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Systemic and Participatory Design Processes in Care Systems

Format: Papers, RSD7, Topic: Health & Well-being

Authors: Campagnaro Cristian, Di Prima Nicolò, Ceraolo Sara

Social inclusion;

The paper discusses the topic of participatory design processes with systemic approach as a tool to negotiate, shape and prototype new inclusive models of citizenship and care to benefit marginal groups in society.
The topic will be addressed via three case studies from the field experience of our action research through Design and Anthropology toward social inclusion (World Bank, 2013). The two disciplines shaped a collaborative and vibrant research environment challenging the issues of participation in design processes. Since 2009, the research operates in several italian cities, entailing both methodological analysis and transformative actions that have tangible effects on social care systems: marginalized people, caregivers, services’ management organizations.

The beneficiaries involved are asylum seekers, migrants, people affected by chronic diseases, and homeless people.
They are usually intended as “fragile” people since they manifest urgent and highly impacting needs that require specific answers, usually provided by the care system, composed both by public and private sector.
Usually, beneficiaries’ needs are multilevel (housing, health, income, work, social relationships, autonomy) and interconnected. The variety of actors that contribute to meet those needs is not part of a coordinated network. From the perspective of our research a care system shouldn’t be intended as a crystallized system but as an ever-changing system that constantly needs to be transformed to better answer to social change.

All the projects described move from the stakeholders’ desire of tangible transformations in order to improve the quality of service: development of new products, redesign of spaces and processes, innovation of the service itself.
In order to support and facilitate this “desire of change”, on the basis of the complexity of the relations that shape the network of the system, it seems to be preferable to operate with a systemic design approach (Jones, 2014) and to develop projects based on participation and collaboration among all actors, in order to include the most of them in decision making processes.

Method and Tools

We developed a specific interdisciplinary method and a set of practical tools to operate into the social care system.

The fundamental elements that define our method are:

1. To observe and analyse the system in order to understand it in its complexity, focusing on the social relationships that occur among people and the stakeholders, and how they shape the system through the usage of spaces and objects. We use focus-group, in-depth interview, video-tour and participatory observation when the project has been undertaken.
2. To carry out co-design processes: all the actors are involved as expert users. We build shared decision making processes designing together a shared vision of change, and tools and procedures to achieve this change.
3. To encourage co-production of the intervention with every stakeholders. They are invited to make available resources in order to produce and manage the interventions.
4. To lead co-creation processes of the most tangible and practical stage of the project set out during the co-design process. We invite the actors to take part to the process sharing knowledge, skills, and competences.

The participatory workshop is the practical tool we adopt to materially shape the desired change. It consists of on-site interventions through creative and collaborative processes, working from within the context.
The workshop is an occasion to stimulate synergies among the actors in an informal and dialogic environment. During the workshop new connections between all the actors are found out, tried out and tightened.
The workshop is also a way to prototype solutions that can be tested, discussed and implemented with all participants.
Moreover, the workshop offers the opportunity to connect the social care system services, so often marginalized, with the society. We do so by inviting in the “outside” to take part to the processes: university students, volunteers, citizens.

CASE 1. Design for Each one _ Co-design of personalised devices for people suffering from multiple sclerosis and muscular dystrophy

The co-design process involves users, care givers, design students and researchers, promoting collaboration between Politecnico di Torino, Associazione Italiana Sclerosi Multipla and Animazione Valdocco, the social cooperative managing the care service.
In the framework of collaborative workshops, everyday life problems of sufferers are investigated by a group of designers and caregivers, through participant observation.
The group investigates on those gestures that users cannot do and they prototype small tools. Within a one-week long workshop, the product is developed and prototyped by a continuous collaborative process with the user. Than, with the same method, the product is implemented and tested for a long time until it is ready to be released.

CASE 2. Cantiere Mambretti _ Participatory renovation of shelters for migrants and homeless people in Milan

The project relies on the collaboration of homeless people and migrants in the role of expert users, workers belonging the organization managing the reception service, designers from Politecnico di Torino, young volunteers as high school students and citizens in general.
The design action places emphasis on ideal of “co-created beauty” as trigger to reshape reception services and spaces.
The co-design process is stimulated by preliminary focus groups with hosts and workers, in order to understand the needs and to define together solutions that all the actors can agree on. Than, the group of participants is engaged in the tangible transformations initiatives: furniture building, wall painting, wayfinding set up.
The project generates a sort of temporary “creative revolution” in the shelter: everybody is welcomed to participate and help with the design interventions.
The vibrant environment of the workshop challenges the reception service’s routines and fixed roles and create a positive impact, also because it involves operators and users in the actions, giving value to people’s skills and aspirations (Campagnaro, 2018).
The effects of this process are diverse in relation to each category of participant: for migrants people, participation acts as a trigger for a sense of protagonism and gratification, while, for the organization’s workers, the project offers the chance to rethink to the way the service is provided and to imagine how the spaces could contribute to improve it.

CASE 3. Costruire Bellezza _ Design Anthropology led lab based in Turin aiming at social inclusion

The group of participants of Costruire Bellezza is heterogeneous: homeless people, care givers, social workers, students and researchers in design and social sciences and creative talents.
The process is rooted in the collaboration between the Municipality services for homeless people, the social cooperative managing these services and our universities (Politecnico di Torino and Università di Torino).
The lab functioning is based on regularly held creative workshops leading to the production of co-design and co-created artifacts for the participants of the project and for the neighborhood communities.
The main outcome of the project can be traced on what the collaboration of the participants generates in terms of empowerment of the homeless people (Sen, 1992) putting in value their capabilities, development of new skills in the students (Margolin and Margolin, 2002), and in the offer of an innovative and informal occasion during which the relationships between social operators, educators and homeless people are tightened.

Design domains

The specificity of the case studies presented can be traced in the extensive use of the co-design method in order to develop all the (tangible-intangible) artifacts together with the users: either the output is a tool, a space or a new social service. However, if we analyse those processes by the “design domains” (Jones, Van Patter, 2009) a scale of incremental impact can be observed between the projects.
The ‘Design for each one’ objects represent an unseen ground for the design of innovative products based on specific needs usually unspoken by the users or not answered by the traditional market because of their specificity. Moreover the project produces an empowerment effect on the organization, fostering the participatory approach also in the educational work.
The ‘Cantiere Mambretti’ projects have an effect on a systemic dimension. They impact on how the reception service is provided in terms of both quality and functionality of spaces. Assuming the co-design model as “a new way to do things”, the stakeholders are connected systemically as agents of change. This environment activates all the participants and design enhances not only physical changes but also the strategy that lies behind the service (Campagnaro, Di Prima, 2018).
Lastly, it is possible to read ‘Costruire Bellezza’ as an example of a project operating on the highest level of the scale of the design domains. Started as an experiment (Binder, Redström, 2006) in 2014 and now recognized by the public administration as a new public service for homeless people and the development of initiative of social cohesion, Costruire Bellezza provides an example of how initiatives of co-design of objects and services can encourage new policy models that rely on the alliances fostered by the participatory design processes.

Final remarks

According to our experience, the systemic vision, thanks to a participative approach, enhances the relationships among all the stakeholders developing new visions of the services, making everybody a “beneficiary”. In order to facilitate and foster an horizontal environment of mutual exchange and collaboration, the researches need to stay within the processes. Doing so, they understand attitudes, behaviors, unspoken needs and outcomes and they can reorient the process on the basis of what the field and the people respond. Places of care can become places of innovation if the project’s system is open, flexible and sensitive to context and individuals. This fosters the cohesion and the inclusiveness of the care systems and it generates the opportunity for all those involved to flourish.


Binder, T., Redström, J. (2006) ‘Exemplary Design Research’, paper presented at the DRS Wonderground conference, 1-4. November, 2006

Campagnaro, C. (2018) ‘Projets interdisciplinaires et participatifs pour/avec les sans-abri’, in Duhem, L., Rabin, K., DESIGN ÉCOSOCIAL: convivialités, pratiques situées et nouveaux communs, it: éditions, Facougney-et-La-Mer (FR), pp. 35-52.

Campagnaro, C., Di Prima, N. (2018) ‘Empowering actions. The participatory renovation of a shelter’, in INTERVENTIONS/ADAPTIVE REUSE, vol. 9, pp.68-75, ISSN:2154-8498.

Jones, P.H., Van Patter, G.K. (2009) ‘Design 1.0, 2.0, 3.0, 4.0: The rise of visual sensemaking’, NextD Journal, Special Issue, March 2009, New York: NextDesign Leadership Institute.

Jones P.H. (2014) ‘Systemic Design Principles for Complex Social Systems’, in: Metcalf G. (eds) Social Systems and Design. Translational Systems Sciences, vol 1. Springer, Tokyo.

Margolin, V., Margolin, S. (2002) ‘A “Social Model” of Design: Issues of Practice and Research’, in Design Issues, Vol. 18, No. 4, pp. 22-30.

Sen, A. (1992) Inequality Reexamined, Oxford: Oxford University Press.

World Bank. (2013) Inclusion Matters: The Foundation for Shared Prosperity, (Advance Edition). Washington, DC: World Bank. License: Creative Commons Attribution CC BY 3.0

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Citation Data

Author(s): OCTOBER 2018
Title: Systemic and Participatory Design Processes in Care Systems
Published in: Proceedings of Relating Systems Thinking and Design
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First published: 2 October 2018
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