Priority setting in hospitals: Fairness, inclusiveness, and the problem of institutional power differences

Gibson, Jennifer L.; Martin, Douglas K.; Сингер, Петер

doi:10.1016/j.socscimed.2005.04.037

Cited by 101 publications

(85 citation statements)

References 10 publications

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“…Perceived capacity of the priority setting institutions has been found to influence credibility and compliance with the decisions and hence successful priority setting [6]. Credible institutions have the (1) legitimacy and mandate to set priorities [10,26]; the (2) Capacity: to enable them to establish the necessary mechanisms, structures and 'rules'; collect and evaluate available data, and identify priorities using the best available evidence and tools [24,33]. (3) Provide incentives-the rewards and the punishments that follow adherence or lack of adherence to set rules [24,33].…”

Section: Relevant Contextual Factors Impacting Successful Priority Sementioning

confidence: 99%

Successful Priority Setting in Low and Middle Income Countries: A Framework for Evaluation

Kapiriri¹,

Martin

2009

Health Care Anal

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Priority setting remains a big challenge for health managers and planners, yet there is paucity of literature on evaluating priority setting. The purpose of this paper is to present a framework for evaluating priority setting in low and middle income countries. We conducted a qualitative study involving a review of literature and Delphi interviews with respondents knowledgeable of priority setting in low and middle income countries. Respondents were asked to identify the measures of successful priority setting in low and middle income countries. Responses were grouped as: immediate internal or external/delayed internal or external. We also identified some pre-requisites for successful priority setting. The immediate internal measures included increased efficiency in decision making, improved quality of decisions and fairer priority setting. Immediate External measures included-improved public understanding and acceptance of decisions, increased public participation, increased trust. Delayed Internal measures included increased satisfaction, understanding, compliance, balanced budget, achievement of organization goals, and improved internal accountability. Delayed External measures include impact on policy and practice, improved population health and reduction of health inequalities, achievement of health system goals and strengthening of health care systems. Identified pre-requisites for successful priority setting included; the presence of credible priority setting institutions, incentives for participation and implementation and resources, capacity and political will to implement. These would be augmented in a conducive political, social and economic context. This framework, although not exhaustive, provides a practical basis for planning and evaluating priority setting in low and middle income countries.

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Section: Relevant Contextual Factors Impacting Successful Priority Sementioning

confidence: 99%

Successful Priority Setting in Low and Middle Income Countries: A Framework for Evaluation

Kapiriri¹,

Martin

2009

Health Care Anal

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“…12 Third, members of the public often perceive an intimidating power imbalance between them and clinician and policymaking experts, which can undermine the legitimacy and fairness of the priority-setting process. 13 Efforts should be made to minimize these imbalances by setting an appropriate tone during deliberations and including a sufficient number of representatives of the public on decision-making bodies so that they do not feel that their membership is token. 13 Even when a commitment to meaningful public involvement is made, often no more than 1 or 2 public members are included; this may be too few for a critical mass and reduces the probability of reflecting the broad views of the public.…”

Section: Box 1: Definitions Of Key Termsmentioning

confidence: 99%

“…13 Efforts should be made to minimize these imbalances by setting an appropriate tone during deliberations and including a sufficient number of representatives of the public on decision-making bodies so that they do not feel that their membership is token. 13 Even when a commitment to meaningful public involvement is made, often no more than 1 or 2 public members are included; this may be too few for a critical mass and reduces the probability of reflecting the broad views of the public. 14 Another barrier to public engagement is concern that those chosen will not be representative of the public.…”

Section: Box 1: Definitions Of Key Termsmentioning

confidence: 99%

Public engagement in setting priorities in health care

Bruni

Laupacis²,

Martin³

2008

Canadian Medical Association Journal

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“…Gibson, Martin, and Singer have argued that a condition for fair process is 'empowerment'-that is, that process design should "optimise opportunities for effective participation. " 21 This has been operationalized in priority setting interventions. 22,23 PBMA studies have also previously reported that vertical budget silos and lack of integration pose significant barriers to effective resource allocation.…”

Section: Discussionmentioning

confidence: 99%

Introducing New Priority Setting and Resource Allocation Processes in a Canadian Healthcare Organization: A Case Study Analysis Informed by Multiple Streams Theory

Smith

Mitton

Dowling

et al. 2015

Int J Health Policy Manag

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Background:In this article, we analyze one case instance of how proposals for change to the priority setting and resource allocation (PSRA) processes at a Canadian healthcare institution reached the decision agenda of the organization's senior leadership. We adopt key concepts from an established policy studies frameworkKingdon's multiple streams theory -to inform our analysis. Methods: Twenty-six individual interviews were conducted at the IWK Health Centre in Halifax, NS, Canada. Participants were asked to reflect upon the reasons leading up to the implementation of a formal priority setting process -Program Budgeting and Marginal Analysis (PBMA) -in the 2012/2013 fiscal year. Responses were analyzed qualitatively using Kingdon's model as a template. Results: The introduction of PBMA can be understood as the opening of a policy window. A problem streamdefined as lack of broad engagement and information sharing across service lines in past practice -converged with a known policy solution, PBMA, which addressed the identified problems and was perceived as easy to use and with an evidence-base from past applications across Canada and elsewhere. Conditions in the political realm allowed for this intervention to proceed, but also constrained its potential outcomes. Conclusion: Understanding in a theoretically-informed way how change occurs in healthcare management practices can provide useful lessons to researchers and decision-makers whose aim is to help health systems achieve the most effective use of available financial resources. Implications for policy makers• Introducing new formal processes for priority setting and resource allocation (PSRA) into healthcare organizations is a challenge of change management.• Concepts from the policy sciences, such as John Kingdon's Multiple Streams theory, can help policy-makers understand and assess the alignment of factors which present the greatest windows of opportunity to introduce change. • Policy-makers should ensure that proposed policy actions fit with agreed problem definitions, and action should be feasible within the context of political constraints. Implications for publicHealthcare organizations can make more effective and efficient use of their limited financial resources, and produce better outcomes for patients and the public, if they use established methods and tools to help make choices about what programs and services to fund. This research should help decision-makers in healthcare organizations to figure out what conditions will help, or hinder, them in moving forward with implementing these changes. Key Messages BackgroundThere is now an established and growing body of literature on priority setting and resource allocation (PSRA) in healthcare. This literature articulates -normatively and empirically -the case for formalized processes. Key features of good formal processes have been outlined, and facilitators and barriers to good practice enumerated. However, we know remarkably

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Priority setting in hospitals: Fairness, inclusiveness, and the problem of institutional power differences

Cited by 101 publications

References 10 publications

Successful Priority Setting in Low and Middle Income Countries: A Framework for Evaluation

Successful Priority Setting in Low and Middle Income Countries: A Framework for Evaluation

Public engagement in setting priorities in health care

Introducing New Priority Setting and Resource Allocation Processes in a Canadian Healthcare Organization: A Case Study Analysis Informed by Multiple Streams Theory

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