Abstract
Health organizations are under pressure to increase their performance while reducing the use of resources. Tensions between financial, institutional social, clinical and professional goals impose a reorganization of the health care setting (Di Pietro, 2003). The school of thought that has been able to capture the different aspects of the health care context and to propose a pragmatic solution, concrete and consistent with the changes taking place, relates to Clinical Governance (Grilli e Taroni, 2004). Health Technology Assessment (HTA) is one of the principal tools of Clinical Governance. HTA represents a multi-disciplinary approach that allows the analysis of different technologies, examining their economic, social, clinical, ethical and organisational implications (Drummond et al., 2008). While hospitals are recommended to organize systematic assessments of innovative and consolidated health technologies, no scientific evidence is available nowadays concerning the most appropriate organization of hospital HTA units. This research project aims to investigate if team work is a relevant solution for better appropriateness in the HTA evaluation at hospital level. Teamworking is another important principle of Clinical Governance, as it is assumed to increase the effectiveness and the efficiency of the organization's performance (Scally e Donaldson, 1998). However, while previous research investigates team work within clinical pathway; little is known about clinicians' team work behaviors in more managerial processes. By investigating the team performance of HTA units, the study highlights if the existing models in the literature are suitable within the specific Italian setting, in order to identify the variables that determine and predict the effectiveness and efficiency of a HTA teams operating at hospital level. Study design In order to achieve the above mentioned objective, a study design consisting of four logical phases was developed. First, a literature review was conducted, concerning: i) the specific features of the health care setting and the professional bureaucracy, ii) different operative and organizational models of HTA at hospital level, iii) team work in general and in the specific health care setting. Second, content analysis on data collected by 11 interviews and the participant observation was conducted, in order to select the specific variables able to predict team performance in the specific context of the HTA at hospital level and in order to build a framework of hypothesis on the relations between the variables. Third, a survey on 95 professionals, grouped in 38 units was conducted. All individuals attended a training course on the HTA issues and every unit produced a complete assessment using a specific the IMPAQHTA model. All the professionals involved in the assessment completed a self-reported questionnaire and were interviewed to get their insights concerning: i) teams' features; ii) time spent to implement the model and to elaborate the report; iii) nature and typology of the evaluated technologies; iv) variables referring to the hospital setting where the assessment was conducted; v) presence or absence of the hospital commitment; vi) level of trust within the working team and vii) degree of psychological safety perceived and viii) level of organizational support received from the hospital host of the evaluation. Finally, the collected data were analyzed considering descriptive statistics, frequencies and distributions. Secondly, inferential analyses were conducted. Multiple-regression Analyses were applied, using the Statistical Package for Social Science (SPSS – version 22.0) software. Findings The HTA units under investigation evaluated 38 different technologies, across various Northern Italy hospitals. The HTA units were composed by an average of 2 individuals; in particular, 71% was multi-dimensional, whereas 29% was mono-dimensional. In order to achieve the above mentioned objective, it was important to distinguish the results according to input and process variables of the teams involved in the analysis. According to the external evaluation, multi-dimensional teams were more effective than mono-dimensional ones, even if they spent more time to implement the framework and to produce the report. The key factors of HTA effectiveness were the presence of hospital commitment and multidisciplinary composition, which was moderated by the level of trust between team members. Instead, when the evaluation was requested by the strategic management board of the Hospital, teams were less efficient and spent more time to complete the HTA report. It is necessary find a solution to this problem and it's possible to find it between the organizational models resumed by the present literature on this topic. Originality/value The original contribution of this project is to underline and study all the determinants influencing the HTA team effectiveness and efficiency in the drawing of an HTA report. These results could explain something that literature has not yet investigated, providing solutions to both the scholars of HTA and the hospitals' strategic management boards. Next steps Future research will investigate a feature of Gagnon's (2014) Ambassador model, i.e. the presence of a coordinator role in the HTA evaluation, and improve knowledge on the role of leadership in HTA teams at hospital level. In the future, it is also necessary to study more carefully the heterogeneity within the groups and to test the team working in the real context and not in the experiment.