Publications
25 results found
Neves AL, van Dael J, O'Brien N, et al., 2024, Use and impact of virtual primary care on quality and safety: The public's perspectives during the COVID-19 pandemic, Journal of Telemedicine and Telecare, Vol: 30, Pages: 393-401, ISSN: 1357-633X
IntroductionWith the onset of Coronavirus disease (COVID-19), primary care has swiftly transitioned from face-to-face to virtual care, yet it remains largely unknown how this has impacted the quality and safety of care. We aim to evaluate patient use of virtual primary care models during COVID-19, including change in uptake, perceived impact on the quality and safety of care and willingness of future use.MethodologyAn online cross-sectional survey was administered to the public across the United Kingdom, Sweden, Italy and Germany. McNemar tests were conducted to test pre- and post-pandemic differences in uptake for each technology. One-way analysis of variance was conducted to examine patient experience ratings and perceived impacts on healthcare quality and safety across demographic characteristics.ResultsRespondents (n = 6326) reported an increased use of telephone consultations ( + 6.3%, p < .001), patient-initiated services ( + 1.5%, n = 98, p < 0.001), video consultations ( + 1.4%, p < .001), remote triage ( + 1.3, p < 0.001) and secure messaging systems ( + 0.9%, p = .019). Experience rates using virtual care technologies were higher for men (2.4 ± 1.0 vs. 2.3 ± 0.9, p < .001), those with higher literacy (2.8 ± 1.0 vs. 2.3 ± 0.9, p < .001), and participants from Germany (2.5 ± 0.9, p < .001). Healthcare timeliness and efficiency were the dimensions most often reported as being positively impacted by virtual technologies (60.2%, n = 2793 and 55.7%, n = 2,401, respectively), followed by effectiveness (46.5%, n =
O'Brien N, Soomro M, Shaw A, et al., 2023, Regional perspectives on patient safety policies and initiatives: A focus group study with patient safety leaders in the Middle East and Asian regions, BMJ Open Quality, ISSN: 2399-6641
Preventing and reducing risks and harm to patients is of critical importance as unsafe care is a leading cause of death and disability globally. However, the lack of consolidated information on patient safety policies and initiatives at regional levels represents an evidence gap with implications for policy and planning. The aim of the study was to answer the question what patient safety policies and initiatives are currently in place in the Middle East and Asian regions and what were the main strengths, weaknesses, opportunities, and threats in developing these. A qualitative approach using online focus groups was adopted. Participants attended focus groups beginning in August 2022. A topic guide was developed using a Strengths, Weaknesses, Opportunities, and Threats framework analysis approach. The Consolidated Criteria for Reporting Qualitative Research checklist was used to ensure the recommended standards of qualitative data reporting were met. 21 participants from 11 countries participated in the study. Current patient safety policies identified were categorized across 5 thematic areas and initiatives were categorized across a further ten thematic areas. Strengths of patient safety initiatives included enabling HCW training, leadership commitment in hospitals, and stakeholder engagement and collaboration. Weaknesses included a disconnect between health delivery and education, implementation gaps, low clinical awareness and buy-in at the facility level, and lack of leadership engagement. Just culture, safety by design, and education were considered opportunities, alongside data collection and reporting for research and shared learning. Future threats were low leadership commitment, changing leadership, poor integration across the system, a public-private quality gap, and political instability in some contexts. Undertaking further research regionally will enable shared learning and the development of best practice examples. Future research should explore the de
Painter A, van Dael J, Neves A, et al., 2023, Identifying benefits and concerns with using digital health services during COVID-19: evidence from a hospital-based patient survey, Health Informatics Journal, Vol: 29, ISSN: 0965-8335
Despite large-scale adoption during COVID-19, patient perceptions on the benefits and potential risks with receiving care through digital technologies have remained largely unexplored. A quantitative content analysis of responses to a questionnaire (N = 6766) conducted at a multi-site acute trust in London (UK), was adopted to identify commonly reported benefits and concerns. Patients reported a range of promising benefits beyond immediate usage during COVID-19, including ease of access; support for disease and care management; improved timeliness of access and treatment; and better prioritisation of healthcare resources. However, in addition to known risks such as data security and inequity in access, our findings also illuminate some less studied concerns, including perceptions of compromised safety; negative impacts on patient-clinician relationships; and difficulties in interpreting health information provided through electronic health records and mHealth apps. Implications for future research and practice are discussed.
O'Brien N, Li E, Chaibva C, et al., 2023, SWOT analysis of the use of digital health technologies in primary health care in the Sub-Saharan African Region: a qualitative study, Journal of Medical Internet Research, Vol: 25, Pages: 1-14, ISSN: 1438-8871
Background:In many health systems globally, digital health technologies (DHT) have become increasingly commonplace as a means of delivering primary care. COVID-19 has further increased the pace of this trend. While DHTs have been postulated to reduce inequalities, increase access, and strengthen health systems, how DHT implementation has been realised in the sub-Saharan Africa (SSA) healthcare environment remains to be further explored.Objective:To capture the multidisciplinary experiences of SSA experts and primary care healthcare providers using DHTs to explore the strengths and weaknesses, as well as opportunities and threats regarding the implementation and use of DHTs in SSA primary care settings.Methods:A combination of qualitative approaches was adopted (i.e., online focus groups and semi-structured interviews), using an online platform. Participants were recruited through AfroPHC and researchers contact networks, using convenience sampling, and included if having experience with digital technologies in primary health care in SSA. Focus and interviews were conducted, respectively, in November 2021 and January-March 2022. Topic guides were used to cover relevant topics in the interviews and focus groups, using the Strengths, Weaknesses, Opportunities and Threats (SWOT) framework. Transcripts were compiled verbatim and systematically reviewed by two independent reviewers using thematic analysis to identify emerging themes. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used to ensure the study meets the recommended standards of qualitative data reporting.Results:Strengths of DHT use ranged from improving access to care, supporting the continuity of care, and increasing care satisfaction and trust, to greater collaboration, enabling safer decision-making, and hastening progress towards universal health coverage. Weaknesses included poor digital literacy, health inequalities, lack of human resources, inadequate training, lack o
Campbell K, Greenfield G, Li E, et al., 2023, The impact of virtual consultations on the quality of primary care: a systematic review, Journal of Medical Internet Research, Vol: 25, Pages: 1-17, ISSN: 1438-8871
Background: The adoption of virtual consultations, catalysed by the COVID-19 pandemic, has transformed the delivery of primary care services. Due to its rapid global proliferation, there is a need to comprehensively evaluate the impact of virtual consultations on all aspects of care quality.Objective: We evaluated the impact of virtual consultations on the quality of primary care. Methods: Six databases were searched. Studies evaluating the impact of virtual consultations, for any disease, were included. Title and abstract screening, and full-text screening were performed by two pairs of investigators. Risk of bias was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis of the results was performed.Findings: Thirty studies (5,469,333 participants) were included in the review. Our findings suggest that virtual consultations are equally or more effective than F2F care for the management of conditions including mental illness, excessive smoking, and alcohol consumption. Four studies indicated positive impacts on some aspects of patient-centredness, however, a negative impact was noted on patients’ perceived autonomy support (i.e., the degree to which people perceive others in positions of authority to be autonomy supportive). Virtual consultations may reduce waiting times, lower patient costs, and reduce rates of follow-up in secondary and tertiary care. The evidence for the impact on clinical safety is extremely limited. Evidence regarding equity was considerably mixed. Overall, it appears that virtual care is more likely to be used by younger, female patients, with disparities between other subgroups depending on contextual factors.Conclusions: Our systematic review has demonstrated that virtual consultations may be equally as effective as F2F care and have a potentially positive impact on the efficiency and timeliness of care However, there is a considerable lack of evidence on the impacts on patient safety, equity, and patient-centredness
O'Brien N, Ghafur S, Howitt P, et al., 2023, How NHS data could benefit us all and how to build the trust needed to make it happen, BRITISH JOURNAL OF HOSPITAL MEDICINE, Vol: 84, ISSN: 1750-8460
O'Brien N, Ayisi-Boateng NK, Lounsbury O, et al., 2023, Digital health in primary health care: Current use and future opportunities in the Sub-Saharan African region, Digital health in primary health care: Current use and future opportunities in the Sub-Saharan African region, Publisher: Imperial College London
Ghafur S, O'Brien N, Howitt P, et al., 2023, NHS Data - Maximising its impact for all, Publisher: Imperial College London
Lounsbury O, Roberts L, Kurek N, et al., 2022, The role of digital innovation in improving healthcare quality in extreme adversity: an interpretative phenomenological analysis study, Journal of Global Health Reports, Vol: 6, ISSN: 2399-1623
Background: High quality is a necessary feature of healthcare delivery. These healthcare quality challenges are particularly present in areas of extreme adversity, such as in conflict settings or sustained humanitarian crises. Digital health technologies have recently emerged as an innovation to deliver care around the world in a variety of settings. However, there is little insight into how digital health technologies can be used to improve the quality of care where extreme adversity introduces unique challenges. Objective: This study aimed to identify where digital health technologies may be most impactful in improving the quality of care and evaluate opportunities for accelerated and meaningful digital innovation in adverse settings. Methods: A phenomenological approach (Interpretative Phenomenological Approach [IPA]), using semi-structured interviews, was adopted. Six individuals were interviewed in-person based on their expertise in global health, international care delivery, and application of digital health technologies to improve the quality of care in extreme adversity settings. The interviews were informed by a semi-structured topic guide with open-ended questions. The transcripts were compiled verbatim and were systematically examined by 2 reviewers, using the framework analysis method to extract themes and subthemes. Results: The participants identified several areas in which digital health technologies could be most impactful, which include engagement in care, continuity of care, workforce operations, and data collection. Opportunities for accelerated digital innovation include improving terminology, identity, ownership, and interoperability, identifying priority areas for digital innovation, developing tailored solutions, co-ordination and standardisation, and sustainability and resilience.Conclusions: These results suggest that there are conditions that favour or challenge the application of digital health technologies, even in specific areas in which
Niki O, Saira G, Arvind S, et al., 2022, Cyber-attacks are a permanent and substantial threat to health systems: Education must reflect that, Digital Health, Vol: 8, Pages: 205520762211046-205520762211046, ISSN: 2055-2076
Cyber-attacks on healthcare institutions have increased in recent years and have made headlines through the COVID-19 pandemic. With the fallout of attacks increasingly reported in academic research and in the media, there is a real urgency to address cyber-threats that must be augmented across and within health systems. Until now, clinical healthcare professionals have considered cyber-attacks on healthcare organisations a predominantly information and communication technology issue, but this perception is no longer fit-for-purpose. This commentary provides insights into the scale of cyber-attacks and their impact on staff wellbeing, arguing that cybersecurity education for all staff in healthcare organisations must be improved through online resources, simulation, and gaming. The role of national educators, policymakers, and multilateral organisations in achieving this is outlined alongside implications for future policy and practice.
O'Brien N, Shaw A, Flott K, et al., 2022, Safety in fragile, conflict-affected, and vulnerable settings: An evidence scanning approach for identifying patient safety interventions, Journal of Global Health, Vol: 12, Pages: 1-10, ISSN: 2047-2978
BackgroundThe number of people living in fragile, conflict-affected, and vulnerable (FCV) settings is growing rapidly and attention to achieving universal health coverage must be accompanied by sufficient focus on the safety of care for universal access to be meaningful. Healthcare workers in these settings are working under extreme conditions, often with insufficient contextualized evidence to support decision-making. Recognising the relative paucity of, and methodological issues in gathering evidence from these settings, the evidence scanning described in this paper considered which patient safety interventions might offer the ‘better bet’, e.g., the most effective and appropriate intervention in FCV settings.MethodsAn evidence scanning approach was used to examine the literature. The search was limited to FCV settings and low-income settings as defined by the World Bank, but if a systematic review included a mix of evidence from FCV/low income settings, as well as low-middle income settings, it was included. The search was conducted in English and limited to studies published from 2003 onwards, utilising Google Scholar as a publicly accessible database and further review of the grey literature, with specific attention to the outputs of non-governmental organisations. The search and subsequent analysis were completed between April and June 2020.FindingsThe majority of studies identified related to strengthening infection prevention and control which was also found to be the ‘better bet’ intervention that could generalise to other settings, be most feasible to implement, and most effective for improving patient care and associated outcomes. Other prioritized interventions include risk management, with contributing elements such as reporting, audits, and death review processes.ConclusionsInfection prevention and control interventions dominate in the literature for multiple reasons including strength of evidence, acceptability, feasibility, an
O'Brien N, van Dael J, Clarke J, et al., 2022, Addressing racial and ethnic inequities in data-driven health technologies, Publisher: Institute of Global Health Innovation, Imperial College London
O'Brien N, Flott K, Bray O, et al., 2022, Implementation of initiatives designed to improve healthcare worker health and wellbeing during the COVID-19 pandemic: comparative case studies from 13 healthcare provider organisations globally, Globalization and Health, Vol: 18, ISSN: 1744-8603
Background: Healthcare workers are at a disproportionate risk of contracting COVID-19. The physical and mental repercussions of such risk have an impact on the wellbeing of healthcare workers around the world. Healthcare workers are the foundation of all well-functioning health systems capable of responding to the ongoing pandemic; initiatives to address and reduce such risk are critical. Since the onset of the pandemic healthcare organizations have embarked on the implementation of a range of initiatives designed to improve healthcare worker health and wellbeing. Methods: Through a qualitative collective case study approach where participants responded to a longform survey, the facilitators, and barriers to implementing such initiatives were explored, offering global insights into the challenges faced at the organizational level. 13 healthcare organizations were surveyed across 13 countries. Of these 13 participants, 5 subsequently provided missing information through longform interviews or written clarifications.Results: 13 case studies were received from healthcare provider organizations. Mental health initiatives were the most commonly described health and wellbeing initiatives among respondents. Physical health and health and safety focused initiatives, such as the adaption of workspaces, were also described. Strong institutional level direction, including engaged leadership, and the input, feedback, and engagement of frontline staff were the two main facilitators in implementing initiatives. The most common barrier to implementation, noted largely by organizations who discussed infection prevention and control initiatives, was inadequate personal protective equipment and supply chain disruption. Conclusions: Common themes emerge globally in exploring the enablers and barriers to implementing initiatives to improve healthcare workers health and wellbeing through the COVID-19 pandemic. Consideration of the themes outlined in the paper by healthcare organizations
O'Brien N, Durkin M, Lachman P, 2021, Lessons post-COVID from national and international approaches to safety and quality in healthcare, Future Healthcare Journal, Vol: 8, Pages: e602-e608, ISSN: 2514-6645
The COVID-19 pandemic has been a challenge as well as an opportunity for healthcare. The pandemic has exposed the inherent weaknesses in health systems globally while, at the same time, revealing strengths on which post-pandemic health systems can be built. We propose lessons on improving quality and safety post-pandemic from a global perspective based on recent policy publications and our global experience. Nine possible lessons are discussed. These lessons can ensure that healthcare does not return to the old normal, but rather builds on what we have learnt as we deliver on the Sustainable Development Goals and universal health coverage. Quality and safety are an essential component of healthcare strategy. Post-pandemic systems require a transparent compassionate culture, with integration of care at its core. The workforce must be trained in the skills to improve care, and patient and healthcare worker protection (both physically and psychologically) needs to be a given. Any development of systems will best be co-produced with the people who receive and deliver care in an equal partnership. Finally, the new systems need to be conscious of emerging threats (such as the challenge of climate change), building sustainable health systems that also address the structural inequities that currently exist.
Shaw A, O'Brien N, Flott K, et al., 2021, How to improve patient safety in fragile, conflict-affected, and vulnerable settings: a Delphi study protocol, BMJ Open, Vol: 11, Pages: 1-5, ISSN: 2044-6055
Introduction There is a high burden of adverse events and poor outcomes in fragile, conflict-affected and vulnerable (FCV) settings. To improve outcomes, there is a need to better identify which interventions can improve patient safety in these settings, as well as to develop strategies to optimise their implementation.Objective This study intends to generate a consensus on the most relevant patient safety interventions from experts with experience on FCV settings, including frontline clinicians and managers/administrators, non-governmental organisations, policymakers and researchers.Methods and analysis The study uses an online Delphi research approach (eDelphi). Participants will include experts from a range of backgrounds, including those working in a variety of FCV settings. Participants will be established contacts known to the research team or recruited via snowball sampling, and will be asked to identify and rank the importance of a variety of patient safety interventions. Consensus will be defined as >70% of participants agreeing/strongly agreeing or disagreeing/strongly disagreeing with a statement. Data analysis will be completed in Microsoft Excel and NVivo. The primary outcome of the study will be a list of the most relevant and applicable patient safety interventions for FCV settings.Ethics and dissemination The study has received approval from Imperial College London Ethics Committee (reference number 20IC665). Anonymous results will be made available to the public, academic organisations and policymakers.
Shaw A, O'Brien N, Flott K, et al., 2021, The urgent need to identify and evaluate patient safety interventions in fragile, conflict-affected and vulnerable settings, Journal of Global Health, Vol: 11, ISSN: 2047-2978
Shaw A, O'Brien N, Flott K, et al., 2021, The urgent need to identify and evaluate patient safety interventions in fragile, conflict-affected and vulnerable settings, Journal of Global Health, ISSN: 2047-2978
Obrien N, Flott K, Durkin M, 2021, COVID-19: leadership on the frontline is what matters when we support healthcare workers, International Journal for Quality in Health Care, Vol: 33, Pages: 1-2, ISSN: 1353-4505
The implications of severe acute respiratory syndrome coronavirus (SARS-CoV-2, henceforth described as COVID-19) on healthcare systems globally are proving to be immense, with unforeseen impacts that are still to fully emerge. Local and national healthcare systems, hospitals and healthcare workers have been overwhelmed by the needs of patients and limited by weaknesses in resources, staff capacity and distribution networks. These circumstances impact the ergonomic conditions within which healthcare staff work and subsequently their behavioural responses.In this commentary, we argue that urgent research is needed globally to bridge the evidence gap that exists on how best to support healthcare workers with the repercussions of working on the frontline of a pandemic. Leadership on the frontline is what matters. It is not only what policies, guidelines and checklists are in place to support nurses, doctors and healthcare workers, it is the actions and behaviours of their frontline and local leaders in implementing initiatives that really make the difference.Recognizing that the leadership style, organizational culture and model of successful implementation are inextricable is the first step to ensure sustainable interventions to support healthcare workers' well-being will follow.
OBrien N, Ghafur S, Durkin M, 2021, Cybersecurity in health is an urgent patient safety concern: We can learn from existing patient safety improvement strategies to address it, Journal of Patient Safety and Risk Management, Vol: 26, Pages: 5-10, ISSN: 2516-0435
Introduction: Cybersecurity is a patient safety concern. Recent cyberattacks on healthcare institutions around the world have shown the risks to patients: from delayed treatment as hospitals and clinics are shutdown, to the threat of harm from the theft of personal data, to patient death. The recent Covid-19 pandemic has further increased cyber-attacks on health organisations. In low- and middle-income countries (LMICs) digital health, including the use of health informatics systems and electronic health records, is an increasing part of the health agenda as national governments move to scale up healthcare on the path to achieving Universal Health Coverage. Frontline healthcare workers are often warned of the dangers of data mismanagement and are advised to take precautions to ensure data is safe. However, as many workers are already overstretched with conflicting administrative priorities, cybersecurity risks are going unnoticed. Discussion: In this commentary we argue that future education and training interventions for frontline healthcare workers on cybersecurity in LMICs can benefit from lessons learned from other areas of patient safety. Validated interventions, including education and awareness programmes and other simple tools, exist which can offer guidance on how cybersecurity awareness and education may be scaled up in frontline healthcare facilities, without adding an unacceptable burden to staff. Conclusions: Efforts to develop frontline interventions on cybersecurity that can be easily implemented and sustained are essential to ensure patient safety is a top priority in a digitally reliant health system.
O'Brien N, Chi Y-L, Krause KR, 2021, Measuring Health Outcomes in HIV: Time to Bring in the Patient Experience., Ann Glob Health, Vol: 87
INTRODUCTION: Over the past decade, the global response to HIV has led to a reduction in the number of new infections, and a decrease in associated mortality. Yet, the number of people living with HIV (PLHIV) is high, with an estimated 38 million infected worldwide. As HIV shifts from being an acute terminal illness to a chronic condition, evaluating programmatic responses to HIV with sole reliance on biological markers (such as viral load or CD4 cell count) as proxies for patient health may no longer be suitable. HIV affects the lives of those infected in myriad ways which should be reflected in programme evaluations by measuring health-related quality of life, in addition to biomarkers. DISCUSSION: In this commentary we argue that there is a pressing need to review how a "good" health outcome is defined and measured in light of care systems moving towards value-based frameworks that measure value in terms of the actual health outcomes achieved (rather than processes of care), global response shifting to providing long-term care for PLHIV in the community, and integrating HIV as part of universal health coverage plans. Efforts should be directed towards validating generic and disease specific patient-reported measures of PLHIV, to identify the most suitable tools. Such efforts will ensure that patient experience is appropriately captured, especially to be used in programme or economic evaluations. CONCLUSIONS: It is only by recognising and measuring the full range of health, mental and social outcomes related to the disease that the health status of PLHIV can be fully understood.
O'Brien N, Grass E, Martin G, et al., 2021, Developing a globally applicable cybersecurity framework for healthcare: a Delphi consensus study, BMJ INNOVATIONS, Vol: 7, Pages: 199-207, ISSN: 2055-8074
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O'Brien N, Martin G, Grass E, et al., 2020, Safeguarding our healthcare systems: A global framework for cybersecurity, Publisher: World Innovation Summit for Health
Uzochukwu BSC, Okeke C, O'Brien N, et al., 2020, Health technology assessment and priority setting for universal health coverage: a qualitative study of stakeholders' capacity, needs, policy areas of demand and perspectives in Nigeria., Global Health, Vol: 16
INTRODUCTION: Health technology assessment (HTA) is an effective tool to support priority setting and generate evidence for decision making especially en route to achieving universal health coverage (UHC). We assessed the capacity needs, policy areas of demand, and perspectives of key stakeholders for evidence-informed decision making in Nigeria where HTA is still new. METHODS: We surveyed 31 participants including decision makers, policy makers, academic researchers, civil society organizations, community-based organizations, development partners, health professional organizations. We revised an existing survey to qualitatively examine the need, policy areas of demand, and perspectives of stakeholders on HTA. We then analyzed responses and explored key themes. RESULTS: Most respondents were associated with organizations that generated or facilitated health services research. Research institutes highlighted their ability to provide expertise and skills for HTA research but some respondents noted a lack of human capacity for HTA. HTA was considered an important and valuable priority-setting tool with a key role in the design of health benefits packages, clinical guideline development, and service improvement. Public health programs, medicines and vaccines were the three main technology types that would especially benefit from the application of HTA. The perceived availability and accessibility of suitable local data to support HTA varied widely but was mostly considered inadequate and limited. Respondents needed evidence on health system financing, health service provision, burden of disease and noted a need for training support in research methodology, HTA and data management. CONCLUSION: The use of HTA by policymakers and communities in Nigeria is very limited mainly due to inadequate and insufficient capacity to produce and use HTA. Developing sustainable and institutionalized HTA systems requires in-country expertise and active participation from a range of stake
O'Brien N, Li R, Isaranuwatchai W, et al., 2020, How can we make better health decisions a Best Buy for all? [version2; peer review: 3 approved], Gates Open Research, Vol: 3, Pages: 1543-1543, ISSN: 2572-4754
The World Health Organization (WHO) resolution calling on Member States to work towards achieving universal health coverage (UHC) has increased the need for prioritizing health spending. Such need will soon accelerate as low- and middle-income countries transition from external aid. Countries will have to make difficult decisions on how best to integrate and finance previously donor-funded technologies and health services into their UHC packages in ways that are equitable, and operationally and financially sustainable. The International Decision Support Initiative (iDSI) is a global network of health, policy and economic expertise which supports countries in making better decisions about how best and how much to spend public money on healthcare. iDSI core partners include Center For Global Development, China National Health Development Research Center, Clinton Health Access Initiative, Health Intervention and Technology Assessment Program, Thailand / National Health Foundation, Imperial College London, Kenya Medical Research Institute, and the Norwegian Institute of Public Health. In May 2019, iDSI convened a roundtable entitled Why strengthening health systems to make better decisions is a Best Buy. The event brought together members of iDSI, development partners and other organizations working in the areas of evidence-informed priority-setting, resource allocation and purchasing. The roundtable participants identified key challenges and activities that could be undertaken by the broader health technology assessment (HTA) community to further country-led capacity building, as well to foster deeper collaboration between the community itself. HTA is a tool which can assist governments and development partners with evaluating alternative investment options in a defensible and accountable fashion. The definition and scope of HTA, and what it can achieve and support, can be presented more clearly and cohesively to stakeholders. Organizations engaging in HTA must develop
O'Brien N, Gore-Boot J, Gelb AW, et al., 2018, 71st World Health Assembly, Geneva, Switzerland 2018, Anesthesia and Analgesia, Vol: 127, Pages: E73-E75, ISSN: 0003-2999
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