Proceedings of RSD6, Relating Systems Thinking and Design 6
Oslo School of Architecture and Design, Oslo, Norway  18th-20th October 2017


Keynote relevant for this section
John Ehrenfeld:
Flourishing Lives in Another World


Other section relevant to the topic of flourishing
Environment and Sustainability



Jyotish Sonowal and Peter Jones:
Reconceiving the Hospital as a Business for Flourishing




Reconceiving the Hospital as a Business for Flourishing

Jyotish Sonowal and Peter Jones

Business model
Social system
Soft Service

The healthcare sector in the Western world is in the midst of a significant change. The majority of healthcare expenses are incurred through major tertiary care, performed in hospitals, which are generally structured and function in much the same way as 100 years ago. Care organizations are undertaking a grueling process of having to maintain clinical continuity and yet advance as businesses in a world where funding policies, clinical and information technology, patient demographics and relationships between other healthcare systems are constantly changing (Cohen et al., 2004). Besides, governments throughout the developed world are under pressure from the goals of the (IHI) Triple Aim, to reduce healthcare costs, while improving the quality of care (Howie & Erickson, 2002; McCue, 1997; Segesten, Lundgren & Lindström, 1998) and satisfy the patient experience. 

In such an environment, healthcare providers are finding it difficult to innovate business models, or to understand the far-reaching social and environmental impacts of their services. Our OCADU research project investigated the adoption of designing business cases as systems for flourishing, to help clinicians and administrators in a hospital to reconceive and analyze their current clinical services, discover gaps and barriers to flourishing, and define recommendations. We take Ehrenfeld’s (2002) concept of flourishing as the aim of sustainability, nothing short of sustaining all life on earth forever. Keyes (1998, 2002) defined social flourishing as the sum of qualities that would ensure a healthy sense of well-being and social integration, which holds significance for healthcare activities. We employ a social ecosystem model to help identify functions and measures of flourishing across nested, multifinal social systems. Using the Flourishing Business Canvas (Upward and Jones, 2016), this research project explores ways of impact definition and evaluation and also measures social and environmental benefits which will help decision makers in a healthcare setting. 

The study resolves a base of relevant literature in business models, business sustainability, lean process, and flourishing, in the healthcare context. A design action research methodology was employed, with expert and practitioner interviews and a business model design workshop. The participatory design workshop introduced the Flourishing Business canvas to clinical decision makers (director and managers) in Toronto’s North York General Hospital in a generative session. The participants were engaged to collaborate and articulate their service lines as businesses, mapping their proposals using the FB canvas in the form of a model. Observations, verbal data, and canvas results were recorded. This and data from interviews with other clinical directors are tallied and analyzed to look for common challenges faced by the hospital and areas of opportunities. This analysis also leads to rich insights on the Flourishing Business modeling process, especially in a hospital setting. 

The unique contribution is the design of a process and method for representing conditions and elements of flourishing within healthcare service lines: a business process that is currently desired but unavailable to organizations (Jones, 2016, personal conversation). The recommended process is an attempt at changing the mindset of planners in a hospital from traditional capital planning to systemic design-based planning and resource decision making. The culmination of the research insights led to service design proposals embodied in a blueprint for a “soft services”, based on the 4C journey model (Jones, 2017) and adapted for this research.






Research-action applied to the design of a flourishing community dedicated to sustainable fashion in the Nouvelle Aquitaine region.
Marion Real and Iban Lizarralde
Design for emergent
Social entrepreneurship and innovation
Systemic design
Fashion communities
Intermediary object

Our research is part of a new decentralized vision of the territories and takes part in the construction of new socio-technical models of circular economy, which seek to increase the environmental efficiency of processes, optimize the use of accessible resources and the autonomy of stakeholders in regional ecosystems. 

Our research focus on the study of intermediary objects of design present in collective entrepreneurial actions and seeks to develop new methods of animation promoting the design for emergence. More precisely, we analyze how to create more synergies between the new entrepreneurs of the territory, the existing industrial cluster and the political decision-makers by investigating three problematics: 
– What tools will enable actors to share a holistic and evolving vision of territorial metabolism? 
– How to prepare and animate organization/business modelling workshops for emergent third-places of open design and distributed production on the territory? (hubs, resource centers, fablabs, living lab…) 
– How to actively manage the flows and tensions present in the structure to accelerate the continuous creation of virtuous loops promoting a more circular economy? 

Our research is anchored in a research-action approach on the territory of Nouvelle Aquitaine. This resolutely inductive and empirical approach considers the field as a place for experimenting and confronting the concepts and tools imagined from the observations and situations experienced within this terrain. From an operational point of view, the research action is based on a collective action aimed to endeavor the development of activities around the valorization of used textiles and old clothing. It involves innovation clusters, the regional circular economy platform, sorting, upcycling and recycling centers, designers, seamstresses, brands and citizens of the territory.


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Systemic Maturity Models and Multi-organization collaborations: the ACMHI Mentally Healthy Campus Maturity Model.
Sharon Matthias and Jess McMullin
policy and policy implementation innovation
flourishing communities
health and population wellness
No single profession, group or organization can successfully address today’s societal No single profession, group or organization can successfully address today’s societal challenges alone. This is increasingly declared, but operationalizing it is a different matter. Conventional management and governance tools are based on implicit design criteria that support individual organizations’ isolated operation. Collaboration that simply combines multiple organizations’ individual actions does not provide the synergy required to achievethe level of collective impact required to match citizens’ increasing expectations and increasing diversity and complexity of users’ needs. Few leaders have robust tools to help them operationalize the need for multiple persons, professionals, organizations and sectors to collaborate effectively and reliably as a matter of routine in all dimensions of operation.
For legacy systems such as healthcare, education, justice and environment, the cost of not attending to this is high. Organizations and professions, as well as the governments that fund them, are focusing on monetary costs while silently leaking citizens’ confidence and trust in their ability to solve problems and achieve required results in citizens’ lives.
One example of a complex societal challenge is supporting people to improve their mental health and provide appropriate services for mental illness and addictions. This requires a complex strategy that integrates the efforts of an individual with many other people, professions, agencies and governments. These must provide a myriad of services and supports, which also recognize the many interacting factors of the individual’s physical, social and informational environments. This challenge also includes moving from illnessorientedstrategies to integrated, wellness oriented strategies that combine the worldview and narrative of increasing health, achieving peoples’ potential and quality of life, as well as those of treating, supporting or preventing illness.
However, operationalizing a holistic view that combines such a host of factors and their differing fields of knowledge, as well as requiring multiple organizations to work together as a matter of routine can be paralyzing: Which factors? How do we know how we’re doing,who should do it, and what should we do next? And how do we know how our own contribution best helps create synergy so we get as much value as possible?
What is a Maturity Model?
A maturity model describes the stages of maturity through which a process evolves, to provide increasing levels of reliability and value. It supports self-review and collaborative conversations – for designing strategies, adapting management and governance systems, and assessing progress.
Unlike traditional evaluation, a maturity model focuses on the organization’s capability to create change, rather than the change itself. A maturity model doesn’t replace evaluation, but can be an important part of a leader’s suite of tools for assessing progress and choosing priorities.
Systemic maturity model for human systems
Some maturity models follow only one dimension or process3, but a human systemsmaturity model will have significant additions:
• First, a systemic maturity model combines multiple related dimensions or processes and the maturity level of each, providing a way to assess each in relation to the whole. This allows a strategic approach to evolve from a population perspective to a whole systems perspective.
• Second, systemic maturity models honour the reality that, to assure its ongoing resilience, a system must continuously adapt in response to changing demands of its environment. To achieve balanced growth and resilience, each dimension or process within a human system must learn from experience and imbed that learning in successive stages, but in a way that supports rather than impairs or neutralizes other dimensions.
• Third, a systemic maturity model acknowledges that participants are not all at the top level in every dimension. Rather than the mirage of perfection with both commitments and goalposts in the distant and unaccountable future, a maturity model shows where specific immediate improvements can be made—the next step or the adjacent possible.
• Fourth, a systemic maturity model can provide the needed, constant reminder of the operational requirements for making a shift in worldview and archetypal narrative – for example an evolution from illness-oriented systems to integrated illness and wellness-oriented systems.
• Finally, human systems are not islands. The seamless interaction between systems is increasingly a core aspect of a client, patient or student’s experience and successful outcome, and critical to achieving a seamless client/patient journey. So, a systemic maturity model must include competence at inter-system as well as interorganizationand interpersonal collaboration, and must include ways for systems to create common understanding of their shared experience among all members of all systems.
Presented as a dashboard or scorecard, a systemic maturity model can provide a powerful communication tool for multiple audiences, and thus a potentially valuable change management and governance tool. Multiple organizations using the same 3 The capability based maturity model is a recognized type of maturity model, though its stages may not include one for adapting and moving to the next developmental stage. 3maturity model can identify their individual contribution in the context of the combined ability to create their common outcome.
An example of a systemic maturity model for a human system
The authors present their experience with ACMHI – the Alberta Campus Mental Health Innovation initiative to improve post-secondary student mental health. An innovation project funded by the Alberta government from 2013 – 2017, ACMHI enabled a student leader organization to stimulate action of student associations on 14 small to medium size post- secondary institutions. The authors were contracted to develop Legacy Tools,including a systemic, Mentally Healthy Campus Maturity Model, that would enable future student leaders to build on the work and learnings of student associations during this initiative. These Legacy Tools also helped student leaders make their case for incorporating student-led initiatives in a province-wide Post-Secondary Student Mental Health strategy.
Student leaders directed that the Legacy Tools embody two key design principles – a wellness orientation and a mentally healthy campus frame. This paper describes the form and elements of the systemic maturity model, operationalizing it for three levels of user capability as well as potential applications to other societal challenges needing systemic design approaches. Keywords
• health and population wellness
• systemic integrated wellness and illness oriented strategy
• mentally healthy campus
• leadership tools for inter-organization, inter-system collaboration and adaptation
• public sector innovation
• systemic design and assessing progress
• practice case


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