Innovation in healthcare and independent living is an economic and social necessity. Spending on health already exceeds 10% of French GDP (9% in the United Kingdom and 17% in the United States), without any prospect of stabilization, while public healthcare budgets are in deficit (13 billion euros in 2015 for France).

Vulnerable individuals, the number of whom has increased as a result of the critical economic situation, also have worse health¹.

This calls for the industry to design attractive and affordable solutions to address new public health problems.

In recent years, a variety of initiatives aimed at closing the gap between the technological potential to resolve the problems experienced on a daily basis by ordinary citizens, and the professionals working in the relevant sectors, have emerged. Brought about, depending on the circumstances, by technological laboratories, health institutions, and economic development agencies and associations, they sometimes result in Living Labs, which reach out to and engage with future users in “real-life” settings.

Living Labs bring together (i) industrial players keen to integrate new use values into their offerings and focusing as much on the change needed in the sector as on their own business success, (ii) investors to support the development of such offerings and (iii) future users.

This co-design approach is a recent development but is enjoying considerable success. It is currently supported by several hundred Living Labs worldwide, a significant percentage of which are in the healthcare and independent living field.

Living Labs remain complex, low-visibility and misunderstood structures. Resulting from local, public, private or combined initiatives, using small numbers of staff, responding to very diverse needs, seeking to gain advantage from new relationships between man and technology, specifically the digital world, Living Labs are strange newcomers in the innovation ecosystem.

Further downstream and closer to demand than competitiveness clusters, less linked to the institutional world than economic development agencies, they are aimed at all sorts of undertaking: accelerators and incubators, but also SMEs and large groups.

Feedback from the Forum LLSA (see Box I.1) validates the triple origin of the Living Labs in healthcare and independent living – LLSA: open innovation, participative design and social innovation. The results shown below are the fruit of collective feedback from the LLSA taken over a year by the Forum LLSA, which forms the network. Based on 20 testimonials from the field, over the course of nine meetings that included 30 people with diverse perspectives, the results show that:

• – LLSAs are multipartner and part of an open innovation approach. Such an approach makes the company more innovative by sharing ideas and expertise and importing third-party resources;
• – LLSAs involve design with and by the future user, often very early on in the process, which helps the company reach its target market better and increases the value of the future product;
• – this recent trend meets growing demand from ordinary citizens for greater autonomy and recognition. Although the way in which users are solicited as part of design processes is usually passive or strictly circumscribed, LLSAs engage in a co-design process embracing a social innovation dynamic that fosters both ordinary citizen and professional involvement.

The birth of the Living Lab concept³ can be dated back to around 1998, at the Massachusetts Institute of Technology (MIT) in the United States. It owes its roots, to put it simply, to two strands of research on innovation crossing:

• – participative design – Participatory Design or “co-design”⁴ – created in Scandinavia during the 1960s and theorized by Von Hippel in the 1980s with design driven by lead users;
• – open innovation, emerging in the 1970s in the United States.

The concept has its source in the development of Web 2.0, and its capacity to extend co-design to a large population of users, especially for information and communication technology (ICT) solutions and interactive systems in a broad sense.

The European Network of Living Labs (ENoLL) initiative appears to be a major event in spreading the concept of the Living Lab, first in Europe, but also in the rest of the world. This initiative was created in 2006, and 2007 saw the first wave of ENoLL branding.

Among the many available definitions, we suggest the following, relatively complete and coherent with the Forum LLSA experience.

DEFINITION.– A Living Lab is a consultation mechanism bringing together public and private actors, businesses, professionals, funding bodies, associations and users in order to design, collectively, innovative solutions in technology, organization and services supporting new responses for communities and society, and evaluating them.

Yet, the concept could become a victim of its own success. In fact, the social dimension of this new form of participation, the slightly restrictive form of existing labeling processes, the absence of a metric to define Living Labs and the bottom up nature of the initiatives have led to an abundance of issues: several hundred Living Labs have been branded, but there is probably an equivalent number of structures using this name, but without a clear link to a known benchmark.

We need to understand that the approach requires much more than various work meetings with experiences of using the equipment installed in a space resembling a living space. The founding characteristics of Living Labs are in fact developing and assuring the economic value of a solution by mobilizing the ecosystem concerned as early as possible, in its complexity, and especially its coproducers, as well as end users.

This book therefore aims to correct this drift, specifically in the healthcare and independent living sector. It does this in an original fashion in the sense that:

• – it uses effective Living Lab practices from the sector as benchmarks;
• – the testimonies reported have been provided by Living Lab holders themselves, who have spent a year discussing practices within a dedicated working group;
• – the contribution of the academic world has taken the form of comparisons taken from different scholarly fields. This intervention only took place at the end of the process, and with the aim of creating balance and symmetry between the contribution values and between practitioners and those who help to reflect on these practices (schematic division, of course, the roles in fact being much less separate).

Such an exercise could only be carried out in the context of confidence and sharing between Living Lab structures and their partners, exactly that implemented more than 4 years ago by what became the Forum LLSA⁵.

It was also necessary to ensure that a number of participants in the group were compatible with the target objective of listening on the ground: indeed, the forum counts 30 Living Labs, which form a sufficiently large starting point. All requests to participate could be accepted. As a result, the present book is limited only to the field of healthcare and independent living. Another reason for this restriction in sector is a shared understanding among the participants in their application context, which facilitates group work.

However, many lessons gathered in this book are without doubt usable in sectors other than those of healthcare and independent living.

Its ambition is very high. In fact, legal structures, the targeted public, the technologies mastered, the academic fields involved and the LLSA’s methods are extremely diverse, while the concept remains vague. The implementation of the network within the forum is a national feature for which France is envied. However, a synthesis of practices seems initially incompatible with the fundamentally creative, diversified and changing character of the LLSAs’ modes of performance.

This work shows that it is nevertheless possible to distinguish shared outlines in LLSAs’ practices, which make it possible to give them greater visibility without, however, erasing their differences and still less making one think that it would be possible to standardize them.

This transparency is essential for LLSAs to contribute to those who will call upon practices in co-design helping to develop them, as much those in industry as actors in healthcare and independent living. The key is the products and services that find a market, and thus sustain both efficiency in public health and competitiveness among businesses. This transparency is shared with the two populations of readers at whom this book is aimed:

• – those within the forum, i.e. those who are members, as the work carried out gives an image of the whole community in what it brings together and makes it possible to unite everyone’s efforts. But these constants also leave everyone with the possibility of differentiating themselves, and this diversity is responsible for the forum’s prosperity. The growth in the number of members of Living Labs in the healthcare and independent living forum is in double figures. Henceforth, the book also has the virtue of being a learning opportunity for those who are currently living the first steps of a LL or those who are already forming before declaring themselves as LLs;
• – outside the forum, to all those who have an interest in or appetite for open innovation in health. The style used aims to speak in a structured way and with a discourse, which is meant to be accessible to the largest number, about the missions, methods and results acquired by Living Labs in healthcare and independent living.

There is no need to be an expert to understand the rest. Easy comprehension of the goal of a Living Lab, grasping the fields for intervention and its potential value added, forms part of the obligatory communication exercise that each Living Lab has to carry out if it wants to reach its target users. The book takes this ability to the level of the network and does so while trying to retain its better properties in the act of communication. Citizens worried about their health, professionals from the world of health, digital technology providers, actors in public authorities, etc., the list of those who operate within the innovation ecosystem in health is long. Their curiosity will probably be piqued by this book; in any case, that is its aim. And it is also its active role, with a wish to change our relationship to health in the future.

This book is divided into four parts as follows:

• – Part 1 tackles co-design in the dynamic of innovation projects, the implementation of these projects by industry, users’ conditions of involvement and methods of collaborations with Living Labs. These aspects relate to the governance of Living Labs themselves and their role in resolving tensions between diverse stakeholders. This part finally mentions the different levels of involvement observed among industrial actors in their collaboration with the Living Labs that they seek.
• – Part 2 focuses more specifically on co-design as a creative and participative practice, aiming to refine or develop a solution. It presents methodological approaches put into practice by Living Labs. These arise from different academic fields (ergonomics, ethnography and design) that sometimes have a tense relationship in the academic sphere. These approaches are applied in diverse contexts and with diverse perspectives (hospitals, homes, individuals who are sick, frail or who have disabilities, or are simply concerned about their health and care as future users). These characteristics explain the great variety of practices seen.
• – Part 3 gathers together observations, criticisms and the reflections of researchers taken from diverse horizons and academic domains. These, occasional participants in the group for the most part, share accumulated material on which the two previous parts are based to suggest new paths in the form of useful references and indications of paths for further research or progress. These elements have been presented, discussed and negotiated in groups during specific sessions.
• – Part 4 discusses some structural elements resulting from group work to promote transparency in the LLSAs, their proposals and practices. Far from aiming to harmonize them, which would go against their vocation as innovation structures, this framework gives some keys for understanding and explaining the differences between Living Labs. This should enable actors in the market to find the Living Lab adapted to their needs more easily.

The “stories from the field” from which these analyses are taken are the subject of a separate book: [PIC 17]. In it the projects lived within the Living Labs are presented. This book thus reveals precisely the implementation of different methods and practices for creative and participative co-design described in the second part. These are concrete cases from real life, where we see the implication and articulation of different stakeholders in each of these projects.