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8 May 2019 · cities · age-friendly

An innovation framework for age-friendly cities

As cities take on disruptive challenges, in particular harnessing technological disruptions and managing ageing populations (see earlier post about updating 'age-friendly' here), this note suggests a five-stage framework to guide cities along their innovation journey. It's designed to be more descriptive than prescriptive - each city will implement in its own way and in line with their other age-friendly priorities.

Five Stages for building an innovation agenda for age-friendly cities

Stage 1: Community Building

A broad-based interdisciplinary community of local people interested in innovation in ageing, made up of: older adults themselves, startups (separated from industry in general), industry, governments, investors and academics and NGOs / CBOs. Events are often the easiest, tangible steps to galvanize the community and create deadlines. An online-community enables the conversation to continue and people to share profiles and interests. Hubs & spaces provides year-round, visible gathering places, and offer an excellent opportunity to drive intergenerational engagement.

Events

In spite of the remarkable progress in video networking and virtual reality (or perhaps because of it) in-person meetings seem to have become more, not less, important. Physical meetings provide energy, inspiration and serendipitous connections outside of one’s echo chamber that algorithms and digital channels have not (yet) been able to match. Events can also serve as a deadline for a process and force consensus. There are now a myriad of events focused on innovation in ageing, some of which include:

Online community

While events come and go, a online stakeholder communities maintain connection during the gaps. An online community lowers the ‘acquisition costs’ of attracting attendees to one-off events and getting new initiatives up to speed. The goal is to support connection between different parts of the ecosystem, help determine key strategic priorities and support implementation. Examples include:

Hubs & spaces

While events gather people together for a focused day or two, an ‘hub’ for innovators in ageing provide a very visible and tangible platform to bring people together throughout the year. Intergenerational innovation hubs - those that bring together startups of all ages with older adults - are still more theory than reality but we expect to see the first examples launch in 2018. There are already many local hubs for seniors - across the US there are approximately 11,000 senior centers which act as local hubs and service providers, while PACE programs, pioneered by OnLok, provide a full set of services including healthcare for a capitated payment. Promising platforms that could become intergenerational innovation hubs include:

Stage 2: Prioritisation

An organic, bottom-up community needs to be focused on local priorities to be effective. The WHO age-friendly process has done this well - with strategic plans based on local consultation. Focus groups & consumer panels can be developed for specific companies or events. Living labs offer the ability to get longitudinal input over time while crowdsourcing virtualises this, enabling ideas to come from anywhere and be built on collaboratively. Finally, Challenges make a public call for innovation based on the agreed strategic priorities.

Focus Groups & Panels

Many innovators in ageing have been inspired by a grandparent, but need to engage a more representative group of older adults. Traditional consumer research, designed for deep-pocketed consumer goods’ companies, is generally not appropriate. Consumer panels are generally convened ad hoc in response to requests from specific companies.

Living labs & crowdsourcing

Living labs allow for ongoing immersion in daily lives. The European Network of Living Labs (ENOLL)FOOTNOTE: Footnote, define living labs as “user-centered, open innovation ecosystems based on systematic user co-creation approach, integrating research and innovation processes in real life communities and settings”. Examples include:

Living labs are generally small scale and the insights generally only available to that geography or project. An online crowdsourcing platform that capture ideas from older people and helps co-create new products is something that has been discussed among various organizations but not yet implemented at scale. There are similarities with corporate innovation platforms that seek expert input. The closest examples we’ve seen include:

Challenges

Challenges takes these priorities to the next level - by focusing on a subset of key topics and (often) issuing public calls for innovators to focus on specific priorities. Examples include:

Stage 3: Starting Up

This is where cities will face a big cultural challenge - thinking like a start up. Specifically, this is about low-cost testing of new concepts, an ‘agile’ approach (iterating with end users), embracing failure for the lessons it teaches and ‘pivoting’ when a new direction is needed. Pitch events & hackathons showcase local startups or spend a weekend developing new concepts. Pilots engage industry and government partners willing to try out (then scale) new ideas, while accelerators bring in investors to provide seed capital and mentorship specifically focused on startups.

Pitch events & hackathons

Hackathons bring tech coders together, usually over a weekend, to work on a specific problem, often with the end users themselves. Initially the preserve of geeks, hackathons have become a mainstream tool, adopted by companies large and small to focus on creating tangible concepts (e.g. after a weekend of coding) to strategic challenges. Case studies include:

Pilots

For startups landing a pilot with a potential customer is often considered a major victory, and when it all works out, can lead to validation of the concept, mutual fit and additional referrals and business. Unfortunately, all too often pilots don’t lead to a

Accelerators

Ask any entrepreneur in the ageing space what challenges they’re facing, and they’ll generally talk about access to consumer insights, distribution, business models and funding. Despite the large population and size of the ‘longevity economy’, which according to estimates by AARP and Oxford Economics accounts for up to half of US GDP, there is still a paucity of venture funding (apart from over $200m in home caregiving networks in recent years). Examples include:

Stage 4: Scaling Up

While starting up challenges cultures and norms, scaling up challenges entrenched business models and vendors and is therefore the most challenging. Moving from small scale tests and pilots to large scale implementation of promising ideas (that have political support) requires three things First, tech platforms that can integrate multiple services and scale. Second business models that connect healthcare savings with innovation activity and align incentives. And third capital & funding to support breakout startups so they can compete with established vendors.

Tech platforms

Language in this space can be confusing - communities, ecosystem and platforms can often be used interchangeably. While there may be a community around a tech platform (with tech developer communities being obvious examples) the two don’t have to overlap. Designing tech platforms for older adults is fraught with complexity, since it will need to include a comprehensive range of services (health, transport, financial services, media etc), stay with the individual into and out of a variety of settings (home, hospital, rehab, nursing home, hospice etc) and also be both attractive, simple and well-designed enough to not be stigmatized, yet functional and complex enough to connect with the health system and offer necessary security / features. Further, there are multiple gatekeepers (family members, senior living staff, local services providers) so the user is not necessarily the buyer, and there is not as year a scalable and accessible distribution channel direct to older people looking to stay independentFOOTNOTE: Footnote. There is no winning platform yet, but some approaches include:

Business models

Manchester is one of a growing number of cities in the UK that has taken over funding for the provision of local services, and manages its own social care and healthcare budgets. As such, they’re in a better position to ‘join the dots’ than many other cities which wouldn’t realize the full benefits for investing in non-medical interventions. ‘Closed systems’ align their input and outcomes.

One interesting type of innovation here, which aligns incentives among a disparate group of stakeholders, is the social impact bond (SIB). This is a financial instrument that allows a beneficiary (such as a government) to specify the social outcomes they’re looking for (such as a reduction in loneliness in a population) and commit to pay the service provider only if those results are achieved (and validated). The service provider can use this ‘bond’ to attract more risk-tolerant capital (such as from charities or impact investors) to pay the up-front costs of the new project, and provide a return to these investors once the project is a success. So far SIBs have mostly been used for prison recidivism and education, however a reduction in healthcare costs for ageing populations could show more immediate short-term benefits. Examples include:

Capital and funding

There are three main types of capital available for growing startups, venture, strategic and impact.

Stage 5: Impact Validation

Stage 5 is about measuring impact and ROI. Despite being the last stage it should be thought about before any implementation, along with the priorities, so necessary benchmarks are in place. Data sharing will be key - ensuring key data are available and interoperable. Benchmarking enables the ability to show progress over time and also compares the city with its peers, while Return on Investment (ROI) is the ultimate yardstick; which can be applied to at least four objectives: quality of life, healthcare costs, healthcare quality and economic growth.

Data sharing

Data sharing is a key step to enable cities to measure impact. Unfortunately, the trend in recent years has been for consolidation by the large technology players (in particular Google, Apple, Amazon and Facebook) who ‘own’ the data generated by users across their ecosystem, and so it can be hard to have a holistic view. Cities should be sure to engage partners that are willing to adopt a collaborative approach to sharing data, and look into emerging initiatives (such as ‘data philanthropy’) that recognize that residents’ data should be easily accessed and shared according to their preferences, and commercial organizations don’t develop unique control points.

Benchmarking

Benchmarks record the current state of before an intervention happens, and are therefore vital to be able to identify whether progress has been made. They can also be used to compare performance of cities with others. There are a number of city indices that have been developed to compare ‘best places to live and work’, with Milken Institute’s Best Cities for Successful Aging a thoughtful analysis of multiple factors that determine livability (although not innovation capacity).

Returns on Investment (ROI)

We can interpret ROI to broadly apply here - not just financial returns but all of the goals that were initially laid out for building the next generation of age-friendly environments:

Innovation In Action : Case Study - Resilient Cities

The Rockefeller Foundation’s Resilient Cities initiative is a $100m effort to support 100 cities with $1m grants to develop strategies (and employ Chief Resilience Officers).

Resilient Cities has engaged philanthropists and cities at scale and caught the imagination of city officials in way that should be inspiring to those seeking to ignite change around the ageing agenda.

Those looking to add innovation to age-friendly cities could learn from this approach and build on it in three ways. First, while all older people are different, there is likely more commonality in challenges around ageing than resilience (which can cover things as diverse as climate change, infrastructure and terrorism). Second, in many AFCCs the local priorities are already identified, so there is a good starting point. And third, the ageing space already has a track record of engaging volunteers which can lower costs to implement initiatives at scale.

Either way, there should be more collaboration and shared learnings across all these related initiatives so each new idea builds on the others, so that the local city officials, and their residents, benefit in turn.

Conclusion

Although the scale and speed of disruptive trends impacting our cities is unprecedented, there are multiple options and paths for bringing innovation into the age-friendly agenda. This will be familiar for some cities and unchartered territory for others. The next post fleshes out more details of the steps with examples / case studies from different active innovation projects around the world.

Thanks to the following for their insightful comments on earlier drafts: Graham Colclough, Alex Kalache, Stephanie Firestone, Eric Kihlstrom and Jordi Piera Jiménez.

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