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natural thing to do, even if it meant the loss of
control over where the journey led.
Perhaps because of a lack of reflection, or
perhaps more likely because we were so immersed
in the various projects that followed one another
without pause or separation, we had no real un-
derstanding of where the journey was taking us
until we neared its end. Now as we approach what
appears to be the end—the patents have been sold,
the last project winds down at the end of 2010—
we have a better idea of the journey and what
happens when control is given to others and the
demands of caregiving and the market determine
the path rather than the goals determined by some
hermetically sealed laboratory protocol. You end
up someplace you never imagined.
We began with an apparently simple goal of
developing a behavioral monitoring system that
could be used to allow at-risk individuals to remain
in their own homes longer and more securely and
we ended by developing an interactive home care
electronic records system that could be used on
any commercially available smart phone/mobile
device. The development of such an electronic
records system was certainly not our goal at
the beginning of our testing in the real world of
caregiving. In fact, it was never really our goal
at any stage of our journey. It just happened as
we responded to the “noise” from the people
with whom we worked. Apparently, this is what
happens when you cede control to others; it leads
you to unexpected, at times frustrating, but always
interesting, and often rewarding places.
There is, however, a final irony to this ceding
of control to others: it turns out that frequently
the individuals who request the new sensor ar-
ray, the new feature, the expanded recording and
sorting capability, do not want it after it has been
developed. This appears to be the result of the
convergence of two laws: the law of unexpected
consequences and the law of “be careful what
you wish for”. Two brief examples illustrate what
happened time after time when we responded to
the requests of caregivers.
Wish Number 1:
Could you develop a way
for us to easily see how our caregivers respond
to alerts? Since our caregiving culture is that we
always respond to the needs of our clients, such
a capability will document the high quality of
our care.
Result Number 1:
The new capability shows
that the night staff is not responding to alerts and
not providing the care for which family members
are being charged.
Consequence Number 1:
Staff members are
fired; we are asked why don't we just arrange for
the data to be sent directly to the lawyers for the
family members so that it would make it easier
to sue the care organization and the capability is
turned off.
Wish Number 2:
Could you develop an infor-
matics system that can be used on mobile devices
in which caregivers could enter data on the road
and which could then be consolidated and used
at care review meetings?
Result Number 2:
Care organization has to
purchase mobile devices for caregivers, an unex-
pected expense going forward, entering the data
on the road is not what the caregivers want to do
resulting in incomplete records, the consolidation
allows for supervisors to “see” the caregivers work
more than anyone anticipated and the scheduling
of care review meetings takes caregivers away
from providing care.
Consequence Number 2:
The anticipated
planned roll out of the Telehomecare system that
includes the requested informatics component
is put on hold while administrators at the care
organization wrestle with added cost, changes in
work rules and issues surrounding the use of new
data in the evaluation of caregivers.
Although initially surprised by these and other
similar responses to our attempts to give people
what they asked for, we came to the conclusion
that this reaction is nothing more than another
form of noise. As such, there are lessons that
can be learned from taking what caregivers both
say and do seriously and not just viewing them
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