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The stakeholders involved in deciding about actual using the microorganism identification technology can be categorized into five groups. Only the dormant and dangerous stakeholders are not present in the process. The most influential stakeholders for using the identification technology are the microbiology physician and the analysts. They are the direct users and can decide whether or not to use the device. The hospital management and the head of the department are dominant stakeholders. They oversee the usage of the product, and when problems arise they may become active. Customers and attending physicians are identified as dependant stakeholders. They have the urgency to get fast and reliable results, and the legitimacy to influence the usage by addressing (potential) complaints to the regulatory bodies and/or look for alternative laboratories.

Discretionary and demanding stakeholders, who possess only one attribute, do not have much influence on managers. Laboratory managers, biomedical engineering department, regulatory bodies and payers, are identified as discretionary stakeholders. They have mainly a consultative a monitoring role. When there are serious issues with the technology they can gain the attribute urgency, and therefore gain more salience. For the eNose company, identified as a demanding stakeholder, it is difficult to attain other attributes than urgency.

Type of stakeholder Actors Explanation Dormant

Discretionary Laboratory manager

Biomedical engineering department

Regulatory bodies Payer

The laboratory manager and the biomedical engineering department are not directly involved in using the new identification technology. When the users are not satisfied with the performance of the technology they can have a consulting role. Regulators represent the stake of customers (dependent stakeholder) and may come into action when the performance of the technology is not adequate.

Demanding e-Nose company The eNose company earns money with each

blood test done with the µDtect. Therefore it has the urgency that it is used, but they lack the power and legitimacy to influence the usage.

Dominant Hospital management

Head of department

These actors are not actively involved with the usage of the technology, but are responsible for the performance of the hospital. Therefore, may the technology cause problems, they may become active and use their power and claim.

Dependent Attending physician

Customers

The attending physician and the other customers do not directly use the technology, but they depend on the performance of it in order to do their own work. When the performance of the technology is not the required level they can influence the use by complaints (through regulatory bodies) or searching for alternative providers.

Dangerous

Definitive Microbiology physician

Analyst

Microbiology physicians and analysts are the main users of the product and therefore definitive stakeholders.

Non stakeholder Partners Competitors

Partners, provider of the blood culture flasks, do not care whether the µDtect or another identification device is used. As long as the culture flasks are used.

Competitors have no influence on the usage of the identification device.

Figure 10: Stakeholders use process

6.4 Implications for the µDtect

Implications for the introduction of the µDtect

The purchase process starts with the microbiology physician and to a lesser extent with the laboratory manager. The eNose company can actively approach these key stakeholders in order to make the µDtect known and convince them of the added value. After that there is not much the e- Nose company can do in order to influence the purchase process.

The purchase process will continue internally. The investment advisory committee has an influential role in this process. It gathers all the investment requests from the hospital and ranks them. It advises the head of department and the hospital management, who will ultimately make the decision whether to invest or not. This advice is based on a business case that the physician provides. Several hospitals have standardized the format of the business case to make requests better comparable and to limit bias. Still the danger of bias remains because the investment advisory committee does not have a standard composition. The medical specialists seated in the committee can have a biased view of what is important, due to personal interests. This can be a danger as well as an advantage for the introduction of the µDtect. An overview of the approachability of the stakeholders of the purchase process is given in table 11. The stakeholders are categorized based on their salience. Stakeholders with high salience and which are approachable are for the eNose company relevant to focus their attention to.

Hard to approach Approachable

High salience Hospital management

Head of department

Microbiology physician Laboratory manager

Medium salience Investment advisory committee

Biomedical engineering department

Purchase department

Low salience Regulatory bodies

Payer

Analyst

Table 11: Approachability stakeholders

Implications for the usage of the µDtect

For using the µDtect there are only two definitive stakeholders, the microbiology physician and the analysts. For the eNose company, these two groups should be the main focus. Demands, complaints, and suggestions should be taken seriously. When these stakeholders are satisfied with the performance of the µDtect, the other stakeholder groups will probably not be able to influence the usage to a great extent.

7.0 Early economic evaluation

In this chapter the results of the early economic evaluation are presented. This evaluation is done by means of a MCDA. The goal of this chapter is to answer the fourth sub-question:

What are the economic and performance attributes critical for introducing a microbiology identification device to the market and how well does the µDtect perform on these attributes compared to competing technologies?

The results of the MCDA are presented in paragraph 7.1. First, it shows the important decision criteria for acquiring a new identification technology. Second, the performance of the µDtect compared to competitors is assessed. This chapter ends with the implications for the µDtect that came forth from the early economic evaluation (7.2).