Unpacking early experiences with health technology reassessment in a complex healthcare system

Abstract

ABSTRACTHealth technology reassessment (HTR) is an emerging evidence-based policy approach that addresses sub-optimal utilization of health technologies at the systems-level. Internationally, there are few documented accounts of HTR processes and little is known of its potential impact(s). The objective of this study is to explore and describe the initial conceptualization and introduction of HTR in a complex Canadian healthcare system, and identify factors that may contribute to successful and unsuccessful HTR initiatives. Semi-structured interviews with 22 healthcare professionals were conducted. Constant comparative analysis of interview data was used to develop a coding framework and key themes and relationships were synthesized narratively. Several necessary conditions to facilitate engagement with HTR, including understanding of the concept and process, communication, effective leadership, and adequate support, were identified. Sustaining consensual and authentic engagement was identified as critical. Four tensions influenced initial HTR experiences: strategic thinking versus immediate success; practice-based versus academic-based research; have’s versus have nots; and incenting versus maximizing value. There is significant potential to integrate HTR in a complex healthcare system; yet identified tensions require careful balancing as they can challenge implementation. These findings will help other healthcare systems to integrate HTR into their operations and advance the field of technology management.