Approach and method
We work in the space in between
What fails in care is almost never a resource. It is a relationship.
It is not the housing that fails: what fails is what happens between the person living in it and the person managing it. It is not the protocol: it is what happens between the worker applying it and the person it is applied to. It is not the diagnosis: it is the distance between what the clinic says and what a family understands. The breaking point is almost always in the bond, which is why neither a bigger budget nor more goodwill can repair it.
A failing relationship is not a matter of character. It is a technical problem. Relationships have structure —hierarchies, incentives, information asymmetries, unwritten rules, predictable biases, unevenly distributed burdens— and that structure can be studied, modelled, redesigned and measured. Doing so takes the same craft as any other infrastructure: wanting is not enough.
That is why this work is done by experts in social relations and behavioural scientists. Zainduz Cuidadanía acts as a technical connector: we translate between languages that do not understand each other and we build the systems —the agreements, the spaces, the protocols, the indicators— that stop a relationship from depending on somebody's goodwill and let it hold on its own.
The six seams
Six relationships, not six services. The points where a care system is stitched together or comes apart.
01
Health professionals and service users
Between the diagnosis and the biography
The clinic speaks in prognoses; people live in projects. We translate clinical judgement into decisions that fit a concrete life, and the biography —what someone wants to keep doing, with whom and for how long— into information a professional team can use. This is not a kind gesture: systematic reviews of shared decision making show that when people take part with structured support, their knowledge improves, their risk perception becomes more accurate and decisional conflict falls.
02
Families and the person, with their wishes, rhythms and power relations
Between wanting to care and being able to decide
No family is a neutral space. Affection, money, historical debts, gender divisions and expectations nobody has said out loud all circulate within it. Our work is to make explicit what is taken for granted —who decides, who carries the load, who pays, who has not been asked— and to give the person back authorship of their own plan. We do not mediate feelings: we organise decisions.
03
The community, the neighbourhood and private space
Between the front door and the street
A well-resolved home is worthless if the route to the bakery, the bank or the square is broken. We work the whole continuum —threshold, entrance, pavement, facilities, neighbourhood network— because autonomy does not live inside the house: it lives in the distance a person can cover without asking permission and without asking for help. Environmental gerontology framed it half a century ago: the less capacity a person has, the more the environment determines what they can do.
04
Private organisations, neighbourhoods and the needs of different groups
Between investment logic and the life that happens afterwards
Developers, operators, financial institutions and insurers decide today the conditions that will be inhabited for forty years. We translate the needs of specific groups into contractable technical specifications, and those specifications into demonstrable value: less turnover, fewer incidents, fewer disputes and a product that does not age badly. Something being socially fair and economically sensible is not a happy coincidence: it is a design outcome.
05
The community and public administration
Between what a neighbourhood knows and what an administration can process
Neighbourhood knowledge is precise, but it rarely arrives in a format an administrative file can accept. We build the missing vehicle: from shared diagnosis to tender specification, from specification to budget line, from budget line to the indicator that shows whether it worked. Public services that work are not produced for citizens but with them; research on coproduction has been showing this since the nineteen-seventies.
06
Public administration, service users and frontline workers
Between the written rule and the practised rule
A policy is approved in a council session, but it is truly defined in the corridor: in the decisions a worker makes every day with insufficient time and a margin of interpretation nobody has regulated. We build that practical knowledge into the design from the outset, so that what is written and what is done do not end up being two different systems. When it is ignored, the rule is not broken: it is reinvented on the fly, unrecorded and unchecked.
Working process
01Framing the brief
Clarifying objectives, boundaries, actors and context.
02Shared diagnosis
Active listening, data, social mapping and a reading of risks and opportunities.
03Co-design and agreements
Agreeing priorities, roles, responsibilities, spaces and decision criteria.
04Pilot or implementation
Testing and coordinating the design in a real context.
05Monitoring and adaptation
Incorporating changes, conflicts and learning.
06Evaluation and systematisation
Analysing results, impact, usefulness and transferability.
07Return and transfer
Creating guides, recommendations, training and contributions to public policy.
Working principles
Anticipation
Addressing decisions before urgency or crisis arrives, and supporting moments of change too.
Scientific rigour
Using hypotheses, data, indicators and evidence to improve the quality of decisions.
Autonomy
Recognising people as active subjects and incorporating the experience of those who use services and spaces.
Interdisciplinarity
Analysing behaviour, space, service, regulation, economics and governance together.
Attention to inequality
Considering age, gender, economic situation and other determinants when relevant.
Transfer
Documenting and evaluating experiences to turn them into tools adaptable to other contexts.
Why this is a craft, not a virtue
This position has a name in social research, and it has been studied for decades.
It has been called boundary spanning, the specific competence of those who work at the borders between organisations. Brokerage, the informational and creative advantage that appears precisely in the gaps between groups that do not talk to each other. Interactional expertise, the ability to speak the language of an expert community fluently without being part of it. And translation, the work of turning one group's interest into another's so that common action becomes possible.
These are four ways of naming the same thing: connecting is not a personal quality or a gesture of goodwill, but a technical competence that can be learned, practised and evaluated.
To that lens we add behavioural science, which supplies what is missing: concrete mechanisms to act on. We know that the default option determines much of what people end up choosing; that a three-step procedure and a one-step procedure produce different outcomes even when the entitlement is identical; that perceived social norms weigh more than information; and that scarcity —of time, money or support— narrows attention and worsens decisions exactly when they matter most. A well-designed relationship does not ask anyone to be a better person: it rearranges the context so that the reasonable option is also the easy one.
That is how we work, with method —hypotheses, data, indicators, piloting and evaluation— and we write it down. A well-connected system has to keep working once we leave.
Scientific basis
- Callon, M. (1986). Some Elements of a Sociology of Translation. En J. Law (ed.), Power, Action and Belief.
- Collins, H. y Evans, R. (2002). The Third Wave of Science Studies: Studies of Expertise and Experience. Social Studies of Science, 32(2).
- Burt, R. S. (2004). Structural Holes and Good Ideas. American Journal of Sociology, 110(2).
- Gould, R. y Fernandez, R. (1989). Structures of Mediation: A Formal Approach to Brokerage in Transaction Networks. Sociological Methodology, 19.
- Star, S. L. y Griesemer, J. (1989). Institutional Ecology, 'Translations' and Boundary Objects. Social Studies of Science, 19(3).
- Williams, P. (2002). The Competent Boundary Spanner. Public Administration, 80(1).
- Ostrom, E. (1996). Crossing the Great Divide: Coproduction, Synergy, and Development. World Development, 24(6).
- Lipsky, M. (1980). Street-Level Bureaucracy: Dilemmas of the Individual in Public Services.
- Lawton, M. P. y Nahemow, L. (1973). Ecology and the Aging Process.
- Mol, A. (2008). The Logic of Care: Health and the Problem of Patient Choice.
- Zelizer, V. (2005). The Purchase of Intimacy.
- Tronto, J. (1993). Moral Boundaries: A Political Argument for an Ethic of Care.
- Stacey, D. et al. Decision Aids for People Facing Health Treatment or Screening Decisions. Cochrane Database of Systematic Reviews.
- Johnson, E. J. y Goldstein, D. (2003). Do Defaults Save Lives? Science, 302(5649).
- Thaler, R. y Sunstein, C. (2008). Nudge: Improving Decisions About Health, Wealth and Happiness.
- Cialdini, R. et al. (2007). The Constructive, Destructive and Reconstructive Power of Social Norms. Psychological Science, 18(5).
- Mullainathan, S. y Shafir, E. (2013). Scarcity: Why Having Too Little Means So Much.
- Bourdieu, P. (1994). Raisons pratiques. Sur la théorie de l'action.
We are
- A cooperative providing technical and scientific advice on care architectures.
- A team applying behavioural science, social research and data analysis to practical decisions.
- A technical partner that designs, pilots and evaluates policies, spaces, services and organisational models.
- A flexible structure working with the public, private and community sectors.
We are not
- A provider of home help, residential care or direct healthcare.
- A studio that only resolves the built project, without the social dimension.
- A consultancy that delivers a report and disappears.
- A care service that decides on people's behalf.