences over five shifts – red for bad and green for good.?

• Workshops: Together health care managers and workers created a shared picture; discussed what caused positive and negative experiences; learned from each other’s perspectives, highlighted the good and what could be improved; prioritise improvements; discussed individual and shared experiences.?

• Role workshop: Improved confidence in and awareness of roles and responsibilities; strengthened collaboration; shared individual reflections.?

• Covid learning workshop: A chance to reflect on the period health care workers and managers had been through; ‘What do we want to continue doing in work life?’; ‘What do we want to stop doing?’; What have we learnt for a potential new pandemic?’?

• Devil's Advocate exercise:? Used hypothetical questions to bring up issues, then looked at potential solutions. Red notes to answer the question eg. ‘What would make the move a disaster?’. Green notes to look at what is the opposite eg. ‘How can we make the move a success?’; ‘What can employees do?’ ‘How do you feel?’ and ‘What can management do?’ This opened up for personal concerns that are difficult to come forward with, as they could frame them as hypothetical.?

Learnings from Insight Methods?

• Shadowing was valuable for quickly gaining deep understanding; outsiders noticed other things; detailed, time-specific descriptions lead to concrete ideas; time consuming; too much insight can be overwhelming. ‘I have learned more about the nursing home after one day of shadowing than in four years as an advisor’??

Ideation, Developing and Testing of the ‘Us and Ours’ Tool??

• Principles for the tool. Principles agreed were to include and inform staff all the way; to strengthen cooperation; to explore and test not jump to conclusions; make it easy to follow for non-designers; address what can be changed and is possible for busy staff; design for relay, to roll out to other nursing homes.?

• Development of the tool. The ‘Us and Ours’ tool was Halogen’s adaptation of the double diamond, but circular to make it clear that the process should be repeated (Explore; Elaborate; Create and Test).??

Key Learnings and Outcomes?

• Learnings: Limit the amount of tasks; verbal guidance has a different effect when written down; make sure users can access the material.?

• Training: A training handbook was produced from the ‘Us and Ours’ tool.??

Results and Conclusion??

• Several of the nursing homes Halogen worked with in the programme have halved their sick leave. The "Us and Ours" tool have been taken into use by a great number of nursing homes since it was launched, and is now in the early stages of being measured.?

• It was a positive experience for healthcare workers to be allowed to contribute, to be seen and to have their challenges recognised. Going through the process was valuable in itself, regardless of the solutions.?

• The solutions were about the organisation of the work which in turn impacted the working environment and quality of the service. This is organisational development, so the process must be repeated again and again.?

About the Speakers?

Siri Moe Megaard?

Siri is the manager of the policy design studio in the Norwegian design agency Halogen. Siri has worked as an advisor/consultant for clients in the public sector for 7 years and worked in communications in the public sector for 17 years before that.? ? She has experience from using design thinking and service design methods to approach complex challenges in society that cannot be solved by one organisation or actor alone, in both municipalities and governmental agencies.? ?

Elin Skogstad?

Elin is manager of the service design studio in the Norwegian design agency Halogen, and has 15 years experience as a project manager and consultant in Halogen.?

She has led large digitization projects and service design projects that aim to solve complex systemic and societal challenges. She strives for a user-centric approach, and focuses on ?all relevant stakeholders and players in order to anchor the process, findings and decision-making basis.?

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