Table 4 Definitions
Health technologies | Health products, devices and equipment used to deliver health care (eg prostheses, implantable devices, vaccines, pharmaceuticals, surgical instruments, telehealth, interactive IT and diagnostic tools). This is a narrow definition which reflects the common use by decision-makers and consumers in the local health care setting. Clinical practices, support systems, or organisational and managerial systems are NOT considered to be health technologies in this context. |
Health technologies and clinical practices (TCPs) | Therapeutic, preventative and diagnostic procedures (eg use of products, devices and equipment PLUS medical, surgical, nursing, allied health and population health interventions). This is a pragmatic term to reflect the scope of most resource allocation decisions in the local healthcare setting. |
Health programs and services | Agencies, facilities, institutions and the components within them that deliver health care, rehabilitation or population health practices such as health promotion and education. |
Disinvestment | Removal, reduction or restriction of any aspect of the health system for any reason. Removal indicates complete cessation, reduction is a decrease in current volume or delivery sites, and restriction is narrowing of current indications or eligible populations. This is a broad definition, in essence the conceptual opposite of investment. This could apply equally to products, devices and equipment; clinical practices and procedures; health services and programs; information technology and corporate systems. |
Principles | Fundamental qualities or elements that represent what is desirable or essential in a system. |
Criteria | Standards against which alternatives can be judged in decision-making. |
Routine decisions | Decisions made on a recurring basis or scheduled via a timetable eg annual budget setting processes, six-monthly practice audits, monthly Therapeutics Committee meetings, reviews of protocols at specified intervals after their introduction, etc. |
Reactive decisions | Decisions made in response to situations as they arise eg new legislation, product alerts and recalls, applications for new drugs to be included in the formulary, critical incidents, emerging problems, etc. |
Proactive decisions | Decisions driven by information that was actively sought for the purpose of healthcare improvement eg accessing newly published synthesised research evidence such as Cochrane reviews or Health Technology Assessments to compare against current practice, interrogating routinely-collected datasets to ascertain practices with high costs or high rates of adverse events, etc. |
Prompt | An informal reminder or encouragement for thought or action. |
Trigger | A formal mechanism that initiates or activates a reaction, process or chain of events. |
Diffusion | Passive processes by which an innovation is communicated over time among members of a social system; usually unplanned, informal, untargeted, uncontrolled, decentralised, and largely horizontal or mediated by peers. |
Dissemination | Active processes to spread knowledge or research eg publications, presentations and other deliberate strategies; planned, formal, often targeted, controlled or centralised, and likely to occur more through vertical hierarchies. |
Maintenance | Active processes to sustain recently implemented change after project support is removed; to integrate the change into organisational systems, processes and practices; and to attain long-term viability of the change. |
Methods and tools | Approaches, instruments or other resources that identify ‘what’ tasks are needed at each step and/or ‘how’ to undertake them. This is a pragmatic inclusive definition developed for use in this review to assist health service staff in disinvestment. This broad definition allows frameworks and models to be included if they meet these criteria. |