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Innovation and Entrepreneurship in Health 2017:4 1–8
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O R I G I N A L R E S E A R C H
open access to scientific and medical research
Open Access Full Text Article
http:
dx.doi.org/10.2147/IEH.S124773
Characteristics of a successful collaboration in
evaluation of a health care innovation: lessons
learned from GPS locator technology for
dementia clients
Don Juzwishin1
Madiha Mueen2
Antonio Miguel Cruz3,4
Tracy Ruptash5
Shannon Barnard6
Meghan Sebastianski1
Rosmin Esmail7
Lili Liu4
1Health Technology Assessment and
Innovation, Alberta Health Services,
2Department of Family Medicine,
University of Alberta, Edmonton,
AB, Canada; 3School of Medicine
and Health Sciences, Universidad
del Rosario, Bogotá D.C., Colombia;
4Department of Occupational Therapy,
Faculty of Rehabilitation Medicine,
Edmonton, 5Continuing Care Special
Initiatives, Seniors Health, Community,
Seniors, Addiction and Mental
Health, Alberta Health Services,
Grande Prairie, AB, 6Integrated
Home Care, Alberta Health Services,
7Health Technology Assessment and
Adoption, Alberta Health Services,
Calgary, AB, Canada
Abstract: Becoming lost or its risk is a problem for dementia clients, their families and caregivers.
The purpose of the paper is to describe, analyze and share lessons from a pilot project to use global
positioning system devices to manage the risk of becoming lost and, at the same time, maintain-
ing client autonomy. The study informs technology implementation approaches and strategies for
innovative health technologies. The project used a prospective mixed-methods approach including
a pre and post paper-based questionnaire, focus groups and individual interviews. Technology
uptake was examined post knowledge transfer using the After Action Review method, which has
shown utility in military and health care settings. Project successes and weaknesses are identified
to inform future approaches of innovative health technology pilot projects. Lessons from the pilot
emphasize the need for innovators to understand the multifaceted context they are entering, enlist
the support of leaders, dedicate a project lead, support autonomous decision making and problem
solving, meet regularly to monitor progress and address issues and support peer-to-peer collaboration.
Keywords: evaluation, innovation, GPS, technology, adoption
Introduction
Dementia is characterized by progressive and i
eversible decline in cognitive function-
ing. According to the World Health Organization, there are about 47.5 million people
who have age-related dementias worldwide with 7.7 million new cases annually. It is
expected that the number of people with dementia will reach 135.5 million by 2050.1
In Canada, 1 in 40 Canadians aged 65 years and older and 1 in 3 Canadians of age
over 85 years have dementia.2 To devastating social effects, the direct and indirect
economic costs of dementia are expected to rise from $33 billion per year in 2016
to $293 billion per year by XXXXXXXXXXIn order to mitigate the social burden on patients
and families, as well as the economic implications for health care, an exploration of
innovative and integrated solutions is wa
anted.
Individuals with cognitive impairment may become disoriented and lost when
alone, while navigating indoors or outdoors.4 Algase et al conducted a review that
esulted in an empirically based, standardized definition of wandering: “a syndrome
of dementia-related locomotion behavior having a frequent, repetitive, temporally-
disoriented, and/or spatially-disordered nature that is manifested in lapping, random
and/or pacing patterns some of which are associated with eloping, eloping attempts or
getting lost unless accompanied”.5 The wandering behavior of people with Alzheimer’s
or related dementias impacts not only their independence but also adds to the stress
Co
espondence: Don Juzwishin
Health Technology Assessment and
Innovation, Alberta Health Services, 12th
floor, XXXXXXXXXXStreet, Edmonton, AB
T5J 3E4, Canada
Tel XXXXXXXXXX
Email don.juzwishin@
albertahealthservices.ca
Journal name: Innovation and Entrepreneurship in Health
Article Designation: ORIGINAL RESEARCH
Year: 2017
Volume: 4
Running head verso: Juzwishin et al
Running head recto: Successful collaboration in evaluation of a health care innovation
DOI: http:
dx.doi.org/10.2147/IEH.S124773
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Juzwishin et al
of family caregivers. For example, more than 40% of family
caregivers report that the emotional stress of their role is
high or very high.6
A variety of interventions are cu
ently used to manage
wandering, including the use of physical ba
iers, physical
estraints and medications to manage behaviors.7 How-
ever, physical interventions inhibit independence, while
medications may cause unwanted side effects. Recently, a
technological solution has shown utility in the management
of wandering: a wearable locator device that uses a global
positioning system (GPS). This technology may be an effec-
tive approach to monitor individuals at risk for getting lost
ecause it enables caregivers to know the geographic location
of an individual with dementia while allowing the individual
some autonomy.8
In spite of the advances and apparent advantages in the
use of GPS technology to monitor and locate people with
dementia, its use is debated. Little is known about the reli-
ability and acceptance of GPS technology among individuals
with dementia and their caregivers.9 Majority of the available
evidence come from descriptive case studies focused on
cognitively intact older persons as well as formal or informal
caregivers providing anecdotal comments about their experi-
ences in using GPS.10–13
From 2013 to 2015, Alberta Health Services led a pro-
spective research study, the Locator Device Project (LDP),
which examined the usability of GPS technology with 45
dyads (primary caregiver–client with dementia) in both
ural and u
an settings. The primary objective was to
evaluate uptake and usability of GPS technology for Home
Care dementia clients and their caregivers. The data suggest
that the devices had high usability, and that they were well
accepted and provided peace of mind to caregivers and inde-
pendence to patients. Detailed results for the primary objec-
tive are reported elsewhere.14 The purpose of this paper is to
eport on the project planning, implementation and evaluation
process within Alberta Health Services related to the LDP.
Specifically, we were interested in 1) knowing which factors
contribute to the success of the LDP and 2) what lessons can
e learned to inform future implementation and evaluation
of new technologies or services.15
Background
In health care, the literature recognizes three realms that have
a direct impact on the successful adoption of innovation:
characteristics of the organization or external environment,
individuals and the innovation itself (Figure 1). Evaluation
of a market-ready technology is viewed as the first phase in
implementation.
Organization/external environment
Organization and external environment factors significantly
impact the acceptance of a technology and its adoption.16
Collaboration between community networks, regulations
and legislation, peer pressure and competition are the
key environmental factors for successful translation of an
innovation from idea into practice.17 Collaboration among
stakeholders is an important facilitator of innovation adop-
tion.17 Additionally, an organization’s social role, formal and
informal, influences the effectiveness of implementation.
Organizations that make staff feel welcomed, promote open
feedback, peer collaboration and clear communication and
offer stability and solidarity among teams are more likely to
achieve successful adoption.18 Not surprisingly, encourage-
ment of staff members to reach beyond their roles and expand
oundaries enables quicker translation of new practices.18
Interdepartmental organizational cohesion19 is also the key
for successful technology transfer and implementation. Scott
et al found that excessive external control negatively impacts
implementation by restricting creativity and novelty, which
are optimized when an organization has open processes and
worker autonomy.20
Finally, successful and efficient implementation is contin-
gent on the effectiveness and support of senior management
and clinical leadership, credible evidence, innovation infra-
structure for the translation of research into practice and the
extent to which organizational culture change is required.21
The individual
Individual attributes are the second factor of success-
ful implementation. Personal features such as leadership
skills, acceptance of change, degree of autonomy, informed
decision-making ability and how one attracts necessary
esources to sustain the changes and improvements in prac-
tice are the key traits.16,22 An individual’s professional and
social networks also play a strong role in individual decision
The innovation
itself
Implementation
of innovation
Organization/external
environment The individual
Figure 1 Factors that have a direct impact on the knowledge transfer of innovations.
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Successful collaboration in evaluation of a health care innovation
making,17 while translation of knowledge into practice ben-
efits from a sustained interaction between researchers and
practitioners.23 Ba
iers to innovation implementation on an
individual level include limited autonomy, insufficient time
and lack of administration support for applying evidence-
ased decisions.17
The innovation
Innovations perceived by users to have a clear advantage
(effectiveness or cost-effectiveness) over other existing
solutions are more readily implemented.20,24 Rogers’ Diffu-
sion of Innovation Theory posits five characteristics of an
innovation that influence its adoption and implementation:
elative advantage, compatibility, complexity, trialability and
observability.17 Of the five characteristics, relative advantage
and observability have been identified as the most influential
factors for implementation.20 This is supported by previous
findings where an innovation that meets a recognized need
and is perceived to be compatible with organizational and
individual beliefs and values is more likely to be imple-
mented.24,25,26 Implementation is also catalyzed by innovations
that are simple, straightforward and demonstrate reduced
isk.19 Lastly, innovations piloted on a smaller scale to gauge
impact and produce positive, observable outcomes are more
eadily accepted and implemented.20
Methods
As part of Alberta’s Continuing Care Strategy: aging in the
Right Place, Alberta government ministries of Health and
Innovation and Advanced Education, along with Alberta
Health Services partnered to examine innovative technolo-
gies that could help seniors to remain in their community
as they age. Alberta Health Services had previously piloted
three market-ready technologies in the Continuing Care
Technology Innovation (CCTI) Project from 2010 to 2012;
however, locator technologies were not commercially avail-
able in Alberta at that time.
Project development – LDP steering
committee
Following similar methodology to the CCTI project and uti-
lizing the learnings from similar recent technology projects
in Canada, Alberta Health Services and researchers from
the University of Alberta assembled a steering committee
of technology and continuing care champions. Chaired by
former CCTI leadership, membership of the LDP Steer-
ing Committee included Alberta Innovation and Advanced
Education and the Alberta Health Continuing Care Branch,
stakeholders within Alberta Health Services: Emergency
Medical Services, Seniors Health Strategic Clinical Network,
Home Care, Addiction and Mental Health, Seniors Health,
Health Technology Assessment and Innovation (HTAI),
Allied Health; as well as external stakeholders: the Alzheimer
Society of Calgary, Alzheimer Society of Alberta, University
of Alberta – Faculty of Rehabilitation Medicine (Department
of Occupational Therapy), Calgary Police Service and Royal
Canadian Mounted Police in Grande Prairie.
Trial design
The LDP used a prospective mixed-methods approach includ-
ing a pre