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

International Journal of Health Policy and Management

卷:5

Laura Dowling¹  Craig Mitton²  Neale Smith²  Mary-Ann Hiltz³  Matthew Campbell⁴  Shashi Gujar⁴ 

[1] School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada;

[2] Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada;

[3] Dalhousie University, Halifax, NS, Canada;

[4] Strategy and Organizational Performance, IWK Health Centre, Halifax, NS, Canada;

关键词: Priority Setting;    Resource Allocation;    Multiple Streams Theory;    Tertiary Care Health Centre;    Canada;   

DOI  :  10.15171/ijhpm.2015.169

来源: DOAJ

【 摘 要 】

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 framework – Kingdon’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 stream – defined 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.

【 授权许可】

Unknown