Organizational aspects

Last updated: 17 March 2024

What's new in this update

No new research relevant to the chapter was identified during the March 2024 update.

Introduction

Health Technology Assessments (HTAs) not only evaluate a health technology and its clinical and cost effectiveness but also consider organizational aspects surrounding its implementation, or sometimes removal, within a specific context or setting. This domain of an HTA examines how various types of resources (administrative, human, technological, etc.) need to be structured when implementing a technology. Any impacts that may result within the health care organization or the health system as a whole are considered (1,2).

In general, the organizational domain explored the following issues, but may also consider others (1,2):

1. Health care delivery processes and how the technology may affect current workflows

2. The structure of health care services and equitable access to the new technology

3. Process related costs for purchasing and setting up the new technology along with budget impacts

4. Management issues

5. Cultural issues including acceptance of the new technology by those within health care organizations

General Search Guidance

There is little information regarding the optimal methods for conducting analyses in this domain and consequently little guidance on best practices for searching the evidence base. EUnetHTA’s HTA Core Model (1) and the Danish Centre for Health Technology Assessment’s Health Technology Assessment Handbook (2) offer the most detailed guidance in this area.

In general, both sources agree that this is a challenging area for information retrieval as evidence on the organization and delivery of health services encompasses a wide range of disciplines, study types, and is spread across a variety of published and unpublished (grey) literature. The information required for this section of an HTA is often context and country specific which can result in little to no published literature being available (1,2).

It is recommended that, as a first attempt, an extensive literature search focusing on identifying systematic reviews of organizational aspects should be conducted. If no systematic reviews are available, then the search should be revised to focus on guidelines and relevant primary studies. If no relevant data are identified, the third step is to identify primary data which might involve conducting surveys or interviews of healthcare professionals and content experts. Data might also be obtained from administrative databases of the relevant organizations involved in the analysis (1). New primary qualitative research might be the only way to assess real world practice use and misuse (2).

Sources to search

A wide range of sources of published and grey literature should be searched. Other search techniques should also be considered including contacting experts and scanning reference lists of relevant papers and hand searching of journals. Information should be gathered not just from traditional health sciences literature sources but also from sources of social sciences, business, and even education literature. The choice and number of resources to search will depend on the topic of the assessment and the time/resources available for searching. At a minimum, the most commonly used databases should be consulted (1,2).

Resources recommended to search for the organizational domain include (1):

• MEDLINE/PubMed

• Embase

• Cochrane Library

• International HTA Database

• NHS EED (National Health  Service Economic Database) up to  2015
  
  In addition, the following sources could also be searched:

• health sciences databases: CINAHL, PsycInfo, Joanna Briggs Institute, any regional/country specific databases of clinical studies

• social sciences or education databases: Sociological Abstracts, ERIC

• ongoing research: EUnetHTA, ClinicalTrials.gov, PROSPERO

• grey literature: dissertations, guidelines, conference proceedings, registries and statistics, administrative data, pharmaceutical registries, working papers, industry reports, handbooks, organizational reports

 
Types of Research Studies to Include in the Search

Because of the complexity of the organizational domain in terms of the variety of literature that is needed, no single type of research study is appropriate. The evidence base may encompass many varying types of studies, both quantitative and qualitative. The HTA Core Model (1, p. 312) recommends searching for the following study types according to research question:

• health delivery process: guidelines, observational (qualitative and quantitative), RCTs, systematic reviews of RCTs

• structure of health care: guidelines, qualitative observational

• process related costs: guidelines, technical handbooks, costing and budget impact analyses

• management: guidelines, qualitative observational, consensus, protocols

• culture: qualitative observational

With this is mind, we also recommend that individuals consult the qualitative research and costs and economic evaluation chapters to aid in the development of search strategies.  

Designing Search Strategies

In terms of designing the search strategy for this topic area, there is little guidance available, and we suggest that information specialists explore published reviews and HTAs to see how others have searched for topics such as health delivery processes and health structures.

Search Filters

A few studies have tested and suggested filters or search strings, each with a specific focus, which may be considered useful in retrieving literature on organizational aspects. Wilczynski et al (3) have developed a health services research filter. Simon et al (4) have created a filter aimed at uncovering nurse staffing research.  An administrative data filter was developed by Van Walraven et al (5).  Hempel et al (6) suggest adding a search string to retrieve quality improvement interventions.  Each of these authors acknowledge that research in these topic areas is difficult to search for because of the wide variety of applicable subject headings and keywords used to describe the field (3-6). While these filters have quite good sensitivity, they all have much poorer precision which is likely to result in quite large search yields and many irrelevant records that need to be manually screened.

Additional search filters can be identified from the InterTASC Information Specialists' Sub-Group (ISSG) Search Filter Resource.

Reference list

(1) EUnetHTA Joint Action 2 Work Package 8. HTA Core Model ® version 3.0. 2016. 

(2) Kristensen F, Sigmund H. (eds.) Health Technology Assessment Handbook. Copenhagen: Danish Centre for Health Technology Assessment, National Board of Health; 2007.

(3) Wilczynski NL, Haynes RB, Lavis JN, Ramkissoonsingh R, Arnold-Oatley AE. Optimal search strategies for detecting health services research studies in MEDLINE. CMAJ. 2004;171(10):1179-85. [Publication appraisal]

(4) Simon M, Hausner E, Klaus SF, Dunton NE. Identifying nurse staffing research in Medline: development and testing of empirically derived search strategies with the PubMed interface. BMC Med Res Methodol. 2010;10:76. [Publication appraisal]

(5) Van Walraven C, Bennett C, Forster AJ. Derivation and validation of a MEDLINE search strategy for research studies that use administrative data. Health Serv Res. 2010;45(6 Pt 1):1836-45. [Publication appraisal] 

(6) Hempel S, Rubenstein LV, Shanman RM, Foy R, Golder S, Danz M, et al. Identifying quality improvement intervention publications - a comparison of electronic search strategies. Implement Sci. 2011;6:85. [Publication appraisal]