TABLE 4.
Strengths and weaknesses of each HB-HTA organisational model in the context of HTA implementation at Polish hospitals.
| Strengths | Weaknesses | |||
|---|---|---|---|---|
| Hospital perspective | Health care system perspective | Hospital perspective | Health care system perspective | |
| Independent group | •“Pioneers” advocating/ promoting HTA units at hospitals | •Meaning of bottom-up initiatives aligned with internal needs | •Unacknowledged importance of HB-HTA among hospital management | •The absence of activity in HB-HTA |
| •“Pioneers” promoting evidence-based medicine approach | •Consideration of managerial effectiveness | •Informal HTA process (high level of hospital latitude) | •Inability to compare practices | |
| •Low level of engagement by “Pioneers” contingent on competence and time capacity | ||||
| •Bias among clinicians with experience in national HTA | ||||
| •Promoting national HTA at the hospital level by clinicians (losing the hospital perspective) | ||||
| Integrated-essential HB-HTA unit | •Initiating lefts of competence in HB-HTA | •Positive pressure on external institutions with lower competency in HB-HTA | •Low general activity level in HB-HTA | •The absence of sufficiently standardized procedures enabling comparisons |
| •Synergies in resources and competence boosting the HB-HTA process and decision-making ability | •Initiating networking activity with others, e.g., hospital clinics | •Low level of formalization | •Limited outreach of HB-HTA | |
| •Promoting hospital managerial effectiveness | •Creating opportunity to compare HB-HTA reports | |||
| Stand-alone HB-HTA unit | •formalization of HB-HTA unit in the organization chart of a hospital | •Bolstering managerial effectiveness of the hospital | •Cost of running an HB-HTA unit | •Good practices limited to a particular hospital without outreach |
| •Capabilities in HB-HTA for hospital managers | •Potential promoting criterion for best managerial practices at hospitals | •Limiting autonomy of hospital managers in making investment decisions | •The absence of sufficiently standardized procedures enabling comparisons | |
| •Center of excellence for developing HB-HTA capabilities for healthcare professionals | •formalization of process adversely impacting the willingness to initiate investments in new technologies | |||
| Integrated-specialized HB-HTA unit | •More structured approach to making investment decisions | •Ability to compare cost-effectiveness of assessed technologies | •Formal established collaboration practices with the national HTA agency | •Integration with national HTA |
| •High specialization in assessment domains (e.g., economic evaluation of health technologies) | •Ability to identify good practices in HB-HTA | •High level of formalization in division of work within an HB-HTA unit | •High standardization of HB-HTA methodology and processes | |
| •Improving the managerial and financial effectiveness of a hospital | •Improving effectiveness of public resource allocation in the hospital sector | •Proliferation of organisational structure | ||
| •Potential criterion for more favourable tariffs related to healthcare services | •Higher administrative costs | |||
Authors’ own study based on: Sampietro-Colom, L., Lach, K., Cicchetti, A., Kidholm, K., Pasternack, I., Fure, B., Rosenmöller, M., Wild, C., Kahveci, R., Wasserfallen, J.B., Kiivet, R.A., et al., The AdHopHTA handbook: a handbook of hospital-based Health Technology Assessment (HB-HTA); Public deliverable; The AdHopHTA Project (FP7/2007-13 grant agreement nr 305018); 2015. Available from: http://www. adhophta.eu/handbook. Access online: May 25, 2020. L. Sampietro-Colom, and J. Martin (Eds.), Hospital-Based Health Technology Assessment: The Next Frontier for Health Technology Assessment (pp. 39–44). Springer. https://doi.org/10.1007/978-3-319-39205-9_4.