The ‘O’ Gap

Dr Tracey TayStaff Anaesthetist, John Hunter Hospital

Clinical Lead, Partnerships, Innovation and ResearchHunter New England Local Health District

@traceymtay

The answer

• Health is a team game

• The goal is wellness

• There has to be a plan

• There has to be leadership

Why the ‘O’ Gap

The biggest learning at the KP Sidney Garfield Innovation Centre?

The OPERATIONALISATION GAP

Innovations failed to implement when the end-

users were not involved from the beginning

HNECC and MNC Research Hub

HNE LHDCalvary Mater Central Coast LHDMid-North Coast LHDHNECC Primary Health NetworkHunter Medical Research InstituteUniversity of NewcastleUniversity of New England

HTA Platform

• To develop a sustainable HTA platform for the HNECC MNC HUB that informs, guides & promotes the implementation of cost-effective health technologies and policies, with the aim of optimising patient outcomes.

…a multidisciplinary process that provides evidence-based information about the clinical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased and robust manner

…a bridge between health research and decision-making

What is Health Technology Assessment

Health Technologies

• Devices

• Drugs

• Procedures

• Guidelines

• Policies

• Models of care

Interviews

• Clinicians

• Managers

• Researchers

• Committees

• Acute care

• Community health

• Primary care

Interview questions

• How do you/your unit/facility/organisation currently make decisions about the introduction of new technologies?

• What information do you use?

• How confident are you that you’re making good decisions?

• What would help you to make better decisions?

Life cycle of health technologies

•Invention

•Horizon scanning

Innovation

•Primary research

•Secondary research

•Health economic evaluation

Initial research and evaluation •Assessment

•Decision

•Procurement

•Implementation

Adoption

•Appropriate use

•Monitoring

•Feedback

Optimisation •Superseded by a better, safer technology

•Found to be unsafe

Disinvestment

Global evidence Local decisions

Findings

• Some formal structures

- New Interventional Procedures Committee

- Procurement Advisory Committee

- New Devices Committee

- Quality Use of Medicines Committee

- Drug and Therapeutics Committee

Findings

• Informal processes

₋ Introduction of new consumables in the operating theatre

₋ Introduction of new dressings in primary and community nursing

₋ Department Equipment “wish lists”

Findings

• Lack of confidence in decision-making

₋ Multiple requests competing for the same budget

₋ Variable levels of evidence provided

₋ Variable skill in interpreting the evidence

Decision-making in the Hub

Contingency Decision-making Framework (based on AdHopHTA 2015

Findings

• Variation between the needs and capabilities of metro and rural areas

• Lack of visibility and access to people and organisations with HTA skills

Knowledge and skills available in the Hub

• Clinical research design and statistics

• Health research economics

• IT

• Bioinformatics

• Clinical trials

• Evidence synthesis

• Ethics

• Clinical risk

• Human factors

• Epidemiology

• Needs assessment

• Administration support

• Evaluation

• Knowledge management

Findings

• Most energy and rigour in the early stages of the technology life cycle

• Minimal emphasis on the optimisation of use and disinvestment end

Proposal for a HTA Platform

• International best practice in HTA practice

• Increase ‘HTA literacy’ and skills

• Align current resources with decision-making needs

• Leverage and support current committees

• Share knowledge and HTA across the Hub

• Support measurement of outcomes

Create new knowledge

Improve the use of current evidence

Increase HTA literacy for clinicians and managers

HTA Platform for HNECC MNC Research Hub

Increase HTA literacy

• Portal for knowledge sharing

- Previous HTAs

- Templates and other tools for simple HTA to guide decision-making

- Links to regional resources (people, funding)

• Education

- Workshops

- Grand Rounds

Cost-effectiveness plane

Improve the use of current evidence

• Provide independent, expert ‘rapid reviews’ of evidence and evidence synthesis

• Formal HTA protocols

• Provision of specialised support

- Ethics

- Aboriginal Health Impact Statements

- Human Factors

- Clinical Risk

Create new knowledge

• Workshops for new researchers

• Health economic evaluation (cost-effectiveness)

• Clinical trials support for local innovations

HTA Platform

• To develop a sustainable HTA platform for the HNECC MNC HUB that informs, guides & promotes the implementation of cost-effective health technologies and policies, with the aim of optimising patient outcomes.

What should our HTA structures and processes look like?

Commonwealth Government Review of HTA (2009)

• sustainable

• transparent, accountable and independent

• consultative and reflective of Australian community values

• administratively efficient

• flexible and fit for purpose

• informed by robust and relevant evidence

Why are we here?

Improving the health

of the population

Improving the

experience of care

IHI Triple Aim

Controlling cost

Quadruple Aim

• Improving the health of the population

• Improving the experience of care

• Controlling cost

• Improving the experience of staff

Health is a team game

Thank you!