Priority setting in health care is a challenge because demand for services exceeds available resources. The increasing demand for less invasive surgical procedures by patients, health care institutions and industry, places added pressure on surgeons to acquire the appropriate skills to adopt innovative procedures. Such innovations are often initiated and introduced by surgeons in the hospital setting. Decision-making processes for the adoption of surgical innovations in hospitals have not been well studied and a standard process for their introduction does not exist. The purpose of this study is to describe and evaluate the decision-making process for the adoption of a new technology for repair of abdominal aortic aneurysms (endovascular aneurysm repair [EVAR]) in an academic health sciences centre to better understand how decisions are made for the introduction of surgical innovations at the hospital level.
A qualitative case study of the decision to adopt EVAR was conducted using a modified thematic analysis of documents and semi-structured interviews. Accountability for Reasonableness was used as a conceptual framework for fairness in priority setting processes in health care organizations.
There were two key decisions regarding EVAR: the decision to adopt the new technology in the hospital and the decision to stop hospital funding. The decision to adopt EVAR was based on perceived improved patient outcomes, safety, and the surgeons' desire to innovate. This decision involved very few stakeholders. The decision to stop funding of EVAR involved all key players and was based on criteria apparent to all those involved, including cost, evidence and hospital priorities. Limited internal communications were made prior to adopting the technology. There was no formal means to appeal the decisions made.
The analysis yielded recommendations for improving future decisions about the adoption of surgical innovations. ese empirical findings will be used with other case studies to help develop guidelines to help decision-makers adopt surgical innovations in Canadian hospitals.
Cites: Health Technol Assess. 2001;5(12):1-7911319991
Cites: N Engl J Med. 2005 Mar 3;352(9):857-915745974
Cites: Health Policy. 2005 Jul;73(1):10-2015911053
Cites: Int J Technol Assess Health Care. 2005 Spring;21(2):219-2715921062
Cites: BMJ. 2006 Jan 14;332(7533):112-416410591
Cites: Health Policy. 2007 Mar;80(3):444-5816757057
Cites: Am J Surg. 2002 Apr;183(4):399-40511975927
Cites: J Am Coll Surg. 2003 Jul;197(1):64-7012831926
Cites: World J Surg. 2003 Aug;27(8):962-612784149
Cites: World J Surg. 2003 Aug;27(8):930-4; discussion 934-512822049
Cites: J Health Serv Res Policy. 2003 Oct;8(4):197-20114596753
Cites: Ann Surg. 2003 Dec;238(6 Suppl):S56-6614703746
Cites: J Neurosurg. 2004 Jan;100(1):2-714743905
Cites: J Infect Dis. 2004 Mar 1;189(5):930-714976611
Cites: J Neurosurg. 1979 Jul;51(1):5-11376786
Cites: Int J Technol Assess Health Care. 1985;1(3):669-8010276734
Cites: J Vasc Surg. 1996 Feb;23(2):191-2008637096
Cites: World J Surg. 1996 Jul-Aug;20(6):687-918662153
Cites: J Gen Intern Med. 1996 May;11(5):294-3028725978