4.1

Hospital managers and leading clinicians do not have a clear idea of what HB-HTA is, how to do it, how they could benefit from it or its role in the hospital.

As a leader of an HB-HTA unit, develop a clear idea, objectives, mission, vision and values for your unit. Identify key people in your hospital (CEO, CMO, hospital managers, leading clinicians), then transmit this message through different activities, such as presentations or face-to-face meetings. Communicate how an HB-HTA unit can contribute to the hospital’s performance, under which circumstances and in what situations.

Afterwards, reshape the objective of the HB-HTA unit and its products based on these interactions with key people (CEO, CMO and leading clinicians).

Suggested content for the message to key people:

• What HB-HTA is.
• The benefits of an HB-HTA unit for the hospital – how the unit can influence a process of adopting health technologies (HTs) (use examples from other HB-HTA units worldwide).
• Your vision of an HB-HTA unit in the hospital, recognising its organisational aspects, profile and position in a region/country, weaknesses and strengths that could be linked to the HB-HTA unit.
• How an HB-HTA unit can reinforce the strengths and overcome the weaknesses of the hospital.
• A plan, a broad picture, of how you envisage that the unit will act in the hospital.

4.2

The adoption and recognition of the new HB-HTA unit has been slow, although in principle it was designed and agreed upon.

Urge managers to comply with what was agreed.

One solution could be to involve the HB-HTA unit more effectively in other existing leadership functions, such as budget planning or procurement functions, or establish close links with a specific clinical department.

4.3

HB-HTA often includes research and quality-of-healthcare activities, hence there could be a potential area of conflict between the envisaged HB-HTA unit and other units in the hospital dealing with research, quality etc. The other units may feel threatened by the emerging HB-HTA unit.

Keep the people in the other units concerned involved in the communication of your HB-HTA unit’s developments and activities. Invite them to contribute to your work if need be.

HB-HTA is dealing with competences in research and quality. Make them understand that HB-HTA is eclectic and complementary to their activities.

4.4

The HB-HTA unit is not usually a separate organisational entity, but is located inside other (bigger) entities, such as the innovation directorate, the quality and research department, the medical directorate, etc. As a consequence, the unit is not visible in the organisational chart of the hospital.

Strive to have your HB-HTA unit included in the organisational chart of the hospital, or make sure that your unit is highlighted as a part of the bigger entity.

4.5

Some clinicians feel threatened and fear that the HB-HTA unit will take sole responsibility for the adoption of new HTs and consequently, the clinicians will no longer be deciding on the adoption of HTs.

Inform clinicians that the activities of your HB-HTA unit are aimed at supporting the process of HT adoption, in which clinicians have a key role. Make it clear that your HB-HTA unit will help to make the process of adoption systematic, objective and faster than previously . Stress that a prerequisite for making this happen is a close collaboration between your HB-HTA unit and relevant clinicians.

4.6

It is unclear whether the results from an HB-HTA report are informative, recommendatory or mandatory, and to whom the results have to be reported.

As a leader of an HB-HTA unit, reach an agreement with decision-makers of the hospital (CEO/CMO) on whether the results from the assessment are informative, recommendatory or mandatory.

4.7

The role of the HB-HTA in the hospital is not understood; it is not clear whether the HB-HTA unit is a decision-making or administrative body or has other roles in the hospital.

Define the role of your HB-HTA unit in the decision-making process of the hospital and communicate it to all stakeholders at the beginning of the HB-HTA process.

5.1

While starting an HB-HTA unit, you are not considered a strong leader in terms of HB-HTA skills.

• Connect locally, nationally and internationally with leaders in HB-HTA from other hospitals and try to get their support or coaching in the process of setting-up your HB-HTA unit. This will allow you to learn from others and get credibility in the field of HB-HTA.
• Start to work collaboratively with the connections you have established.
• To gain strong leadership skills, try to be involved in all the HB-HTA activities of your unit (at least for a time), to improve your visibility.
• Disseminate results of your HB-HTA unit through the internal and external links you have established.

5.2

The HB-HTA unit is not visible to the hospital staff.

Promote your HB-HTA unit and its role in the long-term investment policies of the hospital.

5.3

Acceptance of HTA by the medical community is still a problem.

Communicate the fact that rational, objective and comprehensive decision-making based on your work is essential for quality of care, especially in a context of severe economic pressure. A significant part of your HB-HTA efforts should go into communication.

5.4

Getting information about the activities of your HB-HTA unit to reach key stakeholders (clinicians) is troublesome.

Liaise with heads of clinical departments and attend clinical rounds (department clinicians’ meetings when they usually discuss clinical pathologies) in order to inform them about the activities of your HB-HTA unit.

5.5

Promoting a good external communication policy is troublesome.

Liaise with the communication department of your hospital and try to make your HB-HTA unit visible on the website, intranet, communication materials, leaflets, social media and other hospital platforms.

6.1

It is not clear on what basis HTs to be assessed should be prioritised.

• Ask clinical departments to list HTs they are keen to introduce in the upcoming months/years, so that you can anticipate the workload and prioritise tasks with your final supervisor (CEO/CMO).
• Use the hospital’s general strategic planning to guide the prioritisation of HTs.

6.2

It is not understood why certain technologies are selected for the assessment process and other (major) investments are implemented without evaluation.

Establish explicit criteria for the inclusion of HTs in the HB-HTA process and communicate it to the stakeholders. Notice that the culture of the hospital may have an influence on the process. Consequently, some HTs may not follow this process (even if exclusion and inclusion criteria are in place).

6.3

Manufacturers or clinicians exert pressure for certain HTs to be assessed quickly .

Show these parties your prioritisation criteria and explain to them why their request is not highly prioritised (if this is the case). To do this, it is important to have the prioritisation criteria explicitly described.

6.4

Some clinicians use the HB-HTA process to gain access to technologies they want to carry out experimental research on.

The scope of HB-HTA process needs to be clarified and communicated more efficiently.

If there is a real need to assess experimental technologies, the HB-HTA unit could be involved, but a specific process should be defined.

6.5

Some clinicians want to introduce a cutting-edge, almost experimental, technology to compete with others hospitals.

• Disclose the reason for including a technology in the assessment process.
• Perform a preliminary assessment report and launch a decision for test use. Suggest a re-evaluation after a period of data gathering and mention it in the HB-HTA report.

6.6

The new HT is submitted for assessment at a very early stage of development (e.g., in the absence of clinical evidence, but with animal studies).

• Define the minimum clinical evidence needed to initiate the HB-HTA process.
• Look for CE-marking, FDA Status, Cochrane Controlled Trials Register or other databases (ongoing trials) and check if any other institution has already been exposed to the same new technologies. This information helps to determine the maturity of a new technology.

6.7

The current volume and type of clinical trial activities which involve the use of HTs in the hospital are unknown to the HB-HTA unit’s staff.

Formalise a collaboration with the clinical trial activities unit in your hospital in order to know which technologies are tested and what the manufacturers’ roles are.

7.1

Since the HB-HTA unit is small, there is no time for disinvestment activities.

Address disinvestment by means of a question (in the body of an HB-HTA report) e.g. “Is there any other technology currently used in the hospital that could be replaced if the proposed technology were introduced?” Then answer the question based on contributions from key stakeholders in your hospital.

7.2

The identification of the HT in which to disinvest is not always simple and immediate.

Set-up a working group involving clinicians, hospital buyers, biomedical engineers and other interested parties, in charge of evaluating each year the possibility of disinvestment in the light of current practice and technology evolution.

8.1

Identified ways of adaptation, innovation and improvement of an HB-HTA unit are conflicting with the hospital’s overall plan for adaptation to changing environment, innovation and improvement.

Make a strong case with facts and figures why you are contemplating improvements to and innovations in your HB-HTA unit. Explain this to the right key person responsible for the hospital strategic plan.

In order to make your case strong, have a clear track record of your achievements and developments vis-à-vis what you are proposing and why it is going to be important for the hospital.

8.2

The HB-HTA unit’s staff lack certain skills related to increasing needs for improvement and innovation.

When you draw up your budget, always save some financial resources for training your staff in how to adapt to a changing environment (resources that can be spent on training your staff in skills related to improvement and innovation).

8.3

The HB-HTA unit does not have enough autonomy to select its areas of activities freely.

As your HB-HTA unit matures, strive for a certain level of autonomy and freedom of action. Make this endeavour known to the head of your supervisory body. Your position in terms of autonomy may be reinforced by seeking diversification of funding for your HB-HTA unit (e.g. applying for innovation, research projects).

9.1

Some parts of the HB-HTA report you want to share include confidential information (prices, use of resources, etc.).

Select the parts that can be shared and disclosed openly and anonymise or remove confidential information.

9.2

The HB-HTA report you want to share includes difficult-to-understand technical language.

At one of your joint meetings, ask clinicians and hospital managers to identify any difficulties they have with understanding parts of your HB-HTA report; then amend the report using their suggestions to make the language more accessible.

Perform a similar task with one of your HB-HTA unit members who has not been involved in the production of the report.

9.3

Hospitals are not willing to share their results by submitting their HB-HTA reports to the national database of HTA reports (if one exists) or with other hospitals.

The establishment of a regional structure of both an HTA agency and HB-HTA units or a well-defined network of hospitals with HTA units could promote a mechanism for sharing knowledge and experience among HTA organisations and other HB-HTA units as well as among hospitals with HB-HTA units.

9.4

The HB-HTA unit wants to produce its HTA reports in English, but this is often not accepted by the decision-maker.

Write the main text is in English, but with marginalia and an extensive executive summary in the local language (e.g. you could use a template based on EUnetHTA HTA Core Model for Rapid Relative Effectiveness Assessment).

9.5

Public disclosure of the whole HB-HTA report might be a problem for subsequent scientific publications.

Restrict the “out of hospital” sharing of the HB-HTA report to the abstract and key findings until the publication process is completed.

9.6

It is difficult to gain common understanding of where to store the HB-HTA reports for public access.

The AdHopHTA database or a national HTA agency database could be an option.

10.1

The collaborative assessments produced jointly by hospitals and the national or regional agency take too long to be able to answer the informational needs of the hospitals.

Discuss the problem with the national HTA agency leading and coordinating the assessment process.

10.2

There is low awareness at national or regional HTA agencies of the existence of HB-HTA reports.

Communicate closely with the national or regional HTA agency to increase awareness and send them each new HB-HTA report with a covering letter (if possible).

10.3

Hospital management hesitate over allocating staff resources on local/international collaboration.

Show them that the redundancies of international HTA production represent a waste of public HTA resources. Communicate with them about the positive collateral effects that these activities will bring to hospital.

10.4

It is not known who is doing HB-HTA in your region/country.

• Look for local and international HTA programmes and try to link up with them.
• Present your work at local and international scientific meetings devoted to HTA and hospital healthcare. By doing so, you will also be able to identify who is doing HB-HTA through informal contacts.

10.5

An HT is not sustainable for the hospital, but it could be cost-effective for the regional healthcare system.

The establishment of a regional structure for HTA or a well-defined network of agencies could promote the identification of “hub” centres with a specific funding system for HT not fully reimbursed by the health insurance system.

11.1

The stakeholders inside and outside the hospital (e.g. researchers, library services, administrative and financial staff) do not know about the HB-HTA unit.

Use webpage, networking, offer courses in HB-HTA.

11.2

Some clinicians fail to inform the HB-HTA unit when introducing a new technology.

Try to reach the administrative director of the clinical department and prompt him/her to play a “gate keeper” role in order to refer the clinicians to the HB-HTA unit.

11.3

Administrative data (e.g. consumption of an available medical device or drugs in a specific period) which are required to define the future activity of the assessed HT have to be requested from other units.

• As far as possible, the HB-HTA unit should have direct access to all the hospital’s relevant clinical and administrative data.
• If this is not possible, an authorised person should be officially designated as responsible for the transmission of these data to the HB-HTA unit.
• Close links and constant interactions with hospital professionals who can provide with data should be ensured.

11.4

Other hospital districts are not aware of what HT has been assessed elsewhere.

Set up a shared database and alerts between regional hospitals.

11.5

Clinicians in other hospitals are not aware of the HB-HTA unit’s existence.

• Visit smaller hospitals in order to learn more about their needs. Engage them in the work and encourage the use of your HB-HTA as a tool for introducing new technologies. Contact national or regional hospital organisations to make your work known.

11.6

There is no funding to support collaboration with partner HTA units nationally or internationally.

Advocate networking to improve the quality and efficiency of your HB-HTA unit.

11.7

The HB-HTA unit is not connected with external organisations.

• Get in touch with a range of external partners with profiles relevant to HB-HTA (e.g. academic specialists, hospital staff, medical libraries) and ask them for help in reviewing and commenting on your HB-HTA reports. Start with those closest to you (inside your hospital), then look for outside alliances.
• Make alliances with universities, centres for health research, Cochrane Collaboration Groups, national regional agencies that may be in possession of unpublished results that may be useful for your HB-HTA report.

11.8

Problems occur when another hospital asks the HB-HTA unit for an HB-HTA report.

The establishment of a regional HTA structure or a well-defined network of HB-HTA units in the region with the support of the regional HTA organisation, could promote a mechanism for sharing knowledge and experience among HTA organisations and other hospitals and between HB-HTA units from different hospitals.