This project was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme (project number 05/52/01) and was published in full in Health Technology Assessment 2009; Vol.13: No.59

The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of Health.

Before utilising this section of the toolkit, it is important to recognise:

(1) Information and data on organisational elements is absent from most European HTA reports.

(2) There are no instruments/checklists that have been specifically designed to appraise the reliability of methods and the validity of results of organisational elements assessments. This is probably related to the fact that there is no single way to assess these elements.

(3) Organisational approaches differ greatly between health care settings or countries; this section of the toolkit is the least likely to produce transferable elements, and it would be advisable to supplement with local data.

However, there is increasing interest in including such information in future HTA reports. Therefore, general information regarding organisational elements is included within the toolkit. The organisational elements toolkit domain will simply serve to provide a classification of the elements, and some key questions, that should be considered when adapting this part of an HTA report.

„Organisational elements‟ refers to the ways in which health care is organised within a particular health care system, between organisations or within a health care organisation. For example, which elements of a care pathway are carried out by which organisations (inter-organisational level), which professions are responsible for which elements of care and whether the right skills exist to exploit the technology (intra-organisational level), which technologies would be supported in terms of policy or funding (healthcare system level).

When adapting information and data from organisational elements sections of an HTA report, you should consider the organisational elements matrix shown below (Figure 2).

Organisational elements matrix

The purpose of the organisational elements matrix is to help the user understand what information/data are in the HTA report, thereby helping to determine the relevance of this information for the user‟s own report.

The matrix will help the user clarify which organisational level/s (and which elements within those levels) have been considered within the report, and the type of data and method of analysis that has been undertaken to assess organisational elements. A list of the dimensions of organisational elements that can potentially be affected by the technology, and can affect the implementation of the technology, has been proposed by the EUnetHTA 2006-2008 Work Package 4 (the rows of the matrix in Figure 2 below).

How to use the matrix

It is intended that the user fills out the matrix by inserting ticks within it to show (1) the information/data available for a certain level and dimension and (2) what the user requires information/data on i.e. which levels and dimensions?

Figure 2: Organisational elements matrix

    

"ORGANISATIONAL LEVEL"

("target setting")

NATIONALREGIONALLOCAL

Organisational aspects

Utilisation

Type of data and methods of analysis

Data from research (quantitative and qualitative)

Literature reviews

Routine data

Informal knowledge and anecdotes

Judgements

Models

Work processes
(De)centralisation
Staff
Job satisfaction
Cooperation and communication
Finances
Stakeholder

Guidance Notes

Type of data/information to be collected to answer the question/s:

- Literature systematic review or/and

- In depth interviews, focus groups etc. (qualitative social research methods)

- Survey by questionnaires (quantitative methods)

- Routine data and informal anecdotes

After using the matrix

On completion of this exercise, adaptation questions to ask are (Box 12):

Question Box 12: Organisational elements domain additional questions

a) To assess relevance:

1. Are the dimensions assessed relevant for my own research questions?

If no, adaptation of organisational elements data from this report unnecessary

2. Is the analysis transferable (statistically or analytically)? (this will be dependent on the structure of the health care system and similarities of units of analysis)

A judgement will be necessary here.

3. Are the results applicable to my context?

A judgement will be necessary here.

b) To assess reliability:

4. Are the theories and methods used relevant and reliable ones?

A judgement will be necessary here.