Advancing hospital-based health technology and impact assessments: institutionalizing strategic decision-making in innovation adoption

OBJECTIVES: Hospitals are at the front line of adopting new health technologies, yet decision-making is often hampered by insufficient evidence, limited context, and misaligned priorities. Hospital-based health technology assessment (HB-HTA) provides a structured mechanism to evaluate innovations at the institutional level. However, published accounts of HB-HTA implementation remain scarce, particularly in Asian contexts. METHODS: We describe Singapore General Hospital's (SGH) approach to institutionalizing HB-HTA through a three-pronged strategy: (1) structured two-page narrative proposals to ensure clarity, rigor, and alignment with organizational priorities; (2) establishment of a dedicated HB-HTA team - the Impact Assessment, Program Evaluation, and Implementation Research team; and (3) targeted training programs to build capacity among clinical and managerial staff. Evaluation of the framework included formative feedback from proposers and senior leaders, surveys of participant satisfaction, and qualitative interviews. RESULTS: Between 2023 and 2024, SGH piloted and scaled the HB-HTA framework, reviewing 15 proposals exceeding USD $40 million across domains, including artificial intelligence, robotics, diagnostics, and therapeutic devices. Training workshops engaged 55 participants with high Net Promoter Scores (≥50 percent), while surveys of senior leadership showed that 91 percent were satisfied or very satisfied with the process. Qualitative feedback highlighted improved strategic alignment, transparency, and confidence in decision-making. CONCLUSIONS: SGH's experience demonstrates that embedding HB-HTA requires deliberate organizational design, leadership commitment, and stakeholder engagement. By combining concise narrative proposals with independent in-house assessments, hospitals can strengthen governance, foster accountability, and support value-driven innovation. This model offers a practical roadmap for institutions seeking to formalize HB-HTA within their decision-making processes.