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Table 1 Needs assessment

From: Development, implementation and evaluation of an evidence-based program for introduction of new health technologies and clinical practices in a local healthcare setting

Needs Evidence of need
Identified at initial consultation  
 Appropriate and representative views in decision-making Limited availability of committee members to attend meetings at short notice
 Sufficient preparation time for committee members to review applications Applications provided to committee members 24–48 h before meeting
 Increased awareness of requirement for authorisation of new TCPs New TCPs introduced in the organisation without application or authorisation
 More easily accessible application materials Applicants expressed difficulty accessing application materials
 Explicit criteria for decision-making Lack of documentation for how and why decisions were made
 Increased transparency in decision-making process Lack of documentation of actual decisions
 Mechanism to appeal decisions Applicants are unaware of recourse when they are unhappy with decision
 Resources to monitor newly introduced TCPs Technology/Clinical Practice Committee (TCPC) run by Ethics Committee Secretariat without any additional resources
 Reporting of outcomes following introduction of new TCPs No reporting structure or requirements
 Resources to develop, maintain, evaluate and improve rigorous systems and processes TCPC run by Ethics Committee Secretariat without any additional resources
 Electronic communications to reduce inefficiency and inconsistency All correspondence in hard copy
Identified during program development  
 Appropriate categories of information about new TCP provided to decision-makers Existing application form did not address all principles in Victorian Department of Health guidance
 Appropriate detail in information about new TCP provided to decision-makers Existing application form allowed applicants to determine level of detail provided
 Issues of access and equity are considered Not in previous Monash Health application form or Department of Health guidance
 Opportunities for disinvestment of current practice following introduction of new TCP are identified Not in previous Monash Health application form or Department of Health guidance
 Standardised recommendations and conditions to capture and implement decisions Not in previous Monash Health application form or Department of Health guidance
 Increased understanding, skills and resources in evidence based practice Applications contained inappropriate information to establish evidence of effectiveness
 Availability of expertise in assessing costs and health service resource utilisation Applications contained limited information about costs and resource use
 Process to assess when new TCP can be considered ‘standard’ practice, monitoring can be ceased and special patient information is no longer required. New TCPs are introduced in a ‘probationary’ model. Outcomes are collected and reported and patients are informed that the TCP is new to the organisation and is being monitored.
 Process to assess ‘change in use’ of current TCP to identify any potential risks for the patient, clinician and organisation as a result of the change Current use of TCPs may change to address a new indication or different patient population, if there has been modification to the equipment or technique, or if there are new operators or practitioners.
 Process to assess organisational issues (eg capacity, credentialing, funding) for research applications HREC application process did not address these issues adequately
 Process for approval in urgent or emergency situations is in place Not in previous Monash Health application form or Department of Health guidance
 Communication, collaboration and streamlining of processes between the Therapeutics, Technology/Clinical Practice, Human Research Ethics and Clinical Ethics Committees Applicants submitting to one committee are often asked to submit to a second and sometimes third committee. This results in considerable delays in decision-making and requires additional documentation of the same information on different forms
 Patient information sheets are of high quality and consistent with Monash Health patient information format Brochures submitted by applicants do not meet recognised standards of patient information, do not cover and are not consistent with Monash Health format
 Data collection is accurate and produced in a format that can be collated with others for monitoring and reporting Many clinicians have no knowledge, skills or experience in data collection