Table 3

Included studies under study type ‘evaluations or pilots of proposed purchasing processes’ (n=2)

Study name	Type of article	Journal	Year	Country	Setting	Device/equipment	Main aim of paper	Research methods	Intervention/approach	Lessons/outcome	Limitations
Kuper et al32	Journal article	BMJ	2011	UK	3 hospitals	Oesophageal Doppler cardiac output monitor for fluid administration	To identify barriers to procurement and implementation of oesophageal Doppler monitoring.	Evaluation of process (across hospitals): comparative before (retrospectively available data from matched controls)/after (prospectively collected data from patients) study for patients’ outcome data; qualitative data from survey of anaesthetists and meetings.	A campaign for adopting technology in major surgical specialties explored clinical and managerial barriers throughout the procurement and implementation process. A business case was prepared by each team with support from NHS Technology Adoption Centre, allowing senior management to overcome the unequal spread of costs versus benefits. A survey of anaesthetists revealed concerns about familiarity with the device, which we dealt with by clinicians volunteering to ‘champion’ the technique, supported by standard training provided by the manufacturer. Team encouraged appropriate use of the technology by collecting intraoperative patient-related data and postoperative patient outcomes and by giving regular, timely feedback.	Managerial barriers consisted of silo budgeting, difficulties with preparing a business case and fears about uncontrolled implementation. By collecting outcome data, we convinced senior managers to support and sustain investment. Clinical barriers consisted mainly of scepticism regarding clinical effectiveness and worries about training. Clinicians ‘championing’ the technology took on responsibility for data collection, education, advocacy and spanning boundaries. The project generated a web-based guide to provide tools and resources to support implementation. Patient outcomes improved after managerial and clinical barriers to implementation were identified and overcome.	Non-randomised ‘before and after’ project. Despite matching for specialty and severity of operation, the control and implementation groups had differences in age and physical status scores. Results could have been confounded by other changes occurring over the same time period. At one site, in elective colorectal surgery only, a multidisciplinary enhanced recovery programme was introduced and may have contributed to the observed improvement. Any implementation study of this type is vulnerable to a Hawthorne effect, whereby performance improves as a result of close observation.
Larios et al42	Journal article	Technology and Health Care	2000	Greece	1 hospital	Microbiology equipment such as blood analysers, and medical imaging modalities such as CT, MRI, ultrasound and typical X-ray equipment	To streamline the management process related to procurement to increase efficiency using a management information system (Biomedical-equipment Information System, BIS).	Evaluation of process (within hospital): process model development; pilot test conducted to measure time cycle of procurement process.	Proposing a procurement process for new hospital sites or expanding sites using a management information system: addressing the tasks of: (a) defining appropriate biomedical equipment specifications; and (b) supporting the selection of the best bids among a huge range of alternatives on the basis of quality, cost and time efficiency of the process. The proposed redesigned process was evaluated during the assessment of bids during the equipment purchasing process of the Microbiology and Radiology Departments of a large hospital complex in Athens, Greece, as a pilot application. This paper proposes a streamlined decision-making process, addressing the tasks of: (a) defining appropriate biomedical equipment specifications; and (b) supporting the selection of the best bids among a huge range of alternatives on the basis of quality, cost and time efficiency of the process.	The success criteria of the proposed process are time cycle and efficiency gains in the biomedical equipment procurement procedure, consistency gains and information integration, knowledge reuse and shifting the core of the decision maker’s work towards operations that are of more judgemental than data-handling nature. Time cycle of the biomedical-equipment procurement process has been reduced from an average of 154 days to an average of 92.5 days.	None listed.