Opening the black box of the health technology assessment process at NICE

  • Stacey Noble

Student thesis: Doctoral Thesis


The thesis addresses the diversity of concerns to be represented in the calculative practices of clinical efficiency decisions. The empirical site taken is the National Institute for Health and Clinical Excellence (NICE) and its Health Technology Assessment (HTA) process. The HTA process represents many diagnostic areas within one centralised, calculable process. The qualities of calculative practice, which mediate such complexity within one central framework, are explored.The theoretical lens used to examine the perceptions of calculative practices, from diverse human contributors in HTA, is Actor Network Theory (ANT). In particular, Callon's (1986b) Sociology of Translation is used along with key insights from Latour (1987, 2005). This is underpinned with an interpretative approach to defining calculative practices.The empirical examination involved observations of HTA meetings and interviews with key actors who were involved in contributing to HTA decision making. The degree of enrolment which human actors had with the NICE HTA black box, was shown to vary with several networking elements. These included diagnostic area, tenure of HTA experience, repertoire of health economics, personality/motivation and inter-contributor dynamics. Findings are presented within these particular issues and are analysed through the four stages of Callon's (1986b) model: problematisation, interessement, enrolment and mobilisation.Theoretical and empirical contributions are centred on the examination of NICE, using ANT. Accounting's use of ANT is advanced. The thesis contributes to accounting's work within a healthcare context and advances the need to examine calculative practice with a broad and reflexive interpretation as to what constitutes form.
Date of Award19 May 2016
Original languageEnglish
Awarding Institution
  • University Of Strathclyde
SupervisorAndrea Coulson (Supervisor) & Christine Cooper (Supervisor)

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