On the use of economic evaluation of new technology in helicopter emergency medical services

Abstract

When evaluating new technology in helicopter emergency medical services (HEMS), economic evaluation is normally part of the assessment. The outcome of economic evaluation may provide fruitful insight for the decision-makers, but, due to the complexity of the HEMS system, it is challenging to perform such evaluations in this context. A change in the components affects the whole system, and a lack of consideration of system components and their interactions may lead to unintended economic consequences when implementing new technology. Ultimately, this may cause a negative contribution to overall patient safety. We propose a conceptual methodology, using a systems model as part of the economic evaluation. The article is a revised and expanded version of a conference article presented at ESREL 2017, Slovenia.

Contributions to risk management : On the balance between value creation and protection

“…Although the SEIPS model requires all the relevant components within a work system to be described individually, it forms a framework which emphasises the interactions between the components, in order to provide a deeper and broader understanding of how they influence each other, the processes and outcomes [27]. If any changes occur within a work system, for example that a new technology is introduced, they have possible positive or negative effects on the other work system components, processes and outcomes (see, e.g., [87]). The SEIPS model can identify such implications, which is why the SEIPS model is attractive for the purpose of identifying and structuring relevant knowledge elements, on which a risk assessment can be based.…”

“…Following the single component characterisations, the analyst has a basis to identify interactions among the components that are relevant for the processes. This is more challenging and time-consuming than the single component considerations, but it is also likely to be more rewarding, given that the risk of missing knowledge elements is greater among the interactions [87]. Different approaches are possible [50], but we recommend starting by pairing two and two components and their characteristics, for example the person's level of training and the tasks' complexity, then proceeding with person and physical environment, and so forth.…”

“…A prerequisite for all these methods to be fully informative is that the content of the background knowledge is of high quality, covering, for example, all the relevant assumptions. To identify all the relevant and critical assumptions, however, is not always straightforward, especially if the situation of interest is complex [53,87]. Take the case of evaluating the background knowledge associated with a risk assessment.…”

“…Another practical problem is that it is not feasible to consider all possible knowledge elements; thus, the analyst must limit the identification and assessment of knowledge, to some extent. However, a more or less arbitrary approach to these tasks does not appear to be the optimal solution [87].…”

“…The SEIPS model is relatively easy to use and suitable for most systems and activities, as it forms a general basis for identifying and describing system components and interactions. In addition, the model provides a starting point to evaluate how critical the identified knowledge elements are with respect to the risk assessment; thus, the framework is also a means to increase the trustworthiness of the risk assessment and inform the decision-maker about the quality and uncertainty of the background knowledge [87]. Although the suggested framework can inform the decision-makers about the knowledge, which is an important dimension of risk [16], it is also a means to provide information on which the other system models can be based, such as the Workgroup Occupational Risk Model or Storybuilder [18].…”