Reimagining Chorus: An innovation program to re-design community services

Opportunity

Since COVID-19, feelings of social isolation, loneliness and disconnection have increasingly been the focus of discussions on mental health and wellbeing [1]. However, this trend was also evident prior to the pandemic.

In 2016, a quarter of Australian households consisted of people living by themselves [4]. Feelings of loneliness are not caused by being alone, however they do tend to be more prevalent in people who live alone [3].

As people age, active engagement in the community also tends to decrease. In 2018, 33 per cent of older Australians had not participated in a recreational activity away from their home in the past year and 37 per cent had not had regular weekly contact with people outside their household [5].

People experiencing disability are also less likely to be engaged and connected. When compared with people who did not have a disability, those with a disability were less likely to have had daily face-to-face contact with family or friends living outside the household (16 per cent compared with 20 per cent) [6].

As human beings, social connectedness is fundamental to our physical and mental health. In the short term, connecting with our friends and community and participating in enjoyable activities triggers the brain to release hormones like dopamine and oxytocin. Evidence shows that people who live in connected neighbourhoods, who contribute to and are acknowledged by those neighbourhoods, are happier and less likely to make use of public services such as hospitals, nursing homes and the justice system [5, 7].

Inspired by successful international models of holistic, community focussed health care, Chorus realised there was an opportunity to discover a new service model that works in a WA context. However, fostering connection is more complex than many assume with many ‘common sense treatments’ having been proven ineffective [8]. Operating across aged care, disability and mental health sectors, their vision for Chorus 2.0 was a “fresh approach to community service” which strengthens connections and delivers essential support in a hyper-local setting, rebuilding social capital one neighbourhood at a time.

Approach

To identify new support models, programs and structures which overcome social isolation by enabling people to establish meaningful connections with like-minded people, Chorus established an Innovation Lab. The Lab was co-located at a Chorus community centre in the City of Melville, with the City providing additional support to the project with expanded access to workspaces for low cost and other links into the City’s networks.

A Lab team was established for the duration of the initiative, comprising a specialist innovation Advisory Lead, experts with specialist sector knowledge, Learning Coaches and Facilitators, a co-designer to design and capture experiments and a storyteller to share developments.

For short periods (3-12 weeks), experiment teams were brought together, comprising Chorus employees and volunteers, customers and community members and other partners and stakeholders. Over a nine-month period these teams participated in iterative co-design sessions to design, test and assess multiple innovations that leveraged transformational change to improve outcomes for older people, people with disability, and people with mental health needs.

Topics to be explored were:

• Practices: what practices or methods of relationship-building that enable Chorus staff, volunteers and customers to nurture connection, contribution and belonging?
• Platforms: how can knowledge-building, knowledge-sharing, and communication platforms support local networks of care?
• People: what roles and team structures are required to enable Chorus to deliver the Fresh Approach and catalyse local connections?
• Programming: what community activities bring Chorus customers and other local people together around shared interests?
• Place: how can a physical location provide a base for local engagement with customers and communities and provide a focal point for community-building?

The activities were focussed in Bull Creek, where the organisation had existing relationships with people and had identified potential community partners, including the local shopping centre and library.

Impacts and outcomes

Through the Innovation Lab, Chorus aimed to gain a deeper understanding of how community connectivity could be fostered, and a strengthened knowledge to inform initiatives to be trialled in the community.

The team uncovered three key findings through their explorations in the Lab:

1. Local teams are needed, and practice needs to be highly relational.
   
   In order to increase the time and energy spent working with people, their families and their communities, Chorus had to identify ways to reduce the amount of time spent on administration and reporting. The organisation began to decentralise its organisational structure to create an environment where kindness and connectivity could flourish.
   
   Prior to the rollout of localised, relational teams, front line workers reported feeling disconnected and isolated; “I have great relationships with customers, but I would like to get to know my team better”. During the trial of work practices aimed at building peer support, belonging and connection within the organisation – support workers who participated reported an increase in their responses to ‘I feel supported when I have a problem at work’ and ‘my job is enjoyable’. Another worker reported they enjoyed connecting with “peers who get what I’m going through”. The 2021 redesign of Chorus into 20 Local teams was built around this feedback.
   
   
2. Community connection is best done at a neighbourhood level and requires investment in “weaving”.
   
   This finding led to an innovative project born in response to COVID-19; to better understand individuals’ appetite to connect with their neighbours Chorus trialled a ‘Street Teams’ initiative.
   
   The Chorus Fresh Approach team put the call out to the community of Bull Creek to form networks on their street with ‘Street Teams’ supporting them to create and sustain connections that would contribute to the wellbeing of people through the COVID experience. ‘Street Teams’ was designed to activate networks of care at a street level, simultaneously supporting the residents of Bull Creek through an unprecedented time, but also allowing Chorus to understand how best to work in partnership with communities at a street-sized geography.
   
   Sixty-six people in Bull Creek registered, encompassing approximately 460 households within the potential reach for their Street Team. The Fresh Approach team delivered over 20 subsidiary tests within the rollout of the ‘Street Teams’ experiment, testing ideas on how to stimulate community uptake and ways to capture information about connections formed. One test aimed to grow local connections for four residents. Prior to the test, the participants reported on the number of local connections they had on their street. Numbers ranged from two -12 households. Following the trial, participating residents had met over 100 of their neighbours.
   
   Experimenting in this way has resulted in a repeatable service blueprint for the initiative and allowed the team to build a rich database of Bull Creek community members to inform future work.
   
   “I think it’s awesome! We've got people from all down the street, all ages.  They’ve made some new connections but also cemented some older ones. It’s really good that they touch base, so they can wave to each other on the street and help each other out if they need to.”  Street Teams participant
   
   
3. The need to connect elements of the “(formal) care ecosystem”.
   
   Chorus leadership tested the potential of the care ecosystem in Bull Creek, including hospitals, nursing homes, GPs, private health insurance allied health, pharmacies, local government, other providers, shopping centres and other community assets. This consultation revealed good alignment of intent, concrete examples of operational connection (e.g. between hospital and home care) and even revealed potential funding sources which could supplement Chorus’s core service delivery.
   
   A key output of the Innovation Lab has been the production of the Fresh Approach Tool Kit, developed from 10 months of learning, experimentation and co-design with Chorus people and community members. The Tool Kit turns this research into tools and practices that can be used to implement a more relational, localised approach to community services. The Tool Kit itself functions as a repository of activities which can be used to design a work program.

What worked  

Evidence gives confidence

The design process that underpinned the work enabled the organisation to feel confident that the output (the Tool Kit) was informed by evidence-driven insights and therefore, when implemented, has optimal potential for successful take-up.

A local, physical setting creates opportunity for the community to connect

Establishing a ‘home base’ for the project within the community helped create an accessible touchpoint for relationship building with beneficiaries.

Allowing beneficiary needs to shape the program of work ensured buy-in

The willingness of the team to adapt logistics and approaches to meet the appetite of the community allowed for increased levels of participation and engagement as the work program evolved.

Key challenges

Visionary transformation requires changes to everyday operations, which can be more complex than anticipated

While the Big Picture and vision is important to enthuse and engage the entire team in a transformation as big as Chorus’ ‘Fresh Approach,’ attention must be paid to the day-to-day pieces of the puzzle. Pay systems, staff onboarding, even the definition of a manager’s role can be upended when restructuring, creating blockers to the project’s progression.

REFERENCES

1. Australian Institute of Health Welfare, Social isolation and loneliness. 2021, Australian Institute of Health Welfare: Canberra.
   
   
2. Baker, D., All the lonely people: Loneliness in Australia, 2001-2009. 2012, The Australian Institute.
   
   
3. Kelly, J.-F., et al., Social Cities. 2012, Grattan Institute: Melbourne.
   
   
4. Qu, L., Australian Families Then & Now: Household and Families. 2020, Australian Institute of Family Studies.
   
   
5. Saeri, A.K., et al., Social connectedness improves public mental health: Investigating bidirectional relationships in the New Zealand attitudes and values survey. Australian & New Zealand Journal of Psychiatry, 2018. 52(4): p. 365-374.
   
   
6. Australian Bureau of Statistics, General Social Survey. 2014.
   
   
7. Kemp, A.H., J.A. Arias, and Z. Fisher, Social ties, health and wellbeing: a literature review and model. Neuroscience and social science, 2017: p. 397-427.
   
   
8. Cacioppo, J.T. and S. Cacioppo, The growing problem of loneliness. The Lancet, 2018. 391(10119): p. 426.