My anticipated idea for innovation would be electronic appliance use monitoring. This will help their caregivers monitor them at all times. Their caregivers will be able to keep track at all times and always feel safe when they see what their loved ones are doing. The next thing will be GPS location and tracking devices will also be a good option for people with dementia.© 2017 Juzwishin et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. 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Innovation and Entrepreneurship in Health 2017:4 1–8 Innovation and Entrepreneurship in Health Dovepress submit your manuscript | www.dovepress.com Dovepress 1 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 irreversible 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 2040.3 In 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 warranted. Individuals with cognitive impairment may become disoriented and lost when alone, while navigating indoors or outdoors.4 Algase et al conducted a review that resulted 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 Correspondence: Don Juzwishin Health Technology Assessment and Innovation, Alberta Health Services, 12th floor, 10030-107 Street, Edmonton, AB T5J 3E4, Canada Tel +1 780 735 0741 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 In no va tio n an d E nt re pr en eu rs hi p in H ea lth d ow nl oa de d fr om h ttp s: //w w w .d ov ep re ss .c om / b y 16 5. 21 5. 20 9. 15 o n 10 -M ay -2 01 9 F or p er so na l u se o nl y. Powered by TCPDF (www.tcpdf.org) 1 / 1 http://www.dovepress.com/permissions.php www.dovepress.com www.dovepress.com www.dovepress.com https://www.facebook.com/DoveMedicalPress/ https://www.linkedin.com/company/dove-medical-press https://twitter.com/dovepress https://www.youtube.com/user/dovepress Innovation and Entrepreneurship in Health 2017:4submit your manuscript | www.dovepress.com Dovepress Dovepress 2 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 currently used to manage wandering, including the use of physical barriers, physical restraints 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 because 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 rural and urban 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 report 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 be 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 boundaries 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 resources 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. In no va tio n an d E nt re pr en eu rs hi p in H ea lth d ow nl oa de d fr om h ttp s: //w w w .d ov ep re ss .c om / b y 16 5. 21 5. 20 9. 15 o n 10 -M ay -2 01 9 F or p er so na l u se o nl y. Powered by TCPDF (www.tcpdf.org) 1 / 1 www.dovepress.com www.dovepress.com www.dovepress.com Innovation and Entrepreneurship in Health 2017:4 submit your manuscript | www.dovepress.com Dovepress Dovepress 3 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 Barriers to innovation implementation on an individual level include limited autonomy, insufficient time and lack of administration support for applying evidence- based 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: relative 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 risk.19 Lastly, innovations piloted on a smaller scale to gauge impact and produce positive, observable outcomes are more readily 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