An older woman in Mexico may need rehabilitation advice, assistance with daily activities, reliable transport and information about social support. Her daughter might begin by contacting a municipal DIF office, visit a healthcare facility, approach a community organization and return to another institution when the first cannot resolve the problem. Each contact may be appropriate within that organization's responsibilities, yet the family can still experience the overall journey as confusing and repetitive.
The difficulty is not necessarily that Mexico lacks organizations capable of providing assistance. It is that the connections between existing organizations may be difficult for residents to understand and navigate. Different eligibility arrangements, administrative responsibilities, funding sources and information systems can turn an ordinary request for help into several separate processes.
Within the wider Mexico Aging, Long-Term Care & Community Support Knowledge Hub, this raises an important question: can community care become more accessible by redesigning existing service pathways rather than creating another institutional layer?
The answer depends on how collaboration is organized. Mexico's federal structure, differentiated healthcare institutions, extensive DIF network and significant reliance on family support mean that integration cannot simply be declared through a new policy document or coordinating committee.
Effective redesign requires an understanding of who has authority, which services are genuinely available, how information moves between organizations and where responsibility sits when a person's needs remain unresolved.
This article examines how collaborative service redesign could simplify community care access in Mexico while preserving the institutional responsibilities, professional safeguards and public accountability necessary for reliable delivery.
Why service complexity persists despite existing institutional capacity
Mexico's community support landscape includes institutions with different histories, functions and legal responsibilities. Healthcare, social assistance, disability-related services, older people's programmes and community initiatives do not operate through one universally integrated administrative system.
Healthcare arrangements involve the Secretaría de Salud, social security institutions including the Instituto Mexicano del Seguro Social (IMSS) and the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), alongside services for people without employment-based social security coverage.
IMSS-Bienestar has an important role in healthcare provision for people without social security coverage in participating jurisdictions, although institutional arrangements and practical service availability must be understood within the relevant state.
Social assistance involves the Sistema Nacional para el Desarrollo Integral de la Familia (SNDIF), state DIF organizations and municipal DIF organizations, whose programmes and capacities vary.
The Instituto Nacional de las Personas Adultas Mayores (INAPAM) also contributes to the national landscape of older people's rights, participation and support.
Municipal governments, civil society organizations, private providers and community groups may deliver or facilitate additional forms of assistance.
These organizations cannot be treated as interchangeable. Their funding, eligibility requirements, professional responsibilities and legal powers differ.
A family may therefore encounter several legitimate institutional boundaries while trying to resolve what it experiences as one connected problem.
For example, a healthcare institution may address medical treatment without being responsible for ongoing household assistance. A municipal DIF organization may provide information or particular forms of social assistance without controlling healthcare appointments or federal benefit decisions.
A civil society organization may offer practical support but lack the resources or authority to accept every referral.
The central problem is not institutional specialization itself. Specialized organizations are often necessary to maintain professional competence and clear accountability.
The difficulty arises when people must independently interpret those boundaries, repeat information and discover whether one organization can connect them with another.
Service redesign should therefore distinguish between necessary institutional separation and avoidable administrative fragmentation.
Redesigning the person's journey rather than the institutional chart
Traditional organizational reform often begins with structures. Leaders consider new committees, revised reporting relationships or additional coordinating positions.
Such changes may be appropriate in particular circumstances, but they do not automatically improve the experience of residents.
A more productive starting point is to examine what happens when someone seeks assistance.
Where does the person first make contact? What information is requested? Who determines whether the request falls within the organization's responsibilities? What happens if another institution must become involved?
Most importantly, how does the person know whether the next stage has actually occurred?
These questions expose practical difficulties that may remain invisible in formal institutional descriptions.
A municipal office may record that it provided information. A healthcare facility may record that an appointment was offered. A community organization may record that a person attended an activity.
Each record can be accurate without establishing whether the individual's wider needs were resolved.
Redesigning the journey means examining the sequence of contacts and decisions rather than treating every organizational interaction as a separate achievement.
This approach connects with wider principles of system integration and multi-agency working, although the arrangements must reflect Mexico's actual institutional structure.
The aim should not be to create a single organization responsible for every aspect of care.
It should be to make existing responsibilities easier to understand and the connections between them more reliable.
That may involve clearer information, fewer repeated questions, improved referral arrangements and more consistent communication when assistance is unavailable.
The practical test is whether residents experience a simpler journey without organizations losing control over decisions they are legally responsible for making.
Mapping administrative friction before proposing solutions
Collaborative redesign should begin with evidence about where existing processes create unnecessary work.
Administrative friction can arise through duplicated forms, unclear referral requirements, repeated identity checks, inconsistent service information or uncertainty about which organization should respond.
Some requirements exist for legitimate reasons. Identity verification, eligibility assessment, consent and professional documentation may be necessary to protect public resources and individual rights.
Other requirements may persist because organizations have developed processes independently without considering the overall experience.
The distinction matters because simplification should remove unnecessary repetition, not weaken essential safeguards.
A practical review can follow a small number of common service journeys, such as an older person seeking community rehabilitation, a family requesting disability-related support or a caregiver trying to locate appropriate assistance.
For each journey, participating organizations can examine:
- How many separate contacts and visits the person is expected to make.
- Which information is requested repeatedly and why.
- Where eligibility or professional decisions are made.
- Whether referrals are acknowledged and followed through.
- What happens when the requested service is unavailable.
- Which delays arise from administrative processes rather than service capacity.
The resulting analysis should distinguish delays caused by paperwork from those caused by insufficient staff, facilities or funding.
Removing a form will not create a rehabilitation appointment where no professional capacity exists.
However, eliminating unnecessary visits and improving communication may reduce the time and expense families incur while seeking that appointment.
Organizations examining these questions can draw on the wider principles of intake, eligibility and triage design, while retaining the specific requirements of Mexican programmes and institutions.
Operational scenario: simplifying a rehabilitation referral in Puebla
Illustrative scenario — hypothetical, not an existing coordinated referral programme. An older resident in Puebla experiences reduced mobility following an illness. Her daughter contacts a municipal DIF office to ask about rehabilitation assistance.
The office provides information about possible services but cannot determine eligibility for treatment delivered by a separate healthcare institution.
The daughter contacts the relevant healthcare facility, which requests information already provided during the first enquiry. She is then advised that a professional assessment is required before an appropriate service pathway can be determined.
A proposed redesign begins by mapping the sequence of contacts rather than creating a new referral agency.
The municipal DIF organization and participating healthcare facility agree on a concise information guide explaining their respective responsibilities, the documents residents may need and the correct route for requesting assessment.
Staff receive guidance on what they can explain and which decisions remain with qualified healthcare professionals.
Where an appropriate lawful arrangement exists, the municipal office can help the resident make contact with the relevant service. It does not determine clinical priority or guarantee acceptance.
The organizations establish a limited method for identifying whether enquiries have reached the correct destination, subject to consent and applicable information protection requirements.
After implementation, staff examine the number of unnecessary repeat visits, common misunderstandings and unresolved enquiries.
The daughter still has to follow the healthcare institution's assessment process, but she receives accurate information earlier and avoids several unproductive contacts.
If the rehabilitation service lacks available appointments, that capacity problem is reported separately rather than presented as an administrative failure.
The redesign succeeds only if it reduces avoidable complexity while preserving professional responsibility and making genuine service shortages more visible.
Collaboration without creating another layer of bureaucracy
One of the greatest risks in collaborative service reform is that coordination itself becomes an additional administrative burden.
Organizations may establish working groups, introduce new reporting templates and require staff to attend more meetings without changing how residents access assistance.
The result can be a larger administrative structure operating above essentially unchanged service pathways.
Mexico's institutional diversity makes this risk particularly important.
A municipality, state DIF organization, healthcare institution and civil society provider may each have legitimate reasons to participate in discussions about community support. However, their involvement does not automatically require a permanent new body.
Collaboration should be organized around specific operational problems and decisions.
If the problem is inaccurate referral information, the response may be a jointly maintained service directory and agreed arrangements for updating it.
If the problem is repeated requests for the same information, the organizations may examine whether existing documentation can be used more effectively within applicable legal limits.
If the problem is uncertainty about unresolved referrals, a simple follow-up arrangement may be sufficient.
These changes can be coordinated through existing management responsibilities where appropriate.
A formal agreement may still be necessary when organizations exchange information, commit resources or undertake defined activities on one another's behalf.
But the agreement should clarify responsibilities rather than create unnecessary approval stages.
The strongest governance question is not how many organizations participate in a committee. It is whether the arrangement enables someone with appropriate authority to resolve a problem that previously remained unresolved.
Clarifying responsibility at the boundaries between services
Collaborative redesign becomes difficult when organizations are uncertain about where their responsibilities end.
This is especially relevant where healthcare, social assistance and community support intersect.
For example, a community organization may identify that a participant appears to need medical attention. It can provide information or assist the person in seeking appropriate help, but it should not undertake clinical assessment outside its competence.
A municipal DIF worker may recognize significant caregiver strain without possessing the authority to allocate services administered by another institution.
A healthcare professional may recommend practical home support that is not included within the healthcare institution's responsibilities.
These situations require clear boundaries alongside effective communication.
Redesign should establish who can make decisions, who can provide information, who can initiate contact and who remains responsible for following up within their own organization.
Where responsibility cannot be resolved locally, there should be a proportionate route for raising the issue with someone who has the authority to act.
This is different from transferring responsibility to a new coordinating office that lacks the power to change the underlying decision.
Organizations examining similar questions can use the Governance Maturity Assessment to structure discussion about decision rights, oversight and organizational capability.
The resource is a general analytical aid, not a Mexican regulatory instrument or a substitute for the legal authority of participating institutions.
Clear boundaries protect staff as well as residents.
Workers should not be expected to promise services they cannot authorize or resolve problems that depend on decisions outside their control.
Effective collaboration makes those limitations transparent while helping people reach the organization best placed to respond.
Operational scenario: reducing duplicated enquiries in Guadalajara
Illustrative scenario — hypothetical, not an established metropolitan service arrangement. A civil society organization in Guadalajara supports adults with disabilities who frequently request information about rehabilitation, employment-related assistance and community participation opportunities.
Staff find that residents often approach several organizations because information about available services is inconsistent or out of date.
A local collaboration involving the civil society organization, relevant municipal services and participating providers considers establishing a shared information resource.
Rather than building a new digital platform immediately, the partners first review existing directories and public information.
They identify which organization is responsible for maintaining each service description, how eligibility information should be presented and how changes will be communicated.
The resulting directory explains what services may be available, which institution administers them and how residents can make enquiries.
It does not promise eligibility or imply that all listed services have immediate capacity.
Staff are trained to distinguish general information from professional advice and formal decisions.
The partners also establish a simple correction process so that inaccurate entries can be reported and amended.
During the first review period, residents report fewer unnecessary journeys, but staff identify that some services have lengthy waiting periods.
The collaboration records these capacity limitations separately.
Decision-makers conclude that the information resource improves navigation but does not resolve shortages in provision.
The project demonstrates how a modest operational change can improve access without establishing another administrative institution, while also producing clearer evidence about where additional resources may be needed.
Financing simplification and identifying where savings actually arise
Administrative redesign is sometimes presented as a low-cost alternative to expanding services.
In practice, simplification can require investment.
Staff may need training, information systems may require modification and organizations may need time to agree revised procedures.
There may also be costs associated with accessibility, translation, communication and maintaining accurate service information.
These costs should be assessed against the potential benefits rather than assumed to be negligible.
Mexico's funding arrangements are important because organizations may not share the same financial incentives.
A municipal office might incur additional staff time helping residents navigate healthcare services, while any reduction in repeated enquiries benefits another institution.
A civil society provider may contribute specialist knowledge without receiving continuing funding for coordination activities.
A healthcare facility may benefit from more appropriate referrals but lack a budget mechanism for supporting wider community navigation.
Collaborative redesign therefore needs an explicit understanding of who pays for each activity and who benefits from the resulting improvement.
Where public expenditure is involved, organizations must operate within their applicable budgetary authority, financial controls and contracting requirements.
Not every useful activity requires a new contract. Some improvements may be delivered through existing responsibilities, provided the necessary authority and capacity exist.
Others may require formal agreements or additional resources.
The financial case should examine several dimensions.
Administrative savings may arise from fewer duplicate enquiries, reduced processing time or better use of existing staff.
Residents may benefit through lower transport expenditure, fewer lost working hours and reduced time spent seeking information.
However, improved navigation may also reveal unmet demand, increasing the number of people seeking services.
That outcome should not automatically be treated as financial failure. It may indicate that previous administrative barriers concealed genuine need.
The principles of cost and outcomes analysis are useful because they encourage organizations to examine both expenditure and the practical value created.
Financial sustainability depends on whether the redesigned process can be maintained through realistic staffing, funding and institutional arrangements.
Workforce redesign without transferring hidden responsibilities
Administrative simplification changes how staff work.
A receptionist may need clearer guidance about service pathways. A community worker may require training to recognize when an enquiry needs professional assessment. A manager may need to review recurring referral difficulties rather than focusing only on activity volumes.
These changes can improve service quality, but they should not be introduced without examining workload and competence.
One common risk is that organizations remove formal administrative stages while transferring additional responsibilities to frontline employees.
A worker may be expected to coordinate several institutions, follow up unresolved requests and provide detailed advice without additional time or authority.
Such arrangements can create hidden workload rather than genuine efficiency.
Role descriptions should therefore explain which activities are expected, what training is necessary and when staff should seek support.
Supervision remains important, particularly where workers encounter safeguarding concerns, complex family circumstances or requests outside their competence.
Mexico's reliance on family caregiving introduces another consideration.
Administrative simplification should not merely make families responsible for completing more tasks independently.
INEGI's Encuesta Nacional para el Sistema de Cuidados (ENASIC) 2022 provides important evidence about caregiving responsibilities and the distribution of unpaid care.
Requiring relatives to manage digital applications, arrange multiple appointments or coordinate professional services may appear efficient from an institutional perspective while increasing household burdens.
The wider theme of family caregiving and care burden is therefore central to assessing whether a redesigned pathway genuinely reduces complexity.
Workforce productivity should be measured partly by whether staff can resolve appropriate tasks more effectively, not simply by whether administrative responsibilities have been shifted elsewhere.
Digital tools as enablers rather than new administrative barriers
Technology can support collaborative redesign, but digitalization and simplification are not the same thing.
A new online form may reduce paperwork for an institution while making access more difficult for residents without reliable connectivity or digital skills.
A shared information platform may improve coordination but create additional work if staff must enter the same details into several systems.
Technology should therefore be introduced only after organizations understand the process they intend to improve.
Potential applications include maintaining service information, tracking the status of appropriate referrals, reducing duplicate data entry and identifying recurring access problems.
However, the technical solution must reflect the participating institutions' legal responsibilities and existing systems.
Information sharing requires an appropriate legal basis, defined purposes, proportionate access controls and compliance with applicable Mexican data protection legislation.
The legal framework differs between public bodies and private organizations, and arrangements should be assessed accordingly.
Consent may be relevant in particular circumstances, but it should not be treated as a universal substitute for determining the lawful basis of every information exchange.
Clinical information requires particular care.
Organizations should not assume that a community provider can access healthcare records simply because doing so would make coordination easier.
Where electronic systems cannot communicate directly, an agreed manual process may be more reliable than introducing an expensive platform without sufficient interoperability.
Organizations can use the Digital Transformation, AI and Cybersecurity Readiness Assessment to structure general consideration of digital capability, security and implementation readiness.
It does not certify compliance with Mexican privacy law or determine whether information sharing is legally permitted.
The most appropriate technology may be modest: accurate service information, a reliable communication method and a clear record of outstanding actions.
Digital systems should reduce unnecessary work rather than reproduce existing fragmentation electronically.
Operational scenario: redesigning access in rural Oaxaca
Illustrative scenario — hypothetical, not an existing state or municipal programme. A rural municipality in Oaxaca identifies difficulties experienced by older residents who need information about healthcare, disability-related assistance and community support.
Some residents speak an Indigenous language as their preferred language. Travel to administrative offices is expensive, and information about services is not always available in an accessible form.
A local community organization proposes establishing a new central coordination office.
However, consultation with residents suggests that another office would not necessarily reduce travel or improve communication.
Instead, the municipality considers working with existing community facilities and appropriate local representatives to improve how information is provided.
Participating institutions clarify which enquiries can be answered locally and which require contact with the relevant healthcare or social assistance organization.
Information materials are adapted for local communication needs, with appropriate language support and accessible explanations.
Community representatives receive guidance about confidentiality, professional boundaries and the limits of their responsibilities.
They are not expected to determine healthcare eligibility, undertake clinical assessment or collect unnecessary sensitive information.
Where residents require formal decisions, the relevant institution retains responsibility.
The municipality evaluates the number of unnecessary journeys, residents' understanding of available assistance and the time required to reach the appropriate organization.
Feedback reveals that clearer information reduces some travel, but residents with significant mobility difficulties continue to face practical barriers.
The findings lead to consideration of separate transport arrangements rather than expanding the information role beyond its purpose.
This scenario illustrates why redesign must reflect geography, language and community circumstances rather than assuming that a centralized administrative model will improve access everywhere.
Protecting rights, accessibility and informed participation
Administrative efficiency should never become the sole measure of successful redesign.
A process may become faster for an organization while becoming less understandable or accessible to the person seeking support.
Rights-based service design requires attention to autonomy, dignity, privacy and the ability to make informed decisions.
Mexico's Ley de los Derechos de las Personas Adultas Mayores and Ley General para la Inclusión de las Personas con Discapacidad provide important elements of the wider rights context.
Specific obligations depend on the institution, service and applicable legal arrangements.
Redesigned processes should allow people to understand what assistance is available, what information is required and how decisions affecting them are made.
Where applications or enquiries are rejected, organizations should explain the relevant reasons and any available procedures for reconsideration or complaint.
Accessible communication may require alternatives to written forms or online-only systems.
Residents with cognitive difficulties, sensory impairments or limited literacy may need additional assistance to participate meaningfully.
Family involvement can be valuable, but organizations should not automatically assume that relatives have authority to make decisions on another person's behalf.
Appropriate arrangements should reflect the person's rights, preferences and applicable legal requirements.
The wider principles of rights, consent and decision-making reinforce the importance of making processes understandable without weakening safeguards.
Complaints and feedback also have a central role.
If residents repeatedly report confusion, delays or inaccessible information, those experiences should influence the design of the process.
Administrative redesign becomes more credible when people using services help identify which stages create genuine difficulties.
Measuring whether collaboration improves access
Organizations need evidence that revised processes deliver meaningful improvements.
Counting meetings, agreements or newly produced guidance documents provides limited information about the experience of residents.
More useful measures examine whether people reach the correct service more quickly, repeat less information and receive clearer responses.
Possible indicators include the number of contacts required before reaching the appropriate organization, avoidable repeat visits, referral completion and the proportion of enquiries that remain unresolved.
However, these measures should be interpreted alongside service availability and participant experience.
A faster referral is of limited benefit if the receiving organization cannot provide the required assistance.
Similarly, reducing the number of contacts may not represent improvement if residents are simply told that no service is available without appropriate explanation.
Evaluation should therefore distinguish between administrative performance and actual access.
Baseline information can establish how the previous pathway operated. Subsequent monitoring can identify whether the redesigned process changes outcomes.
Qualitative feedback helps explain why particular difficulties persist.
Staff may identify unclear responsibilities, while residents may describe problems with language, transport, cost or communication.
Organizations can use the Quality Improvement Action Plan Builder to structure general improvement actions, responsibilities and review arrangements.
The resource is not a Mexican regulatory instrument and does not replace institutional reporting obligations.
Where several organizations participate, they should agree which information can lawfully be shared and how results will be reviewed.
The wider principles of outcomes frameworks and indicators can help distinguish administrative outputs from improvements in residents' experiences.
Evidence should ultimately show whether the redesigned pathway makes assistance easier to obtain, understand and use.
Operational scenario: improving caregiver information in Monterrey
Illustrative scenario — hypothetical, not an established metropolitan initiative. A community organization in Monterrey supports relatives caring for older people with long-term conditions.
Caregivers frequently ask where to obtain healthcare information, rehabilitation advice, social assistance and practical support.
Staff provide information but find that many families return with similar questions because the relevant institutional responsibilities remain unclear.
The organization proposes a collaborative review with participating healthcare and social assistance services.
Rather than establishing a new caregiver coordination programme, the partners identify the most common enquiries and develop clearer explanations of existing pathways.
They also agree on a limited method for updating information when programme arrangements change.
The community organization remains responsible for its own activities. Healthcare institutions retain responsibility for clinical decisions and the administration of their services.
Caregivers are consulted about whether the revised information is understandable and whether it reduces unnecessary contacts.
Evaluation shows that families can identify the appropriate institution more quickly, but some continue to report substantial difficulty balancing employment and unpaid care.
The organizations recognize that clearer information cannot replace practical assistance that is unavailable or unaffordable.
They record caregiver support needs separately and consider whether those findings should inform future service planning.
The redesign therefore produces two outcomes: a simpler information pathway and better evidence about the limits of existing provision.
Its success is not measured by claiming to have solved caregiver burden, but by reducing avoidable complexity and making unresolved needs more visible to decision-makers.
Turning local redesign into sustained institutional improvement
One of the challenges of collaborative reform is maintaining improvements after the initial period of attention has ended.
Staff change roles, service information becomes outdated and institutional priorities evolve.
A redesigned pathway that depends entirely on one enthusiastic employee may deteriorate when that person leaves.
Sustainability therefore requires the revised process to become part of ordinary organizational practice.
Responsibilities for maintaining information, reviewing referral problems and updating procedures should be assigned to existing roles wherever appropriate.
Training should be incorporated into normal workforce arrangements rather than treated as a one-time event.
Participating organizations should also establish how changes to services or eligibility requirements will be communicated.
Where formal agreements are necessary, they should identify the relevant responsibilities and mechanisms for review.
However, governance should remain proportionate.
Introducing complex reporting requirements for a modest information improvement may consume more resources than the change itself.
Periodic review can focus on a manageable set of questions: are residents experiencing fewer avoidable barriers, are staff following the agreed process and have new difficulties emerged?
If problems recur, organizations should investigate whether the cause lies in process design, workforce capacity, funding or institutional authority.
These distinctions are important because different problems require different responses.
A training issue may be resolved locally. A persistent shortage of services may require consideration by a state institution or another organization with relevant responsibilities.
Collaborative redesign should therefore create a reliable connection between frontline experience and the people capable of making operational or resource decisions.
International learning and Mexico's future direction
Mexico's experience highlights a challenge shared by many countries: the presence of multiple institutions does not necessarily produce a coherent experience for people seeking assistance.
However, the mechanisms available for improvement depend on each country's legal, financial and administrative arrangements.
Countries with more centralized service structures may be able to establish common procedures through national administrative authority.
Mexico's federal arrangements and differentiated healthcare institutions require greater attention to the boundaries between organizations.
The transferable lesson lies in examining the person's journey before proposing structural reform.
Other systems can adapt the principle of reducing avoidable duplication without replicating Mexico's institutional arrangements.
For Mexico, the stronger future opportunity may involve gradual improvement through practical agreements, clearer information, proportionate digital tools and more consistent review of unresolved needs.
These developments should not be confused with the establishment of a fully integrated national long-term care system.
They represent potential operational improvements within existing responsibilities.
As demographic change increases the importance of community support, administrative accessibility will become increasingly relevant.
Older people, disabled residents and family caregivers may need assistance from several institutions over time.
Making those connections easier to navigate can improve the practical value of existing services, even where wider financing and capacity challenges remain.
Future reform should therefore consider not only which new services Mexico may need, but also how residents can make more effective use of the services and support already available.
Conclusion
Collaborative service redesign offers Mexico an important opportunity to improve community care access without assuming that every problem requires another institution, programme or administrative structure.
The central challenge is to distinguish necessary institutional responsibilities from avoidable complexity in the journeys experienced by older people, disabled residents and family caregivers.
Mexico's federal structure, differentiated healthcare arrangements and varied social assistance provision mean that service integration cannot be achieved simply through organizational declarations.
Practical improvement depends on accurate information, clearer referral routes, appropriate professional boundaries, lawful information sharing and the ability to identify unresolved needs.
It also requires honest recognition of the limits of administrative reform. Simplifying a pathway cannot create professional capacity, affordable transport or practical caregiving assistance where those resources are unavailable.
Nevertheless, reducing unnecessary contacts, duplicated information and confusing responsibilities can make a meaningful difference to residents while improving the visibility of wider service gaps.
The strongest approach is to begin with people's experiences, redesign specific processes, assign responsibilities within existing institutions and evaluate whether the changes genuinely improve access.
For Mexico, sustainable community care transformation will depend not only on developing new models of support, but also on making existing institutions work more effectively together.
When collaboration reduces the effort required to obtain assistance rather than increasing the administration surrounding it, service redesign becomes a practical contribution to independence, dignity and better community outcomes.