Objective: The purpose of this study was to undertake process evaluation of the implementation of tele-care in a large care-providing organization in the Netherlands.

Method: The study was executed as a satellite study of the actual implementation of the Quiet Care tele-care system within the Proteion Care group in the south of the Netherlands. Data on the process of implementation was gathered through extensive document analysis, semi-structured interviews and participant observation. Based on these data the implementation performance and the caregivers' implementation, evaluated by the caregivers/staff/professionals, were investigated, guided by the framework for implementation from Grol and Wensing (2006).

Results: The implementation was started with an introduction to some of the stakeholders at the home-care organization. After several months of practice, there were some misconceptions on the use of the facility, i.e. the fit thereof into daily care practice. Therefore, a restart of the implementation was organized with a customized training programme focusing on the relationship between innovation and professional behaviour as the subject matter. The implementation process involved professional training conveying the (evidence-based) added value of the implemented system. This training was positively evaluated by most of the participants. After the completion of the course the care providers enrolled more new clients for the Quiet Care system and used the outcome from the data to improve daily care and adjust the nursing care plan. The outcome of this changed approach was that the innovation was more accepted by caregivers. Analysis of the implementation process revealed the lack of a formal approach: there was no underlying implementation model resulting in the lack of coherence/commitment/sense of importance from an organizational viewpoint. Caregivers in the organization found the guidance by the staff of the implementation programme very supportive to their learning needs. But such a strongly imbedded ethos in the implementation staff introduced some reluctance in other management staff involved in the programme in taking over the ownership of the implemented innovation and thereby guaranteeing a continuous improvement of the innovation over time.

Conclusion: The impact of the implementation of Quiet Care on the business processes could not previously be fully overseen. Ad hoc decisions had to be made to guarantee a continuous roll-out throughout the organization. The training participants perceived the training to be valuable because it was a) supportive in the use of the technology and b) supportive in their daily professional performances. This outcome supports the aim of the training to provide a meaningful learning environment in which the transfer of the experimental approach to daily practice could occur. The training was well evaluated and turned out to be a key element for success. The absence of a pre-formulated implementation plan proved to be a barrier for acceptance of the system at management level and hindered the uptake of the approach as part of the standard care provision. It is concluded that an implementation plan and evidencebased training programme have to be included as part of a strategy to implement health care technology in professional practice. This should be accompanied by an applied research path to observe the performance.