• Favor representatives visits to establish direct relationships with medical specialists and key actors;|
• Emphasize the incremental benefit harbored by the technology;
• Group together as an association to make unified claims;
• Lobby for funding, promoting innovation, and proposing new ways to reach the main users of the technology.
|In reaction to|
A new set of rules|
• The context of bureaucratization and current budget restriction complicated, codified and institutionalized exchanges between actors;
• A new set of rules has emerged;
• There is a large difference concerning the latitude and the freedom of agency between managers and appraisers, as well as medical specialists.
An increasing number of actors|
• “It can be difficult to explain something very complex in a short message to an increasing number of different actors”;
• Efforts are increasingly targeted towards medical specialists, while less informative information (and therefore, less technical features) is provided to the other actors involved in the acquisition process.
A misalignment of goals|
• The need has to be clearly identified by purchasers and it has to coincides perfectly with the technological offer;
• “The champion is frustrated, because he says we do not understand and yet we have needs; the industry is frustrated because it has a champion, and does not understand why it’s not working; managers are frustrated because they would like to try it but they need more information”;
• “Administrators do not take the patient’s health into account because they rely only on their annual budget”;
• Resistance to change may be much greater than the simple fear towards newness found in the target users of the new technology;
• “Even though we have this study and had the money to do it people must still be prepared to use and pay for it.”
A complex bureaucratic hierarchy|
• “People have new positions in newly recreated decision-making bodies that were not even there when the initial decisions were taken; the latter cast doubt on decisions that have been taken before.”