Aims and scope
The project concerns the further development of a Smart Diaper, as an innovation in elderly care. The system (Abena Nova, as Abena is the firm that developed the mechanism) is a sensor system. It consist of charcoal elements built in the diaper. A clip collects and sent the data to a central server. This sends messages to a smartphone and can be consulted online. The system was already tested by Philadephia (a care organisation) in 2015. Philadelphia and Abena further developed the system and connected Evean (an elderly care hospital), where it was tested further in two psycho-geriatric sections in 2018. The project was also part of a project of the Ministry of Health, Welfare and Sports called ‘Care hospitals for the future’. The test phase started in May 2018 and in total took 10 months. In this period, there was intensive contact between all involved actors including staff of Evean, who had to work with the new system and had to report back their experiences with the system and the (potential) pitfalls of the system. Also other users (patients) were involved, but the main feedback from patients was provided indirectly through the staff.
The initial goals of the project focused mainly on four aspects, which did not change throughout the entire project. These goals were:
- Increasing the health of patients
- Reducing the costs in cotton sheets
- Enhancing the control over the performance of nurses (management goal)
- Making the role of home-nursing future proof.
The ICT innovation tries to combine products from Abena with new technology from MediSens. The Abena Smart Diaper is an intelligent continence aid for everyday use and is based on new wearable sensor technology. The ‘Smart Diaper’ is continuously connected with professional care-providers who are equipped with a digital sensor and wireless connection. The information about wetness levels of continence products is shared real time with care-givers via an App on their mobile devices. The Smart Diaper thus provides personalized medical care services as the data that is used to provide more precise and personalized health care informs the nurses about their patients (e.g. personalized interventions, helps to predict and prevent ‘wet/dirty diapers’ and sick patients). The user can access and control the health of the patients through the innovation and health care services and the communication-interaction between users and health care providers is generally better facilitated by using the Smart Diaper.
Main collaborative innovation conditions
The communication between the caregivers and Abena/Significant was very important. Given the shortage of time, short intensive feedback sessions were mostly chosen to facilitate this communication. There was also room to organise ad hoc meetings, when this was necessary. Also other network management strategies were employed by the partners in the project. The partners used exploring strategies to search for goal congruency and to create variation in solutions. This was done in the Petit Committee meeting in the beginning of the project. Moreover, the partnership attempted to share human resources via connecting strategies. This was a selective process of hiring and searching for the right actors who could fulfil and mobilize vital resources that were necessary to realise the project. Furthermore, during the implementation, the three partners tried to have regular feedback moments with the users (nurses) about problems and complications. The partners exchanged staff and (human) resources to share information. The implementation process was also guided by rules and procedures to align time planning/management and to reduce conflict.
Ideas were mainly generated through the interaction between individuals. Abena Nova was the driving power behind the technology of the intelligent diaper. However, the interaction between the various stakeholders (Evean, Philadelphia) caused that the implementation in various nursing homes in 2018/19 was reviewed as a success. Additionally, the actors in the project focused on finding similarities between different views and ideas. This led to personalised continence care.
Both nurses and patients were involved in the project to advise the partnership about the innovation. However, due to the mental and physical state of the patients (a significant number suffered from various stages of dementia), feedback was mostly provided by the nurses. As we have already mentioned, some patients decided to stop wearing the diaper, which was of course valuable indirect feedback of the patients for the partners.
Implications and lessons learned
The Smart Diaper was in general successful and is easily connected to care-givers who can install the app on their mobile devices. They then receive/stream the information about ‘wetness levels of the continence product’ in real time, which makes the nurses more efficient when they need to help the patients. There were several issues, however, on the practical use of the diapers with patients (e.g. construction did not fit with all patients in the same way and the ICT tool did not always work perfect, nurses indicated that they did not always find the diaper very user friendly), which limited the feasibility of the innovation in some situations. However, according to the evaluation of the results, the number of wet beds decreased by 76% due to the intelligent continence solution of the Smart Diaper. This solution therefore contributes to the efforts to solve the problem of staff shortage in health care – which is one of the biggest problems of this time in the Netherlands.
In general the collaboration was moderately rigid, and the stakeholders were keen and committed to achieve their goals but were also willing to adapt the technology to practical experience. The Smart Diaper is innovative and in principle helps patients who wear the diaper. It also helps nurses to provide better and faster care, since they are better informed about the patients’ needs. We identified the following success factors of this project:
- Support and commitment from the management board
- Nurses could decide themselves if they wanted to join (on a voluntary basis)
- There was room for trial and error during the process.
- The proactive role of the change management firm
- Much attention to the nurses that used the diaper.
 The diapers use sense technology which is developed by another company, namely Medisense. This company was not really contributing to the partnerships or present in the partnership
To read more about the case study, see D7.1 – Practices of external collaboration for service delivery. Comparative case studies on external collaboration in eHealth partnerships report.
About the Authors
Erik-Hans Klijn, Erasmus University Rotterdam
Vidar Stevens, Mulier Institute (previously - Erasmus University Rotterdam)
Samantha Metselaar, Erasmus University of Rotterdam