Health technology procurement a system analysis of health technology procurement in hospitals in the Netherlands

Technology has an increasing role in the modern day health care system. Healthcare Technology Management (HTM) is an area of biomedical engineering including the domains of planning, needs assessment, selection, procurement, donations, inventory, installation and maintenance of medical equipment (WHO, 2017). This thesis deals with HTM in Dutch hospitals from the viewpoint of procurement of high-cost medical equipment. Procurement is considered the main shifting point between resources and being able to provide care with the available technology.Through literature search and semi-structured interviews, we study the decision process for health technology procurement from the hospitals perspective, to answer the following question: What procedures improve the effectiveness of the multi-layered decision making process of procurement of health technology in hospitals in the Netherlands? To be able to answer this question, three perspectives are described.First of all, actor and stakeholder interaction within the decision arena. In the hospital we can define three actor types: clinical, operational and business actors. The project team for procurement processes generally includes a project leader, medical technology and clinical physics, procurement and users. Although it is preferable to have business oriented project leaders, the role is often fulfilled by operational or even clinical actors.The second perspective concentrates on external influences on the decision arena. Two types of external influence are described: regulation and industry influence. The recently introduced agreement medical technology is considered to be the most influential piece of regulation, despite it being a directive and not a law. The agreement medical technology introduced new procedures in terms of risk analysis and justification and induced big steps towards an increasingly formalized procurement process. Despite the fact that the covenant and all other applicable regulation steers to set up procurement processes as functionally oriented as possible, relational capital appears to be important in practice. However, statements about industry interference are variable.The third and final perspective introduced a process view. Procurement processes can generally be described in six steps: specification, selection, contracting, ordering, monitoring, and, aftercare (Veeke and Gunning, 1993). However, two preceding steps are suggested which are: budgeting and initiation. Budgeting holds the allocation of a yearly budget to the division which is the result of a dialogue between applicants, an investment committee and planning & control. The initiation phase is a second gatekeeper in which the actual project initiation is justified and accepted. When we combine the three perspectives several lessons can be learnt.<br/>• Frequently a project leader lacks the competencies to lead a project properly. This has major influence on going through the project steps and the project outcome. A project leader should be a neutral actor who has no advising role towards the project team in terms of content. A competent project leader could increase buyer-supplier relationships which would decrease negative effects from disproportional social capital between physicians and manufacturers. It is suggested to consider full time project leaders with proper education to contribute to an effective purchasing process.<br/>• In the procurement process the ability to save financial resources decreases as is proceeded through the steps. Assuming that the added steps of budgeting and initiation are executed well, the specification step is crucial for the outcome of the project. Participants indicate however that the means of specification does not serve the goal. Detailed programs of requirements are the status quo but lack the ability to differentiate between options because too many basic requirements have to be registered. It is suggested to change towards a best value approach where the desired outcome is described.<br/>• A best value approach improves and demands buyer-supplier relationship. The specification and selection step melt together and the specification of solutions happens in cooperation with a manufacturer. Hospitals and the industry are dependent on each other for executing their purpose. Therefore cooperation between the two industries is already perceived as positive but legislation counteracts this. At this moment this is in this form not allowed for academic hospitals as they are subject to the tender law.<br/>We can conclude that an improved systems approach is essential for an effective procurement process and a project leader should provide in this. Having proper project lead creates the opportunity to experiment with the best value approach and break loose from the strict program of requirements homogenizing the healthcare technology market. Future research could test the potential of this method to increase opportunity for innovation for manufacturers, as well as hospitals.

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