March 2012 - Institute of Physics and Engineering in Medicine

SCOPE | MEETING REPORTS
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to reflect the Trust’s priorities. Mini-competitions were
arranged to assess the equipment offered by different
suppliers. Trust staff focussed on clinical, technical,
training and support, and innovation and product
development aspects. NHS Supply Chain scored the
financial submissions, dividing the financial by the nonfinancial
scores to determine a final score which was
presented to the Trust for awarding contracts. The
process reduced expenditure to £17 million, partly
helped by transferring some existing equipment. Tina
emphasised the significant staff time required,
acknowledging the support available for equipment
projects, including that from NHS Supply Chain.
Paul Webb took us through the selection of a
specialised item of equipment used for operative spinal
cord monitoring. Justification of need was not
contentious – expiry of the existing lease. But the
processes take time, in Paul’s example it was over a year
from identification of need to equipment delivery:
assembling the team; researching alternatives (contacting
suppliers, other users and arranging demos), and
comparing them (based on assessment criteria,
specification and making logical judgements). Key
functional characteristics may emerge during the
process, highlighting the need to fairly and openly
include them in the assessment. This does not mean
altering the specification or criteria to suit a preferred
solution, a concern which was raised by the audience.
The specification will develop and change during the
initial research phase, but the tendered specification
becomes a contractual document between the procurer
and bidders. The procurement report is an important
document that weighs up the evidence, leading to a
recommendation. Who should play a leading role The
speaker argued that the skills and experiences of
scientists and engineers make them well placed to
specify and assess medical equipment, working with
procurement officers.
ADOPTING HEALTHCARE TECHNOLOGIES
Susan Peirce (Cardiff University) addressed the
adoption of innovative healthcare technologies. Susan
noted that ‘innovation’ is a concept with a lot of
desirability, supported by a variety of recent reports. But
the take-up of innovative technologies is still
problematic, with multiple agencies and processes
involved (the ‘innovation landscape’). Just because
something works well does not mean it will be
successful. Technology does not exist in isolation; it has
users, environment, accessories and patients. The human
and organisational influences on the decision(s) to adopt
something novel are many and varied. Sociological
research methods are needed to examine and explain
them, for example interviews, focus groups, document
analysis and surveys. Such research indicates that
concepts such as ‘evidence’ and even the technology
itself, considered to be relatively defined and fixed, are
actually highly variable and dependant on individual
perceptions or viewpoints. ‘Evidence’ is usually
interpreted as meaning peer-reviewed papers, but these
are often not available for new devices. Clinicians want
high-quality data, but tend to value personal experience
(e.g. free samples) or recommendations from trusted
colleagues more highly than the available publications,
and may even ignore evidence for newly recommended
practices where they lack confidence in their use. The
same piece of technology takes on different ‘identities’
depending on the background and priorities of the
person considering: an expensive toy, a Trust’s marketing
opportunity, a useful surgical tool. The ‘reality gap’
FIGURE 2.
Evidence-based
specifications
enable
comparison of
apples with
apples, rather
than apples with
oranges (Angela
Dunigan, NHS
Supply Chain).
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28 | MARCH 2012 | SCOPE