Municipality of Holstebro, Denmark > The Good Kitchen:
How an Improved Food Service Creates a
Better Life Quality for Elderly People

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2) Normal cases:
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3) Stories with validated data:
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In autumn 2007 the Danish innovation and design agency Hatch & Bloom was assigned to design a new meal service for The Municipality of Holstebro. Six month later the idea for The Good Kitchen was created. Thus the way was cleared for a new type of meal service in Denmark, a meal service with more quality, more flexibility and more freedom of choice.

The Danes, like citizens in most developed countries, recognize that the aging of their population presents many challenges. One of these is serving the more than 125,000 senior citizens who rely on government-sponsored meals. Danish municipalities deliver subsidized meals to people who suffer from a reduced ability to function, due to illness, age, or other conditions. Many of the seniors have nutritional challenges and a poor quality of life because they simply do not eat enough. In fact, it is estimated that 60% of Denmark’s seniors in assisted living facilities or residential care units have poor nutrition, and 20% are actually malnourished. The result is both health problems and a low quality of life for the elderly and a greater economic burden on the government. The problem only looks to intensify as the number of senior citizens grows and future generations of seniors expect greater choice and better service.

In response to this growing social problem, the Municipality of Holstebro applied for an innovative program, offered through the Danish Enterprise and Construction Authority, that provides funding to municipalities and facilitates partnerships between those municipalities and Danish design firms. The firm Hatch & Bloom signed on to be part of the effort to improve meal service for seniors. Innovation director Lotte Lyngsted Jepsen led the effort over the next 6 months.

As Lotte recalled it, both Holstebro officials and the leaders of the Hospitable Food Service (Holstebro’s meal preparation and delivery organization) saw the project as straightforward at its outset: the current menu just needed some updating. In their view, they already offered high-quality food and service, so the Hatch & Bloom team’s role would be to ask elderly clients about their menu preferences. As the project progressed, however, this view shifted. The result was the design of a wholly new meal service that offered higher quality, more flexibility, and increased choice. This dramatic reframing of the opportunity emerged from the user-centered design approach that Hatch & Bloom brought to the process.

 

Design Tool: Ethnography in Social Services

We find the ethnographic focus of design thinking to be especially powerful in the social services sector. Despite the best intentions, when leaders of agencies that serve the indigent or the elderly base solutions on their own views of the needs and wants of those clients, the quality of the solutions suffers. We simply cannot be sure that we understand the details of their lives, when we don’t observe and ask.

 

Ethnographic Research: Learning to See What is?

The Hatch & Bloom team began by digging deep into seniors’ behaviors, needs and wishes, using a comprehensive ethnographic-based research process that focused on identifying their current situation and unarticulated needs. Team members rode with food service employees who delivered the meals to the elderly clients, accompanied them into the homes and watched as clients prepared the food, added ingredients, set the table, and ate the meal. In addition to observing current customers, they studied those who had discontinued the service as well as people close to retirement age who might soon qualify for the subsidized meals.

They also interviewed the supervisor of the food preparation process in her workplace. What they saw in the kitchen surprised them. “The people who worked in the kitchen were a major factor that needed to be addressed,” Lotte told us. “We realized only by being there that the atmosphere was not what we would expect to find if the food service was as good as they said it was. Instead of just asking the elderly clients what they would like, we would have to ask the people who worked with the food as well.”

Working in a public service kitchen was a low-status job in Denmark. In addition, there had recently been negative press about poor or even old food being served in such kitchens. “There was a general perception that the people who worked in these public kitchens didn’t know how to cook and were sloppy, and that the kitchens were dirty and so on,” Lotte explained. “We found that the kitchen staff was sick and tired of being told that they should do something differently. But nobody ever asked them how they would like to do things differently.”

It was not going to be enough to focus on the needs of the consumers, team members realized; they would need to address the problems of the employees producing the meals as well. The team decided to broaden the scope of the project beyond just improving menus, and helped the government clients to understand why this was necessary. As a result, the Hatch & Bloom researchers also conducted interviews with and observed the kitchen workers, outlining their needs and work processes. From this dual focus—on the people preparing the meals and on the seniors receiving them—a set of interesting findings began to emerge.

 

Design Challenge: Changing Scope

When we set out to explore an opportunity, we often find that our initial scoping of the issue was flawed. Here a problem that we thought had an obvious solution – whether that be an updated menu or a better search software – actually required the redesign of an entire experience. It’s not easy to reframe an issue or problem. But it can help to think of the initial scope of the project as a hypothesis that you must revisit and refine along the way. Keep in mind – this does not indicate a mistake in our early scoping; it is a sign of important learning.

 

Understanding Kitchen Employees

As the research team observed kitchen employees and interviewed them about their jobs, they were surprised to find that one of the workers’ major frustrations was that they were not empowered to do what they loved. They had chosen to work with food because they enjoyed creating things out of food, but they were forced to prepare the same food from the same menu month after month. The decision to use one menu for three months made sense from an operational logistics point of view, but it was terribly corrosive to the morale, motivation, and commitment of the kitchen employees, and, the team learned, it wasn’t good for customers, either.

During the interviews, another important thing happened: The kitchen employees realized that someone was listening and trying to help. Catering officer Birgit Jespersen noted that this generated tremendous goodwill for the project. “At first, we were a little skeptical, but the project was handled in a good way,” she said. “The designers and management listened to us, and everyone’s opinions and ideas carried equal weight.”

The more the team from Hatch & Bloom got to know the kitchen employees, the more it became apparent that this was a skilled workforce. Public perception and reality were quite different. The workers were making boring, low-cost meals because of perceived economic and logistical constraints, not because they faced a skills gap.

 

Understanding Seniors

The seniors receiving meals also suffered from feelings of disconnection and stigma, the Hatch & Bloom team learned in interviews with them. The social stigma of even having to receive such assistance weighed heavily: Help for cleaning was considered acceptable in Danish culture, but help for more personal needs was much less so. It also mattered who was providing the help. In Denmark a senior hoped to receive it from a relative or a friend. If that was not possible, one would perhaps hire someone. The last resort was to receive assistance from the government.

Also very painful to seniors was the loss of control over their food choices. “We discovered that deciding what kind of food they put in their mouths was the second most important thing for the elderly, after taking care of their personal hygiene,” Lotte explained. Furthermore, they often disliked eating alone because it reminded them that their families were no longer around. All these factors, Lotte pointed out, were linked to the underlying problem: “The less you enjoy the situation, the smaller your appetite.”

On a more positive note, the team also discovered that this generation of seniors was very responsible and capable in the kitchen and had a keen sense of the seasons and positive associations with seasonal food, such as apples in the fall and strawberries in summer. They also often tried to customize their meals by adding spices or using their own potatoes or vegetables.

As Hatch & Bloom began integrating what they had learned from both seniors and kitchen employees, the news was good. Lotte explained:

A lot of the findings in the kitchen actually worked very well with the findings from the users. So, for instance, the fact that it’s incredibly boring to choose from the same menu three months in a row: That’s a typical leader’s decision because it makes logistics easier. You can buy more of the same food at one time, and so forth. But it’s not a chef’s decision, and it’s not a user’s decision, either.

 

 Stakeholder Workshops: Hatching & Blooming

Once team members had finished their ethnographic research, they moved to enlist a broader group of stakeholders in understanding the nature of the challenges and participating in creating solutions. The goal was to solicit a wide range of ideas for developing a new and better meal service. To accomplish this, they held a series of three workshops.

The first workshop brought together municipality officials, volunteers, experts in elderly issues, kitchen workers, and employees of residential care centers. This group of roughly 25 people gathered for the first daylong workshop to review the ethnographic research and develop insights that would later facilitate the creation of innovative ideas when they transitioned from What is? to What if?.

The Hatch & Bloom facilitators began by serving food from the actual kitchen to give participants an experience similar to that of the customers. As Lotte noted, “A lot of the politicians who talk about this food had never eaten it themselves.” The researchers also presented their findings. The purpose of the workshop was strategic: to build awareness of the issue and a shared vantage point as the group proceeded to address it. No solutions were discussed yet.

 

Design Tool: Co-Creation in Social Services

As with ethnography (and for many of the same reasons), co-creation is especially powerful in social service projects. This has to do in large part with the complexity of the stakeholder network. Unlike business, where we often find a single decision maker, social service projects generally involve multiple decision makers, each of whom must support a proposed solution. Enlisting them in the design of solutions is both more effective and even more efficient under these circumstances.

During the second workshop, facilitators and participants used a mind mapping approach, first grouping the key findings and observations gathered during the What is? process into categories—for instance, the delivery of the food or the composition of the menu. They then delved further, exploring what insights flowed from each of these clusters and what these might indicate were the design criteria to best describe what an ideal solution might look like. They then moved into What if? and began generating ideas. Facilitators used analogies as trigger questions to help shift participants’ mental models of food service. The facilitators asked participants to think of the kitchen as a restaurant, triggering a creative rush. “Just the fact that they had to relate to them first being a restaurant instead of being a public service kitchen, kind of changed their perception completely,” Lotte explained as she described her experience of the effect of introducing the analogy, “Because they said ‘okay, but then we must be chefs. And if we’re the chefs, who are the waiters?’”

 

Design Tool: Trigger Questions

Trigger questions provide structure and inspiration for the brainstorming process. The infamous “What are ten uses for a safety pin?” type of trigger question has done much to giving brainstorming a bad name among managers. Truly useful trigger questions help people think more creatively about future possibilities by giving them something specific to work with. Questions often involve the use of analogies, as with our example in this chapter: “What if this public-service food-delivery organization were a restaurant?”

The third workshop, which was much more hands-on, moved into the What wows? phase, involving prototyping their co-created solutions and began testing them. For example, Hatch & Bloom worked with participants on three different versions of the menu and asked them which they liked and how they felt about various aspects, such as which colors they favored and whether they preferred photos or illustrations.

 

Hatch & Bloom had invited a well-known chef to observe the kitchen in action and then to attend the workshop. He was surprised, he told the participants, by the kitchen workers’ skills: They were almost at the level of professional chefs. But they had different results he argued, which was because of their different focus, not a lack of skill. As they prepared meals, the kitchen employees concentrated on maximizing economy rather than food styling or seasoning or other aspects that professional chefs would focus on. Being compared with chefs shocked the people who worked in the kitchens. It also boosted their confidence and sparked an increased passion for the project because they were being told that they were actually good at something.

The workshop participants continued working with the restaurant analogy as they considered the menus. Until that point, the menus had been minimalist factual descriptions of the food, perhaps detailing how it was prepared. For example, one item read, “liver, potatoes, and sauce.” “That is not exactly a description that will make your mouth water, “ Lotte pointed out, “They just printed these menus out and never gave a thought to how they should look. But now they wondered, ‘maybe they should look like actual menus; maybe we should describe our meals in a completely different way.’”

The group also began to focus on the fact that many of the vehicles used for meal delivery were in poor condition. “Some customers asked drivers to go down the street a bit because they were so embarrassed by the car,” Lotte told us. “They really thought the neighbors would think ‘Oh, now she’s having a funeral’ or something like that because the vehicle was really, really sad.”

 

Prototyping with Customers

Hatch & Bloom took the results from the workshops and moved into What works?, testing prototypes with different combinations and ways of presenting the food with the customers they had been observing since the beginning of the project. As before during their initial exploratory research during What is? , they didn’t test the prototypes only with current customers, but also with people who had stopped using the service and with younger people who were nearing retirement age.

The learning from this initial set of experiments resulted in a second project with some quick packaging design changes that allowed for more modular meals where the components were separated, instead of being mixed together. Lotte explained:

“Instead of having a tray where there’s potatoes or rice or pasta, and then there is some meat and some sauce and then there’s some vegetables, we implemented a solution where you pack these things separately so you don’t have to order potatoes if you prefer to do your own potatoes or if you prefer some kind of specific pasta or if you have some of your vegetables. So you can order potatoes and vegetables on the side but then you can mix what you prefer yourself instead of someone already deciding that for you.”

 

From Public-Sector Food-Service Employees to Restaurant Chefs

In order to change the negative kitchen culture at Hospitable Food Service, Hatch & Bloom then brought in a gourmet chef to work with employees. This generated more than a little nervousness among them. “Here was this really competent chef, and we were concerned that he might criticize us,” catering officer Birgit Jespersen recounted, “but he praised our food and said that we had a very high technical level. That was a real boost, and today we feel like chefs ourselves.”

The chef inspired the kitchen employees to introduce more seasonal ingredients and offered ideas for improving presentation. This has made a real difference. “Now we take the time to make an appealing presentation,” Birgit said. “We also are thinking more about colors. For example, we toss carrots with parsley to add some color to the tray. And we are putting an emphasis on seasoning the food well.”

Kitchen employees also received new uniforms that were much more “chef-like.” This was a symbol of their dignity and status, and it signaled a sense of pride and care to their customers as well. “The old uniforms were like nightgowns,” Lotte recalled. “They were very sad to look at, not aesthetically pleasing. Just by having these new uniforms, we gave them a level of authority they were not used to.”

 

From Hospitable Food Service to the Good Kitchen

The process of ethnographic observation, mind mapping, co-creating with stakeholders, and iterative prototyping and experimentation yielded a host of dramatic changes: a new menu, new uniforms for staff, a new feedback mechanism (we’ll get to that in a bit)—an overall new experience for both customers and employees. Employees’ images of themselves and the services they provided changed, and this itself seemed to improve customer satisfaction levels.

The process also yielded a new name: Hospitable Food Service became The Good Kitchen. “We wanted a name that internally and externally showed that the employees were committed to their work,” Lotte explained. “They were doing exactly what you would in your own kitchen, just on a bigger scale. So we changed the name; we changed the identity.” As Paul Sangill, the head of office in Holstebro’s Department of Health and Social Services, observed, “It’s an ambitious name, which was exactly what we wanted, and we are working hard to live up to the expectations.”

The new menu looked like a real restaurant menu. Instead of a list of dishes, it presented categories such as entrees, desserts, and so on. Items were also explained in greater detail. Paul Sangill described the new experience:

“We write about the ingredients in a way that gives the senior citizens a sense of tasting the food. Before we would write ‘fried calf’s liver with gravy, potatoes, and vegetables.’ Now we write ‘pan-fried liver with onions and gravy, potatoes tossed with thyme, and butter-roasted vegetables.’ We now have about 80 people a week choosing liver, where we used to have ten.”

Good Kitchen employees also made changes to the menu based on what they heard from seniors. For example, they learned that a lot of their clients were still very social, so they added a two-course guest menu. They also introduced individual snacks, such as pastries and chocolate, to enable seniors to adapt their meals to their lifestyles and behaviours.

In addition, at the request of customers and with the assistance of a consulting chef, The Good Kitchen began to offer high-quality additions. Some of these were inspired by the finding that the elderly clients had positive associations with foods that had been available, in their past, only at certain times of the year. The menu emphasized traditional dishes with familiar taste experiences but now included dishes such as “lemon spaghetti with mushrooms and parsley” and “soup with Jerusalem artichokes and grilled cockerel.” There was also a “weekly surprise,” which allowed for more creativity by Good Kitchen employees and greater variety for customers.

 

The Good Kitchen Becomes Part of the Family

Employees in the kitchen had not been accustomed to communicating with the people they served (this goes back to the “Who are the waiters?” question). The drivers who delivered the meals, who were all kitchen employees, would enter the seniors’ homes and leave without reflecting on what they saw. So the team developed simple comment cards that drivers began to carry with them and hand to customers, who wrote reviews of their meals and suggestions for how to prepare them. This immediate feedback enabled the staff to gain insights into the seniors’ thoughts and reactions to their food. The comments were read aloud at staff meetings and pinned up in a central kitchen location. The cards motivated employees and gave seniors the ability to influence their meals. Both groups loved the new feedback cards.

This direct contact was reinforced with indirect contact. For example, large photos from home visits were hung on the walls of the kitchen, bringing employees closer to their customers. The Good Kitchen also began publishing a newsletter that included posts from kitchen employees, information about and pictures of new hires, and other important events such as employees’ birthdays and the birth of a grandchild. This gave the elderly a better understanding of what happened in the kitchen and communicated that there were real people standing in front of the stove who took pride in what they did.

Today, Holstebro’s seniors “know who is shaping the meatballs and preparing the gravy in the municipal kitchen,” as Lotte described it. The relationship between the kitchen staff and the customers, which is both personal and professional, has increased the satisfaction of both. Lotte explained the benefit of this improved communication:

“It’s great that we’re in touch with the customers every week through the drivers who deliver the food. Many private companies would pay good money for that degree of customer contact, because it offers a unique opportunity to keep tabs on what’s important.”

 

Results: The Proof Is in the Pudding

Once the transformation from Hospitable Food Services to The Good Kitchen was complete, the results spoke for themselves. Reorganizing the menu and improving the descriptions of the meals drove a 500% increase in meal orders in the first week alone. Within three months, the number of customers had increased from 650 to 700.

One of the most important elements of the transformation has been the shift in employees’ perception of themselves and their work. Kitchen workers are now much more satisfied and motivated. As a result, customers are happier with their food. “If you have professional pride, you’ll also cook good food,” Anne Marie Nielsen, the director of The Good Kitchen, told us. “Good food has to come from the heart! This experience generated so much positive energy. We have received positive reactions from everywhere—from users and partners and colleagues in other municipalities.” Moreover, The Good Kitchen now receives many more unsolicited job applications as word of the improved reputation has spread.

The changes in mind-set were the most significant indicators of success to Lotte, but difficult to pinpoint precisely: “When you do this kind of culture-changing redesign of services, it is very challenging—are the results about our solutions? Or about me looking somebody in the eye and showing interest in their work?”

The Good Kitchen’s success was noticed outside of Holstebro as well. The Good Kitchen and Hatch & Bloom shared the Danish Design Prize for Service Design, as well as the Local Government Denmark Prize for Innovation in 2009.

 

What Do We Take Away from the Good Kitchen Story?

By identifying a public challenge to the health of seniors and a fiscal challenge to the state, and using an arsenal of design tools to address both, the Municipality of Holstebro dramatically improved the service experience and quality of life for both employees and customers. This project comes as close to providing a truly win-win solution as we are likely to find, transforming a vicious cycle of malnourished seniors, unhappy employees, and increased health care costs into a virtuous one with healthier, happier seniors (and employees) and improved costs to the state.

The learnings in this chapter are especially near and dear to us because they highlight design thinking’s ability to produce not just better business results but a better world for us all. So simple, so powerful, so inspiring—using design to change the world, not just make it pretty. But accomplishing this requires that we act in new ways:

 

Be willing to engage the entire system. It is worth noting that this chapter is as much about system design as it is about service design. It reminds us of a lesson that Peter Senge taught us long ago in The Fifth Discipline: Put the whole system in the room. In business, we have gotten much better about the customer part, but we still often neglect employees and communities. Design thinking gives us a detailed suggestion about what to do with the system once all parts of it are in the room: share the findings of the deep ethnographic exploration of the stakeholders we want to serve, build an aligned intent around making their lives better, and then invite everyone to derive insights, generate design criteria, and co-create solutions.

 

Be willing to redefine the problem. Even with the problem definition (much less the solution!), where you start is not where you should expect to end up. And that’s good news. You didn’t get it wrong– you learned. So many of our flawed solutions can be traced to having stuck with a limiting question. One of the most significant contributions of design is to help us live longer in the question. It is our willingness to revisit the question we asked at the outset that allows us to reframe the way we see the world and discover new possibilities. It allows us to end up in places that we never suspected at the beginning of the process. But doing this requires bravery, as Lotte reminded us:

If you use design thinking, you must realize that it might lead you to places you didn’t expect to end up. And if you have the courage to embrace that, you can go tremendously far and you can try out different methods and you can ask, ‘Do they work for me? Do they work for my organization?’ But that requires a certain level of courage and a willingness to change. If you’re not brave enough to face these consequences, and if you don’t have the mandate from your leaders, then it’s very difficult to do innovation. Innovation requires space—mental space and financial space and organizational space.

 

Design feedback into the solution so that you won’t have to fix big problems so often. Why do we spend so much time trying to create dramatic, wrenching change? Usually because we ignored the signals that would have allowed us to adapt more gradually.   If we build those signals into our design of the offering or service, the odds that we’ll see them before the crisis go way up. That is what those simple feedback cards do for The Good Kitchen. They create a seemingly mundane but very valuable ongoing conversation about daily hits and misses that helps employees get to know their stakeholders better along the way and greatly reduces the need for cataclysmic change later on.

 

Appreciate the awesome power of ethnography. We sound like a broken record by this point. But if you take only one thing from this book, this should be it. The story of The Good Kitchen reveals more powerfully than any other why this is true. Most of us reading this chapter are not now elderly (despite what our children think). Most of us can’t recall the sweet pleasure of having strawberries only in summer. We cannot really know what it means to lose, one by one, the freedoms the young and healthy take for granted: to choose our food, to control our personal hygiene, to be able to have dinner with those we care about. Without ethnography, we will not know these things until it is too late to improve the lives of the elderly. We’ll throw strawberries on everything all year long, wasting their ability to conjure up memories of summers past. We will dictate meal choices that are economical or that make sense to us, and package them in servings of one so that they can only be eaten alone. Without the deep insights produced by ethnography, how many opportunities to do something truly special for an elderly person—something that probably costs little or no additional money—will we fail to see?

We recall a Legal Aid attorney’s comments to us about the challenges that she and her colleagues faced in providing truly useful legal services to the poor: We are, and I will make a broad generalization here, ivory tower babies. We’re very privileged. We have telephones and good incomes. And we have transportation. We don’t face a lot of the problems that these clients are facing every day. And so we don’t understand what they go through. But at least design thinking gives us tools to help us try.

 

This case study is an adapted version of a book chapter that has originally been published as “Solving Problems with Design Thinking: Ten Stories of What Works” . It is republished here by courtesy of the authors.


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References

The Authors

Jeanne Liedtka

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1 Comment

  1. I really appreciate the initiatives taken by ‘Hatch and Bloom’ team to care about the elderly population in Denmark. A heart-felt thanks to ‘Hatch and Bloom’s team for their diligent approach in impacting the lives of senior citizens.

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