• Independent advice to policymakers
on all aspects of
health care and health insuranceWHAT?
• Collect and analyze objective
information from healthcare data,
scientific literature and clinical practice
• Use it to conduct scientific studies and
5. Life cycle of a KCE report
byKCE Identify team
(int or ext) ;
if external :
Public call for
Already part of KCE’s research,
BUT not systematic or diversified
relevant - unambiguous - realistic
openness - scientific rigor and objectivity
8. Key principles – Who?
Stakeholders are those who
o are affected
o have interests
o are able to influence
9. Key principles – Why?
o gathering information
(relevant questions - unambiguous results - realistic recommendations)
o identification of controversy
12. Key principles – How?
o Trustworthiness and respect
o Own involvement
o Openness; ‘perplexity’
o Objectivity and fairness
o Leadership and support
13. Current experience at KCE
1. Longstanding practice
2. Involvement of Board
3. Involvement of Communities
4. To be understood by...
5. Stakeholders vs experts
6. Independence is a priority
7. Clear distinction to include in
9. Evaluation of impact
10.Knowledge base of
11. Motivations of SH involvement
12. Adaptation to each project
13. Several levels of involvement
14. Key values are crucial
15. Steering committee
16. EMA and citizen’s panel
17. Timing is an obstacle
18. Patient’s involvment is the
19. Ready to share all
15. Strategic objectives
Individual interviews ‘typical’
stakeholders K K + +
Individual interviews key
informants + K + K
K + x
K K K
Scenario Building Exercise
Online discussion groups/list
Survey (Web, telephone, paper
self-administered, ...) K +
Use of social media
+ + +
+ + K +
16. Strategic objectives
APPROACH 1 – On-site visits to healthcare providers or institutions
Example(s) KCE Reports 20 [Molecular Diagnostics in Belgium], 2005
KCE Reports 46 [Home Monitoring of Infants in Prevention of
Sudden Infant Death Syndrome], 2006
Objective Make the subject tangible (with the focus on the clinical and
Timing At the onset of the project.
Providers/healthcare institution currently using the technology
(HTA) or providing the service (HSR) under study, or caring for
the condition covered by the guideline.
Selection Not necessarily via representative organizations; rather via
personal contacts; look for large-volume centres and quality-
Information of the researchers.
Motivation Avoiding a purely theoretical stance.
Good grasp of the concrete (clinical) practicalities of a
technology, service or diagnostic or therapeutic approach,
including the regulatory/financial particularities (if debatable).
Non-interfering observation of the actual clinical processes,
alternated/followed by discussion with the providers and (if
needed and feasible) with patients. In any case, informed
consent is to be obtained from the patient.
Ideally, all researchers involved in the study should participate.
In practice, at least those involved in the editing of the
discussion and conclusions.
Duration ½ to 1 day.
Stakeholders need little prior information.
Researchers could benefit from prior acquaintance with the
technology, medical condition, jargon, regulatory framework.
None, or a set of remaining questions after preparatory
Deliverable Brief description of the meeting (who, when , where), no
other specific deliverable; an introductory chapter of the final
study report, describing the problem, technology or service,
may benefit from the personal observation notes of the
Follow-up In principle not applicable.
In theory, out of scope for this method; in practice, the very
fact that the researches belong to the KCE may create specific
perceptions among the providers, and bring out potentially
controversial aspects during the visits. Hence, the nature of
the visit, its objectives and the function in the project should
be made very clear.
Confidentiality All observations, and, a fortiori, all patient-related information
should remain strictly confidential.
Limits As representativity is not aimed for, the observations of the
researchers cannot be considered to be formal results, and do,
as such, not appear in the study report.
Risks of the
Perception bias and preconceptions in the researcher, based
upon a very limited, but potentially strong personal
experience. This could require to express these potential
preconceptions and test them with other actors, preferentially
with opposing views.
Absence of signals that “researchers do not really know what
they are talking about” or similar suggestions.
APPROACH 1 – On-site visits to healthcare providers or
Example(s) KCE Reports 20 [Molecular Diagnostics in Belgium],
KCE Reports 46 [Home Monitoring of Infants in
Prevention of Sudden Infant Death Syndrome], 2006
Objective Make the subject tangible (with the focus on the clinical
and practical aspects).
Timing At the onset of the project.
Providers/healthcare institution currently using the
technology (HTA) or providing the service (HSR) under
study, or caring for the condition covered by the