Multi-criteria decision analysis for the assessment of non-clinical hospital services: Methodology and case study

Non-clinical hospital services to support clinical activities, such as the sterilization service and clinical engineering, are an important technology asset in healthcare, and require constant improvement aimed to reduce economic burden and increase quality. The selection of the most effective healthcare service to adopt in a healthcare facility is a multi-criteria decision problem that classical Health Technology Assessment, being mostly focused on medicines, vaccines and medical devices, cannot easily address. Here we present a methodology based on Multi-Criteria Decision Analysis allowing a full assessment of non-clinical hospital services and supporting the selection of the most suitable solution in a certain environment. The methodology involves two different panels of experts: the first one includes international professionals and is aimed at selecting the assessment criteria that are relevant to the target service; the second one is a local panel whose members know the needs and peculiarities of the specific healthcare facility. This approach allows the final decision makers to take into account changes and constraints of their environment, but examining criteria that are internationally recognized as of interest. The proposed methodology, tested in a real context of an Italian Local Health Authority, is versatile and can be applied in any context, even out of the healthcare domain, especially if data in the literature are not sufficient to allow comparisons with similar services in different settings. Abbreviations: HTA, Health Technology Assessment; NCHS, Non-Clinical Hospital Services; CSSD, Central Sterile Services Department; MCDA, Multi-Criteria Decision Analysis; ASM, Local Health