Dementia is a leading cause of death, disability and hospitalization in Canada and globally. A partnership between Ontario Shores Centre for Mental Health Sciences and Ontario Tech University, both located in the Durham Region in the province of Ontario, Canada was established to create a space of technological innovation in front line dementia care on a Geriatric Dementia Unit (GDU). Our goals are to improve patient quality of life and recovery, enhance the health and well-being of patients with dementia and their caregivers, and allow front-line health and social care providers to practice to their full scope.A jam session is defined as a collaborative brainstorming and service prototyping event that does not have to be technology related, but occurs in a condensed timeframe. Currently, little is known about the effectiveness of jam sessions, especially in regards to interdisciplinary problem solving related to dementia care in health care settings.
A collaborative jam session employing Google jam technology between Ontario Tech University and Ontario Shores Centre for Mental Health Sciences was held to engage in problem solving for clinical challenges identified on a GDU. Focus groups were first held to identify the dementia care needs currently facing patients, their caregivers and clinical staff on the GDU (N = 27 total). Thematic analysis of the qualitative data responses collected from the focus groups resulted in the identification of three major themes: (i) Communication and responsive behaviors; (ii) physical environment, and (iii) activities/stimulation. The themes identified aligned with a subsequent comprehensive review of both grey and white literature conducted by members of the research team. The survey consisted of three Likert-type closed-ended forced response questions, and three open-ended questions; where participants were free to answer in their own words.
A total of 19 individuals (100%) completed the evaluation survey administered at the end of the jam session. There were 373 ideas total generated during the jam session, and the specific number of idea generated for the three themes of communication and responsive behaviours, physical environment, and activities/stimulation were 127, 132 and 114, respectively. Overall, the majority of participants felt that the jam session was an effective and innovative way to generate ideas for clinical solutions related to dementia for the GDU.
To our knowledge, this is the first report to examine the effectiveness of Google jam technology to engage in interdisciplinary problem solving for clinical challenges for a GDU. Innovative co-production during the jam session was evidenced by the vehicle of co-creation by all stakeholders involved. These preliminary results suggest that the jam session was an effective method for engaging in interdisciplinary and inter-professional creative thinking and problem solving related to challenges faced by patients with dementia, their family, and clinical staff who administer care to patients with dementia.
Dementia, Jam session, Google Jam technology, Brainstorming
Dementia is defined as a chronic and often progressive neurological disorder that results in a deterioration of mental processes, and is a leading cause of death, disability and hospitalization in Canada [1]. The Alzheimer's Society of Canada predicts that by 2038, over 1.5 million Canadians will have dementia, and the cumulative economic burden will be in excess of $872 billion. It is notable that approximately 9.9 million cases of dementia are diagnosed each year, or 1 new diagnosis every 3.2 seconds globally [2]. Currently, there is no cure for dementia and improving the quality of life for patients and their family is the primary health care goal in Canada and abroad.
A partnership between Ontario Shores Centre for Mental Health Sciences (Ontario Shores) and OntarioTech University, both located in The Durham Region in the province of Ontario, Canada was established to create a space of technological innovation in front line dementia care on a Geriatric Dementia Unit (GDU) located at Ontario Shores. Our goals are to improve patient quality of life and recovery, enhance the health and well-being of patients with dementia and their caregivers, and to allow front-line health and social care providers to practice to their full scope. It is anticipated that the GDU will become a benchmark for national and global comparators in dementia care excellence.
A jam session is defined a collaborative brainstorming and service prototyping event that does not have to be technology related, but occurs in a condensed timeframe [3]. A jam session may include a variety of individuals from a range of backgrounds, expertise, disciplines and life experiences who partake in an innovative and creative problem solving and decision making process workshop [4-6]. Jam sessions seek to encourage "out of box" group thinking, brain storming and problems solving activities within a defined time period, and they have been employed since the 1980s [6-8]. Nonetheless, little is currently known about the effectiveness of jam sessions, especially in regards to interdisciplinary and inter-professional problem solving in health care settings. Accordingly, a collaborative jam session employing Google jam technology between Ontario Tech University in Oshawa, Ontario and Ontario Shores Centre for Mental Health Sciences in Whit by, Ontario was held to engage in problem solving for challenges identified on a GDU. In brief, Google jam boards are electronic whiteboards with many collaborative and innovative technological features including the ability to post sticky notes anonymously, built in wide angle cameras and microphones, 16 simultaneous touch points, and handwriting and shape recognition software (see link for detailed specifications:
https://static.googleusercontent.com/media/gsuite.google.com/en//files/Jamboard_Specs.pdf).
Our research approach entailed a two-step process consisting of focus groups sessions to elicit themes, and a written survey conducted after a jam session was conducted with stakeholders. Stakeholders in this investigation are defined as clinical staff and patients on the GDU; their families, and faculty researchers interested in dementia research from Ontario Tech University who have no financial obligations or requirements to Ontario Shores Centre for Mental Health Sciences or Ontario Tech University. We shall describe the steps that were taken to mount a Google jam session to engage participants in clinical problem solving to support dementia patients on the GDU, their caregivers and clinical staff. As well, we critically reflect upon the experiences to identify both the benefits and challenges of organizing and conducting a jam session.
We first defined clinical problems that currently face our geriatric patients with moderate to severe forms of dementia (e.g., Alzheimer's disease, vascular dementia, mixed dementias), their caregivers and clinical staff on the GDU. Specifically, focus groups were held with the aforementioned stakeholders (N = 27 total) to highlight current clinical challenges faced by patients and staff on the GDU. The following questions were asked by a single experienced facilitator to ensure consistency, and responses were also recorded verbatim and transcribed.
1. What are the complex issues on the unit that require innovative solutions?
2. To create new and innovative practice, how can technology be employed to improve your practice and improve patient care on the unit?
3. How do we enable top of license practice of all disciplines?
4. What are innovative ways of partnering with patients and families?
1. What are the complex issues on the unit that require innovative solutions?
2. To create new and innovative ways of providing patient care, how can technology be used to improve the care provided to your loved one?
3. What are innovative ways of partnering with patients and families?
Thematic analysis of the qualitative responses obtained from the focus groups were distilled into the following three major themes: (i) Communication and responsive behaviors; (ii) Physical environment and, (iii) Activities/stimulation. The researchers subsequently conducted member checks with the stakeholders to ensure that all major themes as identified were, in fact, suitable and correct. The themes identified also aligned with a subsequent comprehensive review of both grey and white literature conducted by members of the research team. Lastly, the three major themes identified were employed as the basis for the Google jam session.
Our research approach employed participatory action research, which is a characterized by the systematic study of the reported needs of stakeholders and the empowerment and implementation of a planned change to mutually and cooperatively solve real-life problems [1]. The jam session event began by dividing the participants into three focus group teams, each comprised of approximately 6 to 8 members total from university faculty researchers, clinical staff from the GDU, family members, and graduate and undergraduate students in the health sciences. Each focus group had their own Google jam board to post ideas anonymously. Each team spent approximately 15-20 minutes on each of the following three identified clinical challenges: (i) Communication and responsive behaviours on the GDU; (ii) Physical environment on the GDU, and (iii) Activities/stimulation on the GDU.
Three research questions guided the feedback sought for the survey component of our study that was completed after the Google jam session, and are detailed below:
1. Is a jam session an effective method for engaging in interdisciplinary creative thinking and problem solving related to challenges faced by patients with dementia?
2. Is a jam session an effective method for engaging in interdisciplinary creative thinking and problem solving related to challenges faced by family members of patients with dementia?
3. Is a jam session an effective method for engaging in interdisciplinary creative thinking and problem solving related to challenges faced by clinical staff who care for patients with dementia?
Participants in the jam session were comprised of faculty members from various faculties on campus and disciplines (e.g., nursing, public health, kinesiology, software development, business and information technology, engineering), front-line health care professionals and staff (e.g., nurses, recreational therapists), family members and students. At the end of the jam session participants were asked to complete a written pencil and paper-type survey to evaluate the Google jam session and their experiences. The survey consisted of three Likert-type closed-ended questions and three open ended questions, which are detailed below.
A total of 19 individuals (100%) responded to the feedback survey administered at the end of the jam session. There were a total of 373 ideas generated during the jam session, and the specific number of ideas generated for the three themes of communication and responsive behaviours, physical environment, and activities/stimulation were 127, 132 and 114, respectively. The first half of the survey consisted of three Likert-type closed-ended forced response questions (Table 1), the second half consisted of three open-ended questions (Table 2) where participants were free to answer in their own words. Table 3 details some of the major solutions derived from the jam session for the three identified themes. Some of the major solutions under the theme of communication and responsive behaviours were the use of a patient portal to communicate with family members such as daily activities on the GDU and progress reports. Moreover, the use of tablets to communicate with patients using real face time (e.g., WhatsApp, Skype) was also suggested. In regards to the physical environment, some of the major solutions suggested included altering the lighting on the unit; use of projected images (e.g., beaches, fish swimming) to create a calming environment, and use of Snoezelen® multi-sensory environment rooms. Under the activities/stimulations theme, some of the major solutions to decrease negative responses (e.g., hitting, biting behaviours) was the use of music therapy during procedures (e.g., while providing personal care). It was also suggested to use interactive consoles (e.g., Xbox One, PlayStation 4) to encourage patients to engage in physical activity and stimulation (Table 3).
Table 1: Likert- type survey questions. View Table 1
Table 2: Open-ended survey questions. View Table 2
Table 3: Possible solutions derived from the Google jam session for each of the three major themes. View Table 3
Question 1 stated: "Overall, I believe that the jam session format was an effective method or approach to engage in interdisciplinary problem solving related to dementia". No participants (0%) responded that it was not effective or slightly effective to this question; whereas 10.5% (N = 1) of participants responded that it was an effective methods, 42.1% (N = 8) responded that it was quite effective, and 47.4% (N = 9) that it was very effective. Hence, these results suggest that the jam session was an effective method/ vehicle for engaging in interdisciplinary and inter-professional problem solving activities related to dementia.
Question 2 stated: "I believe the jam session was an effective and constructive approach for the identification of possible solutions for the three noted themes examined today?" No participants (0%) responded that it was not effective or slightly effective to this question; whereas 21% (N = 4) responded it fairly effective, 42.1% (N =8) responded it was quite effective, and 36.8% (N = 7) responded it was very effective. Taken together, these preliminary results suggest that the jam session was an effective method/vehicle for finding potential solutions for the three noted themes critically examined.
Question 3 stated: "I believe the ideas clustering session at the end of the jam session on the jam board was an effective and practical way to visualize and prioritize items." No participants (0%) responded that it was not effective, 5% (N = 1) responded that it was slightly effective, 42.1% (N = 8) felt it was only fairly effective, 26.3% (N = 5) responded that it was quite effective, and 26.3% (N = 5) that it was very effective. It is noteworthy that the majority of respondents (N = 8) felt that clustering of ideas on the jam board at the end of the session needed some work to increase its effectiveness. This is also echoed in the open-ended questions detailed below in terms of time constraints and some noted problems in using the technology (Table 1).
Question 4 stated: "In your opinion what worked well during the jam session and WHY?" The specific feedback statements are detailed in Table 2. In brief, participants reported that the jam session was well organized and planned. The use of technology for the posting of "sticky notes" and its anonymous nature was appreciated by all. Participants reported that the mixing of frontline workers, staff, faculty members and students was an effective method for generating ideas.
Question 5 stated: "In your opinion, what did not work during the jam session and WHY?" The specific feedback statements are detailed in Table 2. In brief, participants reported that the technology acted-up at times or were not working properly for the entire session. Time limitations placed for problem solving for each of the 3 themes was deemed as inadequate by some participants. Lastly, trying to categorize the themes and ideas at the end of the session was reported to be difficult and/or frustrating by some participants.
Question 6 stated: "Any additional comments or suggestion for improving future jam sessions? "The specific feedback statements are detailed in Table 2. In brief, participants reported that the jam session was a fun/enjoyable way to engage in problem solving activities. It was also suggested that the specific time limitations for problem solving for each theme be increased. Lastly, better instructions and facilitator training was also noted as areas requiring improvement/ refinement (Table 2).
In sum, participants enjoyed posting and exchanging their ideas using Google jam technology boards without any noted constraints or pressures. Notably, participants appreciated the fact that their postings on the jam boards were anonymous in nature, which also helped prevent bullying or domination by a single team individual. The strategy of bringing frontline staff, faculty, and family members and putting them into mixed teams was critical for the generation of novel and unique ideas and solutions. Overall, the jam session event itself was found to be well organized, planned and executed. Thus, there was a request for more jam sessions to be held in the future by participants.
Although jam sessions have been employed in the context of reconnecting musicians, artists and dancers for creative expression for patients with dementia [9-12], to our knowledge this is the first report to examine the effectiveness of Google jam technology for engaging in interdisciplinary brain storming to solve clinical problems on a GDU. Although there has been growing interest in the use of electronic assistive technologies for dementia care to help support patients and families living with dementia in their homes, little is currently known about the use or effectiveness of these technologies in clinical settings involving patients with dementia [13-15]. Information Communication Technology (ICT) devices designed to support patients are usually referred to as Assistive Technology (AT) or Electronic Assistive Technology (EAT) [16,17]. It may be argued that the low costs and wide availability of electronic devices makes it an attractive option for the benefit of patients with dementia and front-line clinical staff [15-17].
We acknowledge that our sample size was limited (N = 19), which could affect the power of the study, total number of ideas identified, and outcomes achieved. Nonetheless, it is critical to note that the space to conduct the jam session was also limited to a single room and that only three working Google jam boards were available for use. Although some participants indicated that more time on each of the three themes would have been desirable, we were also cognizant of fatigue setting in, as the total session was approximately 3.5 hours in duration from start to finish. Organisers of a jam session should consider and weigh whether or not the "problems" and potential "solutions" are, in fact, worth the effort, time, resources, planning, costs, and stakeholder willingness for engagement [6,8]. Our working group plans to subsequently examine each idea and solution generated and view it through the lenses of impact, effort and feasibility. It will also be determined whether the ideas and solutions generated are supported by both white and grey literature related to dementia care [13-17]. Further research is warranted to examine the effectiveness of Google-based jam technologies for collaborative interdisciplinary and inter-professional idea generation related to dementia care between research-based universities and health care centres for dementia.
The future of healthcare must be transformed from discrete processes to integrated interdisciplinary services; from curative and rehabilitative to promotive and preventive one, and from primary clinician focused to patient-centred care in a unified continuum of care [18,19]. Running an effective jam session requires organization and planning, the willingness of participants to surrender personal control, skill in terms of the use of jam technology, and structure themes to work on and find innovations solutions to. It may be argued that collaborative problem solving during a jam session is a form of "participatory culture" where formal and informal teams work together to co-create, problem solve, prioritize and plan for potential clinical challenges faced by patients with dementia, staff, and family members. Moreover, innovative co-production during the jam session was evidenced by the vehicle of co-creation by all stakeholders involved. In conclusion, these preliminary results suggest that the jam session was an effective method for engaging in interdisciplinary creative thinking and problem solving related to challenges faced by patients with dementia, their family, and clinical staff who administer care to patients with dementia.
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All authors have contributed to the conception, collection of data, and writing of this manuscript.