A process-oriented investigation of technology assessment in Italian hospitals: Insights and open challenges

Hospital-Based Health Technology Assessment (HBHTA) enables hospital managers and professionals to navigate financial constraints while enhancing care delivery through innovation. Past literature has focused mainly on assessment criteria, offering limited evidence on HBHTA from a process-oriented perspective.

This study aims to examine how HBHTA is operationalised in hospitals and to identify the organisational and contextual factors facilitating or hindering its routine implementation.

Evidence was collected from 16 Italian hospitals with a significant legacy in HBHTA. These hospitals vary in terms of size, governance, and specialization. Key informants were clinical engineers who chaired the HBHTA process.

The findings underscore a markedly fragmented HBHTA landscape across hospitals. While some hospitals implement structured, multidisciplinary assessment approaches enhanced by digital technologies, others resort to ad hoc evaluations shaped by immediate needs or resource limitations. In many cases, strategic leadership exerts a decisive influence on the assessment process, producing outputs that vary widely-from comprehensive HTA reports to concise recommendation briefs. Although HBHTA awareness continues to grow, its implementation remains constrained by persistent challenges, including dedicated workforce shortages, absence of standardized procedures, and insufficient monitoring of technology performance. Additionally, the post-pandemic environment has accelerated procurement cycles, often sidelining comprehensive evaluation processes. Nevertheless, encouraging developments, such as the adoption of digital platforms, prioritization frameworks, and dedicated oversight committees demonstrate potential pathways toward more systematic institutionalization of HBHTA.

This study offers novel evidence to further the ongoing debate on HBHTA. The adoption of a process-based perspective leaded to generate practical recommendations.