Health managers can influence HTAs

Dr Máirín Ryan, Director of Health Technology Assessment (HTA) with HIQA, describes how stakeholder engagement fits into technology assessment, and why senior health managers should get involved.

Dr. Mάirίn Ryan
Dr. Mάirίn Ryan

HTA is a structured form of evidence-based research that generates information about the clinical and cost-effectiveness of health technologies. Technologies can include drugs, medical devices, diagnostic techniques, surgical procedures, and public health programmes such as cancer screening programmes.

A HTA may also look at the social, ethical, medico-legal and organisational issues associated with use of a technology, including its resource implications and budget impact. Fundamentally, a HTA typically answers a number of questions about a technology: can it work; does it work; is it efficient; is it affordable? HTA is used as a decision support tool: the information provided by the HTA is used to inform health policy decisions regarding the investment in (or disinvestment from) these health technologies.

Senior managers are often in a position to identify critical factors that may influence whether or not a technology or intervention will work when adopted.

In HTA, stakeholders are the interested parties affected by a funding decision for a health technology and may include senior health managers, patients or their representative organisations, and service providers. Stakeholder engagement is an iterative process of actively soliciting the knowledge, experience, judgment and values of individuals selected to represent a broad range of direct interests in a particular issue. The use of stakeholder engagement facilitates the creation of a shared understanding, and can ensure that an assessment generates relevant, transparent and effective advice. Stakeholders provide a form of quality assurance of both the process and the content of the HTA.

Stakeholder involvement at all stages of the HTA process can help to ensure that the assessor takes all relevant and important issues into account, that the advice and reporting in a HTA are accessible, transparent, and user-friendly, and that the findings reach those impacted by the decision (such as senior health managers and affected patients). If conducted correctly, stakeholder engagement is mutually beneficial for the assessor, the stakeholders, and the decision makers.

Engagement can be in the form of consultation, participation, or a combination of both. Consultation allows the assessors to obtain feedback from stakeholders on specific documents or findings that have been made available to the stakeholders. Participation, through an expert advisory group for example, can be used to actively involve stakeholders at all stages of the assessment to ensure their concerns are understood and considered, and to give them some influence on and ownership of the resulting advice.

Senior health managers have a direct interest in which technologies are funded. They also have very substantial organisational experience, and therefore can make valuable contributions to assessments. Senior managers are often in a position to identify critical factors that may influence whether or not a technology or intervention will work when adopted. They may also be able to ensure buy-in at an organisational level, thereby leading to the successful implementation of new interventions. Therefore, the involvement of senior health managers in stakeholder engagement is vital to ensure the accuracy and relevance of technology assessments.