Investigating technological strategies in the hospital setting: insights from the Dutch context

Rapid advancements in technology are significantly impacting the healthcare sector, and hospitals play a vital role in adopting and implementing these innovations. With an often very decentralized healthcare system, many decisions on technology procurement, adoption and implementation are made on a hospital, department, or professional level. The latter play a significant role in prioritizing and embracing new technologies. As an attempt to better standardize the management of healthcare technologies, national bodies are experimenting with decision making at the macro level, also collaborating with the meso level. However, hospitals may have different technological visions and strategies, and may employ different ways to implement technologies, complicating centralization. The present study aims to understand the existing hospitals’ technological strategies, and their implementation, with a particular emphasis on scanning and assessment activities. To do this, the authors performed a qualitative analysis including a set of different hospitals in the Netherlands, a country characterized by a strong healthcare innovation and decentralization. We performed interviews in seven hospitals with different actors involved in technological innovation, on different levels in the organization: CEOs, medical doctors, medical physicists or similar roles, and innovation managers. Through the data analysis, we organized the results in themes and categories to better understand how technological innovation is related to hospitals’ strategies and how it is implemented. Understanding the degree of diversity in technological strategies and their implementation in hospitals helps in figuring out the feasibility of a more centralized decision-making. From our results, it emerged how hospitals generally aim to provide optimal care for patients, while academic hospitals also prioritize research and education. Some hospitals, more than others, aim at being frontrunners. Personalized and patient-centric healthcare is a common goal among the hospitals. Technological strategies are not precisely designed in hospitals. The main factors that shape them are people, financial constraints, the need to answer important questions, and the external environments. Results reveal that hospitals' scanning of emerging technologies is not systematically conducted. Information on emerging technologies is gathered from conferences, scientific literature, industry proposals, and internal knowledge sharing. Some interviewees expressed the need for better standardization and professionalization of the scanning phase. Regarding technology evaluation, hospitals employ various practices, like business cases, hospital-based health technology assessment, or randomized controlled trials, but evaluations before and after technology adoption are not consistently performed. The need for systematic assessments is recognized by some interviewees, while others emphasize the importance of experimenting without the constraint of evaluation, perceiving it as a hurdle delaying innovation. The findings of the study indicate the complexity and diversity of technological strategies in Dutch hospitals. The role of centralization in decision-making regarding the introduction of healthcare technologies is an ongoing debate to which we would like to contribute with this study. Centralization in this sense could represent a benefit for hospitals, allowing them more streamlined decision-making addressing their challenges, but in some cases it could also be perceived as a barrier. Involving hospitals’ specialists and stakeholders in centralization thus, would be crucial not to impose it from the top, but to achieve it through a joint effort between the meso and the macro level . The study has some limitations and suggestions for future research like the one of focusing on a specific hospital, involving more stakeholders, and exploring other decentralized healthcare systems like Italy.