Comparative table of healthcare and wellness devices. (1) Continua Certified.
\r\n\tHydrogen gas is the key energy source for hydrogen-based society. Ozone dissolved water is expected as the sterilization and cleaning agent that can comply with the new law enacted by the US Food and Drug Administration (FDA). The law “FDA Food Safety Modernization Act” requires sterilization and washing of foods to prevent food poisoning and has a strict provision that vegetables, meat, and fish must be washed with non-chlorine cleaning agents to make E. coli adhering to food down to “zero”. If ozone dissolved water could be successively applied in this field, electrochemistry would make a significant contribution to society.
\r\n\r\n\t
\r\n\tOxygen-enriched water is said to promote the growth of farmed fish. Hydrogen dissolved water is said to be able to efficiently remove minute dust on the silicon wafer when used in combination with ultrasonic irradiation.
\r\n\tAt present researches on direct water electrolysis have shown significant progress. For example, boron-doped diamonds and complex metal oxides are widely used as an electrode, and the interposing polymer electrolyte membrane (PEM) between electrodes has become one of the major processes of water electrolysis.
\r\n\t
\r\n\tThe purpose of this book is to show the latest water electrolysis technology and the future of society applying it.
The increasing average age of people and the consequent rise of chronic diseases will result in a growth in the need for assistance and healthcare within the coming years. Nevertheless, this is not the only challenge that developed countries face regarding healthcare services. There is an increasing demand for outpatient care accessibility, maintaining and restoring health, as well as maximizing the independence of patients [1], [2].
While the broader field of telemedicine and/or telehealth has been used in various forms for many years, Ambient Assisted Living (AAL) systems in Telemedicine are a relatively recent innovation [3] and an emerging area of interest to service providers and consumers [4]. Smart environment is a rapidly evolving domain focused on providing personal care settings with the primary intent of supporting the patient rather than office visits with health professionals. AAL is used in a wide sense and encompasses the use of audio, video and other telecommunication technologies to evaluate patient status at a distance [5], [6]. Remote healthcare monitoring systems could aid in reducing costs and alleviating the shortage of healthcare personnel [1].
Additionally, the Internet has experienced a large growth over the past three decades, evolving from a network of a few hundred hosts to a platform linking billions of “things” globally [7]. The growth of the Internet shows no signs of slowing down and it has steadily become the cause of a new pervasive paradigm in computing and communications. This new paradigm enhances the traditional Internet into a smart Internet of Things (IoT) created around intelligent interconnections of diverse objects in the physical world. This approach enriches the AAL environment and offers new possibilities for healthcare [2].
Wireless connectivity is a feature of IoT, and is becoming increasingly used in AAL systems with intensive use of Short Range Devices (SRD) such as Radio Frequency Identification (RFID), Ultra Wide Band (UWB), Near Field Communications (NFC), Wireless Local Area Networks (WLAN), Bluetooth, ZigBee, telealarm buttons (social alarms) or domotic devices. These systems involve sensors, computing and communication devices working in increasingly dense electromagnetic environments. One emerging approach to improve the wearability of continuous ambulatory monitoring systems is to improve body-attached sensors with built-in wireless telemetry, thus freeing the user from having to carry a data recorder.
For these telemetry systems, it is likely that a large number of wireless links coexist in the same area sharing the electromagnetic (EM) environment [8]. Electromagnetic Fields (EMF) are present everywhere in our environment and will continue to increase. In this way, our environment will be surrounded by multiple mobile and stationary devices, communicating wirelessly, and working together. The level and frequency pattern of that exposure is continuously changing as technological innovation advances. Exposure to the general public cannot be avoided, since various devices emitting low-level EMF are almost omnipresent in the environment, including wearable devices attached to clothes or directly to the body. Electromagnetic Interference (EMI) can be a serious problem for any electronic device, but working with medical devices can have life-threatening consequences. Practical commercial deployment of these wireless networks requires measurements of the Electromagnetic Compatibility (EMC), as a guarantee of lack of interferences 24 hours a day, seven days a week.
Improvements in medical technology and healthcare have helped people to live longer and with a better quality of life. Nowadays, our societies are facing new challenges in terms of economically and socially supporting their ever more costly welfare systems and increasing elderly population and chronic patients. The future of health care provision will see an exchange from centralized health care services, provided in doctors\' offices, clinics, and hospitals, to ubiquitous and pervasive health monitoring in everyday life. The reason for this development is twofold. Firstly, demand for better, more comprehensive and proactive health care and health provision is steadily increasing. Long-term unobtrusive monitoring of biomedical signals to enable early-stage diagnosis of health issues represents a key component in proactive health care. Secondly, there is the requirement to mitigate increasing health care costs caused by the demographic changes of an aging society. By providing health services at a patient\'s home where the cost is lowest (as opposed to expensive clinical environments), large cost reductions seem to be feasible while at the same time providing a better quality of life [9]. New medical technologies and improvements in health information systems have benefited medical supply ordering and management, patient record administration, medical diagnosis, and the provision of patient services [10].
In recent years we are seeing great advances in all areas of technology from low-power electronics, Short Range Devices and sensor technologies to the development of new and original wired and wireless communication. These advances have already led to the development of new small-sized wireless medical and environmental sensors that are capable of monitoring the human body as well at its environment in a more efficient way. These advances in sensing, communication technologies and in software engineering make it possible to build new solutions for wearable healthcare systems and ubiquitous healthcare smart homes. With these systems, elderly people and those with pre-existing health conditions can remain in their own home, while healthcare providers can remotely monitor and advise them to improve their well being and provide them with quality healthcare.
Over the last few years, the number of short range systems has increased in residential environments. These systems provide a great variety of emerging applications such as tracking and mobile telecare and welfare, with the possibility of the inclusion of many types of conventional alarms (gas, smoke, flood, etc...). Short Range technologies provide direct benefits when applied to a healthcare environment. The main objective of these SRD is to communicate emergency situations due to domestic accidents or health emergencies. These are low-cost information gathering and dissemination devices and facilitate fast-paced interactions among objects themselves (vehicles, cell phones, habitats, habitat occupants), as well as the objects and people in any place and at any time [11]. The special implication of these devices with welfare and safety requirements involves a special interest in its operating conditions as well as in promoting correct habits of usage.
With the rapid advances in increasing computational performance while allowing for ever smaller integration sizes, on-body networks of wirelessly connected computing devices is becoming a reality. The vision of ubiquitous health (U-Health) care is addressed by this Body Area Network (BAN) and Body Sensor Network (BSN) technology [12]. As is shown in Figure 1, a network of interconnected Wireless Sensor Nodes (WSNs) in or around the body monitors a range of biomedical signals to assist in the detection and diagnosis of health - related problems.
Ubiquitous health monitoring: a Body Area Network (BAN), wireless sensor nodes, monitoring biomedical signals and remote health assistance (WRTF: wired telephony service)
In the emergent IoT approach, a wide range of SRD is used. Smart applications and services to cope with many of the challenges individuals and organizations face in their everyday lives, such as environmental and personal health remote monitoring systems. These applications would change the way societies and especially our healthcare system function and thus would have a big impact on many aspects of people’s lives in the years to come. IoT is not a mere extension of today’s Internet or Internet system. It represents intelligent end-to-end systems that enable smart solutions, and, as such, covers a diverse range of technologies, including sensing, communications, networking, computing, information processing, and intelligent control technologies. Furthermore, technical advances in miniaturization and wireless communications have enabled applications of wireless sensing and biomonitoring, using devices that are now available for general use by healthcare professionals, patients and caregivers [7], [9].
These solutions could significantly reduce the cost of welfare systems while maintaining existing hospitals and dedicated centers for people who cannot benefit from these Information and Communications Technology (ICT) solutions. U-Health Smart Home, a home equipped with ICT to support people directly in their homes, has been identified by governments and medical institutions as an important step toward financial savings, as well as a technologically and socially acceptable solution to maintain the viability of the welfare system. However, there are several obstacles to the acceptance of these solutions, some are technological, and others are more related to human acceptance in terms of comfort and business value.
a. Research objectives
Given the current pace of implementation, this work reviews the literature regarding the use of SRD in healthcare, both systematically and comprehensively, following an innovation decision framework. We provide a brief introduction on these technological options, the current challenges, and the improvements that occur as a result of the use of this new technology. Then we analyze the specific uses of SRD technology in different areas of healthcare. The potential benefits are evaluated as a driver that will promote its adoption, and possible barriers to their acceptance are identified [13].
In this work the EM conditions have been analyzed and the radiation patterns of several models of social alarm devices have been obtained. Given the increasing use of domiciliary telealarm devices, and the non-existence of previous studies of the working conditions and the emission levels, this paper analyzes two of the aspects that have to be considered to assure a proper, reliable and safe usage of these systems. The first is the compatibility with other communication networks and implanted electric devices. The second is the compliance with exposure levels threshold, to quantify and analyze the risk of exposure caused by the use of these devices.
b. Current state of knowledge
For some years now short range technology has been considered a very promising option to cope with healthcare monitoring challenges. Consequently, this work aims to show the new technological advances and which factors might explain the penetration rate in healthcare.
The appearance of smart phones has been the major developmental breakthrough in the field of wireless personal area networks (WPAN). This has conditioned to a large extent the proliferation of devices in AAL systems that use the aforementioned smart Phones as a gateway to the network.
Factors like, accessibility, price, processing and communication capacity, as well as the use of cameras, navigation systems, such as the Global Positioning System (GPS), and accelerometers allow for a great flexibility in the development of further applications. The increasing use of operating systems, such as, Android, iOS, Symbian or Windows Phones that use the Software Development Kit (SDK) allow the development of certain applications to became easier and easier. As a result, networks that are compatible with the smart phones (Bluetooth, Wi-Fi o NFC) are currently the most frequently used by devices that are found within personal area networks in the healthcare environment.
Within the area of AAL three types of wireless networks need to be considered, Wi-Fi networks, domestic networks and networks made up of social alarm devices (SAD). Wi-Fi networks because of their widespread usage, reduced price and operability with other such as PCs, tablets or smart phones are a very attractive proposition for network usage within assisted environments, without forgetting their main advantage, that of internet access. Disadvantages could be the high energy consumption and time required to establish a connection.
With regard to SAD, they are perhaps today the most frequently installed device within elderly households. Within Spain it is estimated that there are currently around 300.000 SAD and that 4% of Europeans of more than 65 years of age, have access to a device of this type [14]. The platforms of SAD are suitable for integration with other devices within the assisted environments. SAD work on a frequency of 869.2-869.25 MHz and operate under the guidelines of the Commission Implementing Decision of 8 December 2011 (2011/829/EU) [15]. Currently, as well as wristband and chain alarms there are devices to detect falls, to monitor lifestyle, to monitor biological parameters, to detect technical alarms (such as smoke alarms, flood alarms or gas emissions), medicine dispensers and many other systems and technical aids.
Within the household wireless systems the Z-Wave technology stands out. In comparison to Wi-Fi, the device runs on batteries and the speed of transmission is lower, from 9.6 Kbps to 40 Kbps. Z- Wave operates in Europe on a wavelength of 868 Mhz.
As is shown in Table 1 with regards to the possible wireless communication options the vast majority use Bluetooth for data communication, differentiating between those that use the conventional form of Bluetooth and those using the newer low consumption version. You can see that there are several devices that are certificated by Continua, which ensure compatibility of data between platforms. Far behind, we can find those that use Wi-Fi as a form of wireless communication and finally you can find some that operate with Zigbee o with ANT.
\n\t\t\t\t | \n\t\t
\n\t\t\t\t | \n\t\t
Comparative table of healthcare and wellness devices. (1) Continua Certified.
Regarding the use of Zigbee, and although not reflected in this table, you can find numerous examples of research project initiatives that have developed devices orientated towards healthcare or assisted environments and that use Zigbee as a channel for communications, however, it has to be noted that very few of these initiatives have reached the commercial markets.
In the following paragraphs, we will compare low energy Bluetooth, ANT and Zigbee.
ANT is an initiative that operates on a low power proprietary protocol, works on a 2.4 GHz frequency, and supports the following network topologies: point to point, tree, or mesh network topologies with a range of between 1 and 30 meters, reaching hundreds of meters or kilometers depending on the typology and number of nodes in the network. With regard to the consumption, it is estimated to be in terms of microamperes in latent mode (sleep) and 18 mA in wake mode (wake up) and in transmission. The transmission rates can reach 1 Gbps, but to maintain real lower consumption transmissions, only a few bytes per second are estimated with a possible lifespan of over three years.
Zigbee uses the standard IEEE 802.15.4 on a frequency of 2.4 GHz, as with ANT it can support point to point, tree, or mesh network topologies with a range of between 1 to 100 meters and reach extensive areas using mesh typology. With regard to consumption we are speaking of around 35 mA in transmission and in terms of microamperes when in sleep mode. The rate of transmission can reach 250 Kbps and have a lifespan of up to six months.
Finally, Bluetooth Low Energy (BLE) a feature of Bluetooth 4.0 under the standard IEEE.802.15.1 within a short range (up to 50 meters) can only support peer to peer and star typology, and as a result can not establish a meshed network, with a data transmission speed that can reach up to 100 Kbps. It is possible to reach low consumption levels of around 25 mA in transmission, and microamperes when in the sleep mode. The lifespan of the battery may be calculated in terms of tens of days.
a. Review of literature
The ratio of penetration of SRD and its real effectiveness in healthcare remain unknown. This work reviews technological advances on SRD, produced from 2001 to 2011, to be applied in healthcare scenarios and mainly in AAL ones.
The research methodology employed for examining the adoption of SRD in healthcare has been divided into four phases: literature collection, categorization of the selected papers, analysis of the publications included in every category and results.
Search strategy
Both automatic and manual searches were carried out on professional databases including EMBASE, MEDLINE and PUBMED in order to identify relevant articles published between 2001 and 2011. The keywords used in the searching areas of title, keywords and abstract were a combination of ‘short range device (or devices)’, ‘short range technology (or technologies)’, ‘radiofrecuency, ‘rfid (and synonyms)’, ‘bluetooth’, ‘near field communication’, ‘wlan’, ‘uwb’ and finally ‘humans’. The number of papers initially located was 653. After eliminating duplicates and other inaccurate results, 378 were excluded and 275 were finally taken into account. Other systematic reviews carried out by different authors some years or months before were also very useful in identifying and including relevant studies not located by search engines.
Publication types reviewed were: Article, Article in Press, Conference Abstract, Conference Paper, Conference Review, Editorial, Erratum, Letter, Note, Review and Short Survey. Editorials, Letters, and Opinion Papers were excluded as well as those studies which dealt with ethical and legal aspects. No restrictions were imposed on the quality of the study design.
Data synthesis
Two authors independently reviewed the selected papers in order to classify them into one of the following categories at least:
Electromagnetic compatibility
Electromagnetic health risks
Electromagnetic effects on the biological tissues
Monitored environments
Ambient assisted living
Technological assessment
A more careful reading of the summaries showed that selected papers not always matched with the focus of this review. The found papers using search engines contained the words we were looking for but they were not always in the proper context. Search engines usually work using orthographical criteria and not semantic ones and this is a great weakness in automated searches.
b. Measurements: electromagnetic laboratory evaluation
The systems of social alarm devices consist of two operational units: the buttons that are worn by the users typically hung over the neck or attached at the wrist, and the fixed unit that is connected to the home phone. When the user is in a distress situation, he can push the button, a radio frequency signal will be transmitted to the fixed unit and an emergency phone call will be made to the monitor centre.
The buttons transmit a signal that typically consists of three pulses (depending on the model) at the frequency of 869.21 MHz. These are emissions in domestic settings that can affect the electromagnetic environments and can involve the increase in the exposure to electromagnetic fields of users, patients, medical workers and people in general.
Laboratory measurements have been carried out to characterize and analyse the RF emissions of the more extended social alarm devices. The objectives were to obtain the radiation pattern in order to identify the position when the electric field is at a maximum, and to calculate the power density and the Equivalent Isotropically Radiated Power (EIRP) for each of the tested devices.
The electric field strength and other parameters of the emissions of the device under testing have been measured to examine the compliance with exposure guidelines.
The performed environmental study of the working conditions of the social alarm devices helps to quantify the exposure of assisted people and to analyse the EMC of networks and equipment that operate in the surrounding areas.
For this work five models of social alarm devices were chosen from among the most frequently used in telecare monitoring activities. These devices AMIE+ Tunstall, Neat Atom, TX4 Bosch, S37 TeleAlarm and System 5000 Smart Call, are shown in Figure 2.
Selected models of social alarm devices: (a) AMIE+ Tunstall, (b) Neat Atom, (c) TX4 Bosch, (d) S37 TeleAlarm and (e) System 5000 Smart Call.
The measurements were performed in a semianechoic chamber, shown in Figure 3 and Figure 4. The room has dimensions of 9,76 m x 6,71 m x 6,10 m, the walls are lined with a foam based radiofrequency absorber material (RANTEC Ferrosorb300) specified to have a reflection/absorption coefficient of -18 dB at the frequency of 869.21 MHz.
All of the measurements during this work were made in the far field region with respect to the sources. At 869.21 MHz, the wavelength is about 34 cm, which means the reactive near field extends to around 5.5 cm from the source (based on the usual λ/2π criterion, where λ is the wavelength). The antennas of the social alarm devices are no more than around 5 cm in size, and they are integrated inside the casing device. Hence, the radiating near field extends no further than around 1.5 cm at 869.21 MHz (based on the usual 2D2/λ criterion, where D is the maximum source dimension).
The devices tested were mounted on a manual positioning device with an EMCO 1060 motor, allowing the device to be rotated and permitted the measuring antenna to sample the radiation pattern at any angle. All the measurements were performed in vertical and horizontal polarizations; a positioner with an EMCO 1051 motor allows the changes of the position of the measuring antenna that is a VBAA-9144 Schwarzbeck biconical antenna with a frequency range of 80 MHz - 1 GHz. The instruments and devices used to obtain the radiation pattern are shown in Figure 3.
Measuring antenna and positioning devices to obtain the radiation pattern inside the anechoic chamber.
The radiation pattern of the models (a) AMIE+ Tunstall, and (b) Neat Atom are shown in Figure 4.
Radiation pattern of two models of social alarm devices: (a) AMIE+ Tunstall, and (b) Neat Atom.
After obtaining the radiation pattern, the position of each tested device at which the electric field strength is maximum was fixed. In that position the electric field strength was measured as a function of distance in horizontal and vertical polarization in the far field region in steps of 10 cm, from 0.2 m to 1.7 m. The positioning device used to determine the distances was a FSM 016, with an HD10 controller to move it automatically. This positioning device is shown in Figure 5.
Measuring antenna and positioners required for the E-field measurements inside the anechoic chamber.
The measurements were carried out with an EMI Test Receiver ESIB26, Rhode & Schwartz with a frequency range of 20 Hz - 26.5 GHz. The EMI test receiver calculates the electric field strength taking into account the antenna factor and the cable attenuation, according to the following equation [16]:
Where E is the electric field strength (dBuV/m), V is the measured voltage (dBuV), AF is the antenna factor (dBm−1), and ATT is the cable attenuation (dB). After obtaining the horizontal and vertical components, the total field strength was calculated. The power density was derived using the following equation:
Where the unit of S is W/m2 and E has now been converted to linear units. The EIRP of each tested device was calculated for comparison with the emission limit of 16.4 mW set by standard regulations [15][17]. EIRP is the power that would have to be emitted if the antenna were isotropic in order to produce a power density equal to that observed in the direction of maximum gain of the actual antenna.
The EIRP is obtained from the power density as follows:
Where EIRP is in units of W, r is the distance to the antenna in meters, and Smax(r) is the maximum power density measured at each distance in W/m2. The EIRP was calculated using the maximum measurement of power density, so the measurements of the electric field strength were realized in the direction of maximum radiation.
c. Compliance with exposure levels threshold
This research addresses the characterization of EM environments that are actually present in households, taking into account an analysis of the potential safe usage of domestic telemedicine systems. The data had been analysed with regard to potential risks and operational disturbances in accordance with existing European standards.
The field strength recorded from the tested devices have been compared with the corresponding International Commission on Non-ionizing Radiation Protection (ICNIRP) reference levels values defined for the general public depending on the working frequency [18].
It is also useful to compare the obtained levels with the thresholds for the safety and basic performance of the electromedical equipment. The International Electrotechnical Commission (IEC) Standard IEC 60601-1-2 [19], sets a minimum immunity level of 3 (V/m) for non-life supporting devices.
After calculating the parameters that characterize the emissions of the social alarm devices under testing, the results recorded are compared with the limit values set by the national and international bodies: Commission Implementing Decision of 8 December 2011 amending Decision 2006/771/EC on harmonisation of the radio spectrum for use by short-range devices (2011/829/EU) [15], and the Spanish National Table of Spectrum Location (ITC/332/2010) [17].
a. Review of literature
Although most of the papers collected only partially cover the subject matter, the research performed for this chapter clearly demonstrates the high number of publications related to SRD in healthcare during recent years.
The number of papers seems to have increased significantly since 2001 as Figure 6 shows. The 248 papers finally included in our review were classified into six categories.
Papers which mention SRD technology in healthcare from 2001 to 2011 (Npapers: 248)
However, it is important to note the lack of publications which evaluate the effectiveness of SRD in real healthcare scenarios and most of the studies found only cover technological issues as is shown in Figure 7.
Applications Areas in terms of functionality (Npapers: 248)
In this work, the two categories which are of most interest to the authors are AAL and monitored environments. Both characterize more complex scenarios, where SRD are combined with sensors to work together in a wireless network, finally connected to remote information repositories of data and software, as presented in Figure 1. Reducing hospital admissions and length of stay are main objectives in order to save economic and human resources, as well as to improve a patient’s quality of life. However, most of these outpatients are elderly, or have a temporary or permanent disability, and many have no caregivers to help and technological advances can be very useful to fulfill that goal. From 2007, as shown in Figure 8, the number of papers dedicated to these two categories has been increased.
Papers dedicated to AAL and monitored environments (Npapers: 95)
Figure 9 shows the different technologies that can provide useful help to patients, healthcare professionals, caregivers and families in emergent healthcare environments. There is a lack of published papers in the years 2001 and 2003.
Technologies shown in papers for healthcare environments (Npapers: 95)
b. Measurements: electromagnetic laboratory evaluation
Different types of social alarm devices have been analyzed taking into account their emission features, the type of wireless technology, etc... This work presents a comparison of these systems in terms of their working conditions, and parameters that provide information about the emission levels.
Figure 10 shows the variation of the power density as a function of the distance for the tested devices operating at 869.21 MHz. The power density calculated from an EIRP equal to 16.4 mW limit is shown for comparison. The ordinate axis is represented in logarithmic scale to improve the comparison between the obtained results and the set limit of 16.4 mW. Overall, the power density plots calculated from maximum electric field strength as a function of distance broadly follow the expected inverse-square dependence on the distance.
Variation of the power limit and the EIRP limit in function of distance for the five tested alarm devices: (a) AMIE+ Tunstall, (b) Neat Atom, (c) TX4 Bosch, (d) S37 TeleAlarm and (e) System 5000 Smart Call.
Table 2 shows the values of the maximum electric field strength (E), power density (S), and EIRP as a function of the distance, for two of the selected models of the social alarms devices, (a) AMIE+ Tunstall, and (b) Neat Atom.
c. Compliance with exposure levels threshold
ICNIRP guidelines contain reference levels expressed as values of the electric field strengths and power density that can be compared with measured or calculated values. All the field strengths recorded in this study are well below the corresponding ICNIRP reference level of 40 V/m defined for the general public at the working frequency (869.21 MHz) [18]. It means that electric field strength levels in healthcare home environments are apparently safe according to the health and safety requirements on the exposure of patients, professionals and the general public for protection against possible health effects from nonionizing radiation. The exposure levels thresholds stablished by the ICNIRP are shown in Figure 11.
The reference levels are not intended as limits, but are designed in such a way that complicance with them should ensure compliance with more fundamental basic restrictions.
One prominent concern to take into account is the possible interferences with medical devices. The IEC electromedical devices standard, IEC 60601-1-2 (IEC, 2002), permits radiated-immunity testing of non-life-supporting and life-supporting equipment from 80 MHz to 2,5 GHz, and safety distance limits for patient-coupled devices. This standard sets a minimum immunity level of 3 V/m for non-life supporting devices [19]. Examining the results, the maximum value of the electric field is much lower than the 3 V/m.
\n\t\t\t | \n\t\t\t\tDevice (a)\n\t\t\t | \n\t\t\t\n\t\t\t\tDevice (b) \n\t\t\t | \n\t\t||||
\n\t\t\t\tD(m)\n\t\t\t | \n\t\t\t\n\t\t\t\tE(mV/m)\n\t\t\t | \n\t\t\t\n\t\t\t\tS(mW/m2)\n\t\t\t | \n\t\t\t\n\t\t\t\tPIRE(mW)\n\t\t\t | \n\t\t\t\n\t\t\t\tE(mV/m)\n\t\t\t | \n\t\t\t\n\t\t\t\tS(mW/m2)\n\t\t\t | \n\t\t\t\n\t\t\t\tPIRE(mW)\n\t\t\t | \n\t\t
0,2 | \n\t\t\t310,662 | \n\t\t\t0,256 | \n\t\t\t0,129 | \n\t\t\t419,038 | \n\t\t\t0,466 | \n\t\t\t0,234 | \n\t\t
0,3 | \n\t\t\t249,879 | \n\t\t\t0,166 | \n\t\t\t0,187 | \n\t\t\t283,527 | \n\t\t\t0,213 | \n\t\t\t0,241 | \n\t\t
0,4 | \n\t\t\t219,518 | \n\t\t\t0,128 | \n\t\t\t0,257 | \n\t\t\t289,373 | \n\t\t\t0,222 | \n\t\t\t0,447 | \n\t\t
0,5 | \n\t\t\t196,383 | \n\t\t\t0,102 | \n\t\t\t0,321 | \n\t\t\t267,815 | \n\t\t\t0,190 | \n\t\t\t0,598 | \n\t\t
0,6 | \n\t\t\t164,764 | \n\t\t\t0,072 | \n\t\t\t0,326 | \n\t\t\t243,292 | \n\t\t\t0,157 | \n\t\t\t0,710 | \n\t\t
0,7 | \n\t\t\t142,712 | \n\t\t\t0,054 | \n\t\t\t0,333 | \n\t\t\t215,788 | \n\t\t\t0,124 | \n\t\t\t0,761 | \n\t\t
0,8 | \n\t\t\t134,910 | \n\t\t\t0,048 | \n\t\t\t0,388 | \n\t\t\t138,447 | \n\t\t\t0,051 | \n\t\t\t0,409 | \n\t\t
0,9 | \n\t\t\t105,952 | \n\t\t\t0,030 | \n\t\t\t0,303 | \n\t\t\t146,854 | \n\t\t\t0,057 | \n\t\t\t0,582 | \n\t\t
\n\t\t\t | \n\t\t\t\tDevice (a)\n\t\t\t | \n\t\t\t\n\t\t\t\tDevice (b) \n\t\t\t | \n\t\t||||
\n\t\t\t\tD(m)\n\t\t\t | \n\t\t\t\n\t\t\t\tE(mV/m)\n\t\t\t | \n\t\t\t\n\t\t\t\tS(mW/m2)\n\t\t\t | \n\t\t\t\n\t\t\t\tPIRE(mW)\n\t\t\t | \n\t\t\t\n\t\t\t\tE(mV/m)\n\t\t\t | \n\t\t\t\n\t\t\t\tS(mW/m2)\n\t\t\t | \n\t\t\t\n\t\t\t\tPIRE(mW)\n\t\t\t | \n\t\t
1 | \n\t\t\t83,361 | \n\t\t\t0,018 | \n\t\t\t0,232 | \n\t\t\t125,115 | \n\t\t\t0,042 | \n\t\t\t0,522 | \n\t\t
1,1 | \n\t\t\t85,096 | \n\t\t\t0,019 | \n\t\t\t0,292 | \n\t\t\t104,006 | \n\t\t\t0,029 | \n\t\t\t0,436 | \n\t\t
1,2 | \n\t\t\t76,252 | \n\t\t\t0,015 | \n\t\t\t0,279 | \n\t\t\t72,701 | \n\t\t\t0,014 | \n\t\t\t0,254 | \n\t\t
1,3 | \n\t\t\t73,644 | \n\t\t\t0,014 | \n\t\t\t0,306 | \n\t\t\t83,463 | \n\t\t\t0,018 | \n\t\t\t0,392 | \n\t\t
1,4 | \n\t\t\t73,285 | \n\t\t\t0,014 | \n\t\t\t0,351 | \n\t\t\t68,100 | \n\t\t\t0,012 | \n\t\t\t0,303 | \n\t\t
1,5 | \n\t\t\t64,293 | \n\t\t\t0,011 | \n\t\t\t0,310 | \n\t\t\t94,780 | \n\t\t\t0,024 | \n\t\t\t0,674 | \n\t\t
1,6 | \n\t\t\t75,860 | \n\t\t\t0,015 | \n\t\t\t0,491 | \n\t\t\t84,643 | \n\t\t\t0,019 | \n\t\t\t0,611 | \n\t\t
1,7 | \n\t\t\t59,532 | \n\t\t\t0,009 | \n\t\t\t0,341 | \n\t\t\t81,043 | \n\t\t\t0,017 | \n\t\t\t0,633 | \n\t\t
Maximum electric field strength, power density, and EIRP for two models of the tested devices: (a) AMIE+ Tunstall, (b) Neat Atom
ICNIRP reference levels and the lower limit at working frequency of social alarm devices (869.21 MHz)
The recorded values of EIRP are well below the level that would be expected based on 16.4 mW, set by the national and international regulations: Commission Implementing Decision of 8 December 2011 amending Decision 2006/771/EC on harmonisation of the radio spectrum for use by short-range devices (2011/829/EU) [15], and the Spanish National Table of Spectrum Location (ITC/332/2010) [17], so the tested social alarm devices operate in safe conditions under the set limits of EIRP.
This research identifies relevant studies which exemplify the penetration of SRD in new healthcare environments in real work flows. The evaluation of the methodological quality of studies has not been an easy task because of the heterogeneity of the papers included in the review. There are a lack of published papers in the years 2001 and 2003, as is shown in Figure 6. Most of the papers included only partially cover the subject matter.
The research performed for this chapter clearly demonstrates the high number of publications on technology assessments. However, despite the large number of studies found, there is a lack of publications evaluating effectiveness of SRD and most of the studies only cover technological assessment issues as can be observed in Figure 7. The absence of homogeneous criteria among authors to choose keywords to describe their papers may have an undesirable consequence: an indeterminate number of papers may have been omitted by search engines.
After reviewing the works it can be stated that wireless sensor nodes will play a key role in enabling the ubiquitous and proactive health monitoring and health care services of the future. To achieve the small form factors required, the reduction of node power consumption eliminates the need for large batteries and increases the energy autonomy of the node, hence reducing the amount of maintenance required. In this work several short range technologies for biomedical monitoring have been described in detail.
Future SRD and wireless sensor network applications in the health care domain are likely to require an even greater amount of data derived from a multitude of different sensors. The algorithms employed within these applications will become computationally more complex, resulting in a higher processing effort. Also, depending on the use of case scenarios, multisensory applications put higher demands on radio transmission. At the same time, the new care environments should operate on very small energy budgets, occasioanly using energy provided by harvesting devices alone, rendering power and energy-aware wireless sensor node design even more important. As well as this, the sensors need to be carried conveniently without disturbing the users\' normal way of life: small in size, with low power consumption, and using wireless communications.
The fact that in the field of healthcare applications the most studied technology is Bluetooth, as shown in figure 9, and that the percentage of studies dedicated to the assessment of the technology is higher than any other, leads to an important lack of publications on EM risk exposure and EMC between wireless networks and medical equipment.
The use of SRD in assisted environments provides a lot of benefits and an important advance in the monitoring of patients and the elderly, improving the efficiency and the quality. But these successful factors may be accompanied by drawbacks if thresholds of exposure to electromagnetic fields are exceeded and if wireless networks cause degradation in electronic medical devices, which could potentially result in deaths, serious injuries, or administration of inappropriate treatment. The study of these critical successful factors can guide not only in the promotion, but also in the prevention in the use of SRD in healthcare applications. Therefore, the new implemented healthcare solutions must consider issues with respect to EMC and regulatory compliance.
Concretely, the conclusion of the analysis of Figure 7 and Figure 9 is that there are no previous studies about AAL and monitored environments based on social alarms devices operating at 869.21 MHz, and even less about the evaluation of the EMF levels in healthcare environments, despite the fact that these social alarm devices are very widely spread in the monitoring of daily activities of the elderly.
Therefore, one of the main objectives of this study is to quantify the exposure of people, and to analyse the compatibility between equipment and networks in monitored environments by social alarms devices. The electric field strength and the EIRP are well within the guidelines set by the ICNIRP, the IEC, and the thresholds set by standard regulations. It means that electric field strength levels in healthcare home environments are apparently safe according to the operational, health, and safety requirements on the exposure of patients, professionals and the general public for protection against possible health effects from nonionizing radiation.
Although one of the findings of this study is the development of an environmental study of the working conditions of the social alarm devices, it is also important to consider the absorption of radiofrequency energy in the body of a person that wears the device. ICNIRP guidelines are also expressed in terms of specific absorption rate (SAR), measured in W/Kg, in the body tissues. To address this, a parallel study should be carried out to measure the localized SAR arising from social alarm devices in the people that wear them.
On the whole, this chapter presents an overview of the current literature regarding the ratio of penetration as well as their real effectiveness. It provides physicists, patients and healthcare providers with information about parameters, effectiveness and the safety of SRD related to healthcare applications. The subject\'s content provides useful data for technology implementers in this growing field of AAL. Pervasive healthcare has been widely approved to be the next generation form of healthcare, in which distributed, patient-centric and self-managed care is emphasized compared to the more traditional hospitalized, staff-centric and professional managed care. The integration of SRD with other pervasive computing technologies such as communications protocols and wireless sensor networks is leading to further innovative applications in the telemedicine area, particularly for ubiquitous persistent monitoring of elderly or disabled people, as well as for patient follow-up during the rehabilitation phase where self-management of medication is prevalent. In recent years, many efforts have been made to develop contactless, portable sensors for continuous vital signs monitoring. But as of now, there are no standards for the system\'s size, architecture or performance.
Poor compliance for treatment, rehabilitation protocols and medication has become a well-known problem all over the world and causes worsening of disease, death and an increase in healthcare costs. In this context, AAL offers new possibilities to support outpatients in their daily routine to allow an independent and safe lifestyle without caregivers. The objects are capable of identifying, locating, sensing and connecting, and thus can lead to new forms of communication between people and things and things themselves. The development of real smart objects should be the next step, including ingestible or subcutaneous sensor tags.
These functional advantages can be overshadowed if the exposure thresholds are exceeded or if the use of SRD causes malfunction in other medical devices.
Given the increasing use of domiciliary telealarm devices, and the non-existence of previous studies about the working conditions and the emission levels, this paper analyzes two of the aspects that have to be considered to assure a proper, reliable and safe usage of social alarm devices operating at 869.21 MHz. The first is the compatibility with other communication networks and implanted electric devices. The second is the compliance with exposure levels threshold, to quantify and analyze the risk of exposure caused by the use of these devices.
After selecting the most widely used model devices, the emission levels were measured, saved, processed and analyzed to compare them with the existing standards. The obtained results show that electric field strength levels and the EIRP in healthcare home environments are apparently safe in terms of risk of exposure and EM compatibility.
The presented study provides a global, immediate and accurate vision that can help to avoid EM interferences, and monitor the exposure to EM fields of people using and in the proximity of social alarm devices in home environments.
New health solutions based on any kind of Short Range Technology must consider the issues of electromagnetic compatibility and regulatory compliance. Currently, the degree and type of EMF exposure need to be characterized in household settings, in order to ensure that applications operate properly and exposure guidelines are not exceeded.
Financial support of this research was partially provided by the research grant DGPY 1301/08. Authors want to thank the valuable cooperation offered by the General Direction of Telecommunications and Information Technologies, Electromagnetic Compatibility Services, Madrid, and without which, the work carried out in sections 4.b and 5.b would not have been possible in any way.
Consensus agrees that the term known as “marketing” first appeared between the years 1906 and 1911 in the United States. Although its origin is linked to the act of sales and distribution by the period’s small-time merchants, Kotler believes that, instead, it was born alongside the arrival of humanity [1].
\nThe American Marketing Association (AMA) introduced the first formal definition of this discipline as “the conducting of business activities that direct to the flow of goods and services from the producer to the consumer or users” ([2], pp. 191). This definition was widely accepted by the international scientific community and is still in use today.
\nIn retrospect, marketing has experienced substantial change in its conceptualization since it first appeared. One such case is the introduction of a strategic component to the discipline during the 1980s, where a proactive vision of environmental control was created in alignment to a new idea of marketing that is capable of generating change and expanding its influence in the field [3]. In this regard, Sheath et al. [4] classified marketing into 12 different schools of thought, organizing the common denominators and components into the general theory of marketing.
\nConsidering the aforementioned, it is Kotler and Keller [5] whom proposed the new concept of marketing that best adapts to the current world. According to the authors, and from the perspective of companies, marketing is “the process of planning and executing the conception, pricing, promotion and distribution of ideas, goods and services to create exchanges that satisfy the specific objectives and organizations. Marketing management is the art and science of selecting target markets and to attract and retain customers through the generation, delivery and communication of superior value” ([5], pp. 816).
\nIn addition, the theories and domains of marketing have increased in number since the very start of the discipline [6]. Hence, the current approach of marketing now defines that it must not only be beneficial for all the relevant actors and people involved in the business but must also bring positive benefits to society as a whole [3]. These numerous changes have increased interest in marketing from various groups in society [7]. It is in this context that the relationship between marketing and innovation has been highlighted [8, 9], bringing an understanding that innovation in marketing serves to utilize and generate significant change in design, packaging, positioning, promotions, relationships, brand, and product or service pricing, all with the aim of increasing sales [3].
\nIn this regard, innovation in marketing mainly tackles client needs beyond the general scope of the product [8]. Hence being part of a corporate competitivity nurturing process that contributes to the economic development of companies and society [10, 11]. In addition, innovation in marketing can bring to (1) the rise of a new idea, such as developments or radical innovation, and (2) incremental innovation, which is incremental modification of an existing concept, thus improving it [12]. Regarding radical innovation, this includes new products or business models [12], as well as generating value over an already existing product by means of improvements [12].
\nRegardless that the literature originally considered innovation in marketing as an effect of competitivity, modern context highlights the importance of the relationship as an indicator that measures a company’s competitive level [13, 14]. This considers the fact that resource-advantage theory recognizes competitive advantage as a function of marketing, identifying a company’s capability of innovating in marketing as a true measure that demonstrates a firm’s true abilities [15, 16, 17, 18].
\nThe resource-advantage theory shows that the firm is determinant of profitability and not only the industry. This theory is based on the view that superior performance and a sustainable competitive position depend primarily on the resources of the firm [16, 18]. The key challenge is to transform imitable and substitutable resources into core competencies, which form the foundation of superior competitive positions in specific market segments [16, 17]. By doing this, these resources are developed and embedded as core competencies within the firm, not acquired, and improve with use, making them a source of sustainable competitive advantage [18].
\nThe interest in resources and capabilities highlights the role of the management and strategic development. That means the firm’s ability to make decisions regarding the resources to be allocated for the main actions to take place, where the effectiveness will be influenced by such decisions and their objectives [19]. Hence, the process of innovation transforms existing markets by creating new markets and opportunities. Furthermore, innovation encourages financial growth and is an important element in the search of sustainable competitive advantages that can ensure the survival and growth of companies [20, 21, 22, 23, 24, 25].
\nInnovation in marketing is a key factor for company survivability, growth, job creation, improved productivity, and corporate competitiveness [9, 26, 27]. To benefit from it, pioneering firms must develop organizational models that can align to the business context, client needs, and company situation [28]. Traditional business models focus mainly on creating and retaining corporate value. In retrospect, the new economic environment requires business models to ask additional questions pertaining client value and structural reconfigurations for companies in the field [29]. Such reconfigurations demand firms to develop competitive capability through innovation and collaboration with providers, clients, government agencies, and other organizations [30].
\nIn this regard, organizational capability is a work method that represents a collective problem-solving system due to its “dynamic” aspect. This dynamism is possible from its tendency to evolve in time through learning processes, which is distinctive and superior in the role of combining and assigning resources [31, 32].
\nWhen an organization possesses a specific ability, it means “the organization (or the parts that compose it) can perform an activity in a trustworthy, and at least in a minimally satisfactory manner” ([33], pp. 1244). “Minimally satisfactory” is defined as that the result of an activity complies with the minimum requirements of the organization. The use of organizational capability is linked to an action and performance. An organization possesses capability when it does something that is valued in an effective manner when compared to others. However, a case of isolated effective performance does not imply that the organization possesses the capability to solve the problem, as this would require the existence of recurring (problem-solving) patterns in time [34].
\nBased on this logic, a strong (dynamic) capability in organizational innovation in marketing would mean superior capability (in regard to the competition) to integrate, construct, and reconfigure internal competences to tackle or achieve changes in the corporate environment and diverse marketing situations [35]. Hence, understanding the determinants of innovation capability in performance is of great importance to companies, particularly when faced with markets that have different factors and competitive intensity [36].
\nThe new models of competitivity in organizations highlight the existence of strong capabilities as sustainable competitive advantages. This is due to companies having learned how to copy various systems of costs, technology, distribution, service chains, manufacturing processes, and product features [37]. This makes it important to create business models that allow for the development of dynamic organizational capabilities related to innovation and proactive response to the needs of clients, consumers, and society as a whole [35]. Thus, business model sustainability is the result of creation and transformation of organizational capability [35].
\nIn this regard, in the context of resource-based vision (RBV), a company builds a sustainable competitive advantage due to its resources and capabilities, which can be rare, valuable, inimitable, and nonsubstitutable in the market [38]. The capabilities (or competences) allow companies to use resources to achieve a desired result [39]. Thus, integrating resources and complementary capabilities encourage a generation of innovation and increase positive innovation influence, improving corporate performance [40, 41].
\nHenceforth, managing a marketing innovation project in today’s world has deeper significance than simply planning and developing a series of sequential and interrelated activities. It now requires taking actions from before the official “project development phase” by helping encourage an enabling environment [42]. This increase in complexity also requires greater coordination and collaboration efforts [43]. The latter, where knowledge and resources are exchanged, allow companies to benefit from the advantages that come from specialization, knowledge integration, and post-innovation performance [44].
\nCollaboration is defined as a type of cross-organizational integration with high levels of transparency, responsiveness, and synergy [45]. Collaboration refers to the capability of two or more actors/groups to communicate, coordinate activities, and share a team goal [22]. Concerning the aforementioned, various studies show the role of cooperation networks in the generation of innovation [46, 47]. The most common arguments presented for collaboration involve the beneficial combination of sharing risks, resources, and competences [48, 49], gaining access to new markets and technologies [50], accelerating the launch of products to the market and combining complementary skills [51, 52], encouraging joint solutions of problems [53, 54], and facilitating the generation of cocreation of value and conservation of clients [55].
\nThus, the choice to collaborate depends on balancing the risk versus the returns. Companies collaborate to acquire resources and abilities that they cannot internally produce but only when the risks of cooperation can be controlled at a tolerable level [56]. After all, there are always risks and limitations that are important to consider when collaborating [57, 58]. Based on the intangible nature of the assets in play, the probability of experiencing opportunistic behaviors and knowledge disclosure increases, hence also increasing the transactional costs required to prevent such behaviors [48, 51]. Furthermore, organizations might have difficulty in evaluating the value of a partner due to information asymmetry and the secret nature of collaboration itself [59]. In addition, each additional collaborator increases the costs of monitoring, coordination, and transactions [59].
\nIt is important not only to collaborate between companies [60], as the involvement of other agents in marketing innovation can bring positive effects to future quality of service [61]. In this respect, project changes have strategic impact when the relationship between development efforts of an area and the business results are achieved through collaboration with the agents of interest [62, 63, 64]. Agents can be other companies, trade associations, universities, and even public institutions depending on the economic sectors and objectives that are sought [65, 66, 67]. Therefore, innovation is a collective process that involves multiple actors [65].
\nWith the corporate cooperation for innovation is reflected in cocreation value, which emphasizes stakeholder participation in the various innovation processes [68]. Since “value is always co-created” and “all social and economic actors are resource integrators,” value creation is increasingly interconnected and collaborative by nature [55]. As value is “always uniquely and phenomenologically determined by the beneficiary” ([55], pp. 9), value cocreation processes can include multiple actors; thus value as an outcome is subjectively determined.
\nPerks et al. [69] define cocreation as “the joint creation of value by the company and its network of diverse entities (clients, providers, and distributors). Hence innovation is the result of the interaction and behaviour between individuals and organizations” ([69], pp. 935). Therefore innovation is the valuable potential result of interactions and meetings with the involved actors in the process of cocreation [70, 71].
\nSeveral researchers have studied cocreation value and coinnovation, highlighting the importance of commitment, teamwork, and generation of convincing experiences in the creation of value [68]. Based on the works of Sheath and Uslay [72], Vargo and Lusch [55], Frow and Payne [70], and Frow et al. [73], 12 specific different forms of cocreation can be identified: (1) coconception of ideas (i.e., solutions of public origin), (2) joint design (i.e., product personalization), (3) coproduction (i.e., working collaboratively with producer), (4) copromotion (i.e., brand community), (5) shared prices (i.e., political events), (6) joint distribution (i.e., direct and indirect distribution channels), (7) coconsumption (i.e., digital platforms), (8) joint maintenance (i.e., army), (9) cooutsourcing (external customer support and service), (10) codisposition (i.e., recycling initiatives from tech companies), (11) joint experiences (i.e., adventure-based vacations), and (12) creation of shared meanings (i.e., organizational culture).
\nRegardless that the list covers a substantial number of possible ways of cocreation, Frow and Payne [70] recognize that in the future, new ways can rise. These authors also point to the fact that one form of cocreation can jointly exist with others. Thus, in a cocreation framework value is created for all actors through a win-win perspective [74]. In this regard, the inclusion of various agents that can form part of the cocreation value process becomes the very reason that the output can be so attractive [75, 76].
\nCocreation allows companies to use the creative thought of other agents in the innovation process [77]. The sum of results in each process produces an increase in collective cocreation performance [78, 79]. Considering that cocreation generates benefits to the interested parties, it also brings forth new challenges due to the characteristics, interests, and diverse objectives that exist among the different involved actors [80].
\nThe participation of various actors (such as clients, providers, and partners) makes the cocreation value process to be complex by nature. Hence, it needs the development of new frameworks to analyze the creation of value because of numerous relationships between all involved actors, instead of only focusing on the relationship between providers and clients [74]. Based on previous research, a firm can establish collaborative activities in marketing innovation with a wide range of agents. These can be categorized as (1) those belonging to the value chain, providers and customers, with those who seek to optimize existing skills; (2) those with which new knowledge is generated, universities and research centers; and (3) those with which both ends can be sought, governments, competitors, and others [62, 63]. Thus, understanding the determinants of innovation capability in performance is of great importance to companies, particularly when faced with markets that have different factors and competitive intensity [36].
\nStrategy is defined as the logical combination of actors, factors, and actions selected among other combination alternatives to achieve a specific objective in a specific context [81]. It is the ability (of the organization) to make decisions regarding the resources to be allocated for the main actions to take place [19]. The effectiveness of project strategy management is influenced by the decisions and the objectives set during the process.
\nThe operation of a firm is focused on achieving the objectives, facing difficulties, and facing opportunities in the context in which the company carries out its activities with the capabilities and resources it possesses. Hence, in seeking to achieve its objectives, a firm will intend to ensure the development of these activities in the most appropriate manner while generating value [82].
\nIn this regard, Brand et al. [83] affirm that governance consists of setting control mechanisms, incentives, rules, and penalties and coordinating the actions of network players, which the authors define as collective structuring [84]. These elements of governance are the mechanisms used by managers and network players to ensure better control over the formal and informal aspects of the network [83]. Concerning network management, Roth et al. [85] state that management is responsible for positively influencing the members’ competitiveness and for reaching the goals proposed by the organization. The authors also list some of the roles of interorganizational network management such as member selection, planning and communication, assessment, integration, providing services to members, coordination, incentives, and controls.
\nHence, innovation management is an intentional systematic process where the level of affinity that the company has with its environment plays an important role [86]. A firm can choose to apply different innovation strategies to achieve its objectives or improve its competitive advantages [87]. Thus, innovation stops being a single act that applies novel ideas, instead becoming a manageable and susceptible process that is both measured and systematically controlled [88]. In this regard, the structuralization of innovation processes becomes the starting point of great interest for companies [86].
\nThe structuralization of innovation is managed through the stabilization of processes and the setting of conditions, restrictions, behaviors, and expected results [89]. Hence, the management of the innovation process must consider the framework, criteria, and tools for identifying, elaborating, and systemizing each of the involved activities. Under these conditions, each organization will be able to control, improve the different aspects of innovation, and thus integrate them into the total processes of the company.
\nThe literature has addressed a series of aspects related to management structure and control such as the rules, penalties, formal agreements, and control mechanisms that include leadership and coordination, which are relevant to sustain innovation initiatives [84].
\nOrganizations must take into account the relevant guidelines to build, implement, and evaluate innovation strategies adopted by the company. Innovation strategy must (a) recognize the importance of the client in the process, (b) develop strong ties with providers, (c) integrate different phases and actors in the constructive process, (d) improve the flow of information, (e) transmit knowledge of one project to another, and (f) encourage the use of rules based on the results, which are not pre-established [90]. This is important because in any collaboration process, there are risks and limitations that are considered [48, 57]. Based on the intangible nature of the assets at play, the probability of experiencing opportunistic behaviors and knowledge disclosure increases, hence also raising the transactional costs required to prevent such behaviors [51]. Furthermore, organizations might have difficulty in evaluating the value of a partner due to information asymmetry and the secret nature of collaboration itself [59]. In addition, each additional collaborator increases the costs of monitoring, coordination, and transactions [59, 91, 92].
\nTherefore, collaboration is evaluated with a largely strategic focus [48]. The option to collaborate must depend on balancing the risks versus the returns, where companies collaborate to acquire resources and skills that they cannot internally produce, if the cooperation is maintained at a tolerable level [56].
\nAs humans are social beings, the creation of networks and relationships are phenomena that span since the very start of society [93]. The social network theory states that various agents of a society find themselves connected to each other, forming communication and influence channels [94]. In this regard, networks are among the most common tools for diffusing and acquiring knowledge. A (social) network is a means for communication, bonding, advice, and support that exists between the members of a social system [95]. The features and structure of relationship networks, created by an organization, are crucial to determine the flow of idea diffusion, innovation, and sharing of experiences [94, 95].
\nAn interorganizational cooperation network stands itself on the management of relationships between its members [84, 96, 97, 98], which are composed of individual and collective interests [99, 100, 101]. The former brings new members to take part in the network to chase common goals, thus obtaining individual and collective benefits [84].
\nManagement efficiency in the relationship with agents of interest is the main source of income and opportunity that increases profitability of a business [102]. It is the ability to collaborate interorganizationally; share risks, resources, and competences; unify skills; and foster joint solutions; among others [55, 103]. Superior performance comes from market detection capability, better reception of ideas, use of information, and bonding [104]. Thus, a relationship is the repetition and maintenance of solid interactions between parties due to the existence of economic or social links between them to achieve mutual benefits [102]. The exchange based on relationships corresponds to a larger number of complex exchanges of resources and information [55].
\nIn the case of innovation, cooperation can be a dilemma due to the existence of the transfer of knowledge, abilities, and resources, which can make members distrust in participating [36]. Some of the preoccupations in the innovation process that can be considered as deterrents for collaboration can be found in the form of profit splitting of a new tech, research and development decisions, and fearing that a member can benefit more than another, among others [47, 97, 105, 106].
\nThus, the concept of networks highlights two key observations: (1) intra- and interorganizational collaboration is not simply a means to compensate for the lack of internal skills; and (2) collaboration is not a series of discrete transactions. The value and capability of a company as a collaborator are based on its internal assets, but simultaneously, the activity of collaboration will develop and strengthen those internal competences. This means that companies deepen their capability to collaborate by not only managing relations in a dyadic way but also by instantiating and refining routines for synergistic association [107].
\nIn the literature, innovation is shown in two ways: as a structural approach and as a process-oriented approach [108]. The structural approach is tradition-based by nature, where by structuralizing certain parameters with innovation, companies bring value to the users and final consumers [109]. The process-oriented approach views innovation as a complex process that follows a defined design through the interaction of various social groups at an internal and external form from the organizations [110]. Both cases understand innovation as an iteration of decisions and implementation of new ideas by people who communicate with other people [108]. In this regard, the competitive environment in which a company operates affects the benefits and costs of collaboration [111]. Disclosure costs are higher for companies in highly competitive markets, where information leaks quickly translate into loss of market share, making collaboration riskier [112, 113, 114].
\nStrategic marketing literature assumes that the key to the success of organizational processes lies in the belief that market orientation provides the capability to detect the market, have a proactive attitude toward customer satisfaction, obtain greater use of information, possess a better reception of ideas, and have a degree of connection that leads to superior organizational performance [104]. This puts the concept of market orientation as an organizational cultural approach or as an integral part of the mission, vision, and values of a company [115]. It is important to note that the perspective from the conception of generation of intelligence identifies a series of specific actions around information [116].
\nThese different approaches are considered as interrelated perspectives [117]. Strategic orientation will reflect a company’s philosophy on how to conduct business through a set of deeply held values and beliefs that guide the company’s attempt to achieve superior performance [118]. In addition, these values and beliefs define the resources to be used, transcend individual capabilities, and unify resources and capabilities into a cohesive whole [119].
\nConsidering the concept of market orientation, there is a broad general consensus that it is a combination of three critical dimensions [116]: (1) generation of intelligence on all the elements of the market (customers, competitors, and the environment), (2) dissemination or establishment of internal common knowledge of the said intelligence, and (3) development and implementation of a response action that involves the effective satisfaction of the established target audience [115].
\nThe results of this chapter should be the obtainment of improved capabilities to adapt to changes in the business environment or to obtain a proactive decision-making ability to produce competitive advantages [120, 121, 122]. Hence, a company learns to acquire and develop new relevant knowledge and skills that will help it remain competitive in the market [115, 116, 123, 124].
\nThe methodology employed is exploratory by nature. This research uses the IBM SPSS version 14.0 statistical software, with a self-administered survey through Qualtrics platform. The survey considered three sub-scales that represent each of the three variables previously mentioned. The authors used a structured questionnaire, with closed questions on an 11-point Likert scale and questions regarding business characteristics. The scale considers that the most favorable response receives the highest score, while the least favorable response the lowest score.
\nThe authors sent the survey to 580 potential participants, obtaining a response rate of 41.7%. Thus, the sample is composed of 242 executives in relevant positions in the decision-making process of industrial companies with offices in Chile. This last inclusion criterion used by the authors has the objective of ensuring that the respondents have experience within the industry. Most of the respondents had positions of management and corporate levels (56.2%) and professions related to engineering (64%). The main industrial sectors represented are the iron and steel industry (15.7%), distribution (15.3%), mining (14.9%), financial (14%), and agroindustry (12.8%). Most of the companies have clients from the national market as their main buyers (80.2%), with most of the surveyed respondents being mainly established in the central region of Chile (71.9%).
\nA confirmatory and exploratory analysis using AMOS was done to have access to the properties of latent variables. The relation of variables can be observed with a 99% of confidence, KMO over 0.6, goodness of fit of data (\n
Industrial sector | \nManagement and strategic development | \nRelations and network management | \nMarket orientation | \n
---|---|---|---|
\n\n \n\n \n\n | \n\n\n \n\n \n\n | \n\n\n \n\n \n\n | \n|
Mining | \n6.9 | \n6.1 | \n7.0 | \n
Iron and steel | \n6.5 | \n5.8 | \n6.9 | \n
Distribution | \n6.5 | \n5.5 | \n6.5 | \n
Financial | \n5.6 | \n6.3 | \n6.2 | \n
Agroindustry | \n6.7 | \n5.0 | \n5.3 | \n
Others | \n6.9 | \n5.9 | \n6.7 | \n
Average | \n6.5 | \n5.8 | \n6.4 | \n
Empirical results.
Self-elaboration; α, Cronbach’s alpha; σ, standard deviation; k, standardized coefficient.
Based on the empirical data, the degree of progress in each of the analyzed variables (see \nTable 1\n) of the different sectors of the sample has been calculated. At a general level, the study shows an evaluation value of approximately 6 points (“Often”), which turns out to be regular with respect to the maximum of 11. The level of development is 54.5%, with respect to the potential of each variable according to the perception of the respondents. The relations and network management are the least perfected capability, while management and strategy development is the most developed.
\nAccording to the results of this study (\nTable 1\n), the mining sector is the one that presents the best overall evaluation due to the sector placing great importance in considering long-term strategic planning. This in part is due to the “virtuous, inclusive and sustainable mining by 2035” plan. Nonetheless, there is still a long way to go in terms of collaboration. Regarding this point, the management of relations and networks is the factor in which the mining sector shows less development and in which the managers should emphasize their future strategies. This would allow them to increase the value proposition and get a more stable level of profitability in the long run.
\nThe agroindustrial sector is worrisome regarding their relations and network management and market orientation. The companies of this sector require a greater focus on the external analysis of clients and competitors that would help them guide their plans toward innovation in marketing. This would allow them to increase their efficiency and effectiveness of their projects in those areas. In addition, data shows that the financial sector must work with special emphasis on management and strategic development in terms of collaboration. One of the lowest values obtained in this variable is on the establishment of collaboration as a source of competitiveness.
\nAt the variable level, the study shows that strategic focus makes possible improvement on organizational innovation capabilities. Without strategic value, the efforts and resources devoted to it will always be scarce. Hence, even though they possess the capabilities to develop initiatives successfully, in practice, this will not necessarily be true. It can be observed that the companies point out that the activities they do the most are to consider the costs in their planning, to encourage the participation of different functional areas of the company in the development of a project, and to consider innovation in long-term strategic planning.
\nFor its part, relations and network management were the worst evaluated variable according to the sample. It is interesting to note how companies have better results in the network items with clients than with other agents. This shows that companies are willing to cooperate with their clients with a short-term view oriented to sales but do not find it relevant to establish promises with other agents in the long term, which would allow them to establish continuous innovation projects over time. This short-term focus on products may impair the viability of long-term business relationships, where other factors such as networking and collaborative actions have a significant impact on results.
\nIn terms of market orientation, the results show that the lowest scores come from companies investigating close to nothing on what their competitors do. Based on these results, it is possible to deduce that companies have a research process more focused to their own projects or problems than to surveillance mechanisms on what competitors do. For instance, agroindustrial sector, which was the worst ranked in this dimension. In addition, their values are significantly lower than the other sectors in the study.
\nThe chapter reveals that innovation in marketing is conceived as a process oriented to the market and the use of knowledge, which is modeled by the characteristics of the organizational culture, through a management that controls and assumes risks in its projects, often developing relevant activities collaborative in the process. The role of the degree of market orientation, collaboration, and strategic project management is highlighted as incident characteristics of the company’s capacity to reconfigure its assets and compete in current, emerging, or mature businesses.
\nCurrently, society is constantly evolving, so innovating is no longer a “nice to have,” but it has become a necessity in companies. In this context, innovation must be considered activity in the company strategic axis, where its magnitude and focus should be supported in the organizational plan. Innovating should not be just having a brilliant idea; it is generating something that creates value for the market, the organization, and/or the other agents of interest. The company must be able to identify, anticipate, and characterize its own potential to formulate the best strategy for innovation in the future. A methodology must be established to innovate and how to structure strategically innovative processes.
\nManagers should question possible gaps in the positioning map of the sector, decide to cover them, and make them grow. To develop an innovative strategy, you must question the business in which our organization is located, how we develop our processes, and what we know about the market. Reflect on our client (current and potential); analyze our availability of resources, skills, and our ability to develop new, as well as how we relate to other agents of interest.
\nAs a result, new businesses will not be discovered if they do not leave the security offered by the current ones. Innovation implies a need to be market oriented. When an organization makes the decision to innovate, it must have the ability to question how it does business and rethink it. Managers should look at new sources of their own ideas but also monitor innovation processes in their industries or in other industries, national or foreign. The key to success is not only in playing better than the competition, but in how an organization can effectively change the rules of the game.
\nHowever, having a look at strategic innovation and market orientation does not ensure success. The different mechanisms, networks, and relationships that facilitate the organization to carry out these processes must be taken into account. In this line, it is important to develop the capacity and corporate culture in the company to take risks, boost the commitment of employees, and empower them to propose ideas to innovate.
\nFor the above to be possible, it is important to promote the sharing of information between the different lines of business. But this collaboration is not just about encouraging conversations but generating structured processes that allow interacting and giving support to each of the areas on relevant issues of the process, where the contribution of the top managers is essential. To link collaborative initiatives to larger business objectives, the manager must create a comprehensive and measurable strategy that responds to the complexities of the extended enterprise. It is therefore important to adopt a methodical and detailed approach to collaboration and innovation. Collaborative initiatives should be linked to high-level business objectives, with careful attention to risk profiles and tolerance levels throughout the company.
\nHowever, collaboration must also extend beyond the company. The organization is in constant interaction with other organizations and agents that have their own knowledge of the industry and, therefore, turn out to be components that can and should influence the strategic direction of innovation processes. There is no generic list of possible collaborating agents, not even from the same sector. Each organization must identify and prioritize all those groups that can contribute to innovate, understanding that these can change over time. The prioritization criteria are ponderable, adaptable, and unique. However, a proposal of criteria could include analyzing the following strategic variables: (1) capacity of influence or dependence (current and future), (2) interest in the commitment and willingness to participate, (3) knowledge of the organization and industry, (4) geographical dimensions, and (5) social context (organizational culture, legal restrictions, etc.). Finally, the company must define the collaboration model to be developed. There are different existing tools to facilitate a model of integration of the relationship with stakeholders with different management levels that can be modulated according to the different strategic variables already raised.
\nIn conclusion, the strategic innovation depends on the sector where the organization competes, the real needs of the client, and the competitive position of the same, bearing in mind all the support of resources that the organization has, because without the operation and efficiency of these is difficult to ensure its success. Managers are required to be in a constant state of contemplation of their company, from an internal and external point of view with a long-term focus. This approach makes possible the strategic management of innovation, which becomes increasingly essential in the company.
\nThen, this study opens new lines of research and helps establish guidelines in which managers in innovation or marketing could manage their relationships with stakeholders in a proactive and efficient manner. This chapter shows a better understanding of the opportunities and challenges of organizational capability in marketing innovation, and cocreation value is achieved, allowing the identification of specific issues that need to be developed at the company and country level. For instance, long-term competitiveness for any company will depend on its ability to comprehend the environment, integrate knowledge about competitors and consumers’ needs, develop improvements, and manage the buying behavior of its customers. Furthermore, this business intelligence could be useful as a guide for businesspersons, politicians, managers, and researches, among others.
\nAuthors are listed below with their open access chapters linked via author name:
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\\n\\nFei Wei 2016-18
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\\n\\nXin-She Yang 2017, 2018
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