title: Listening to the decision makers: sustainability of PBMA in Alberta.
abstract: BACKGROUND
  Decision makers within the Calgary Health Region adopted and applied programme budgeting and marginal analysis (PBMA) for priority-setting activity across major service portfolios within the Region.
  
  
  METHODS
  Seventeen in-depth qualitative interviews were conducted with senior managers and clinicians to gain a user perspective and identify specific areas for process refinement. Data were thematically coded and categorised into relevant themes.
  
  
  RESULTS
  Key strengths included a culture shift in thinking about the need to reallocate resources within a fixed funding envelope, whereas a key challenge identified was in putting forth genuine disinvestment options. Areas suggested for improvement included evoking an incentive system for stakeholder engagement and having a mechanism for tracking the effect of resource reallocations.
  
  
  CONCLUSIONS
  Both an evidence-based approach to priority setting, as well as a way of thinking around managing resource scarcity, can be integrated into organisational processes. Findings reported in this article will influence further application in Calgary and should provide insight for those attempting such activity elsewhere.
authors.affiliation: Centre for Healthcare Innovation and Improvement, BC Research Institute for Children's and Women's Health, Vancouver, British Columbia, Canada. cmitton@cw.bc.ca
authors.forename: Craig
authors.initials: C
authors.lastname: Mitton
authors.forename: San
authors.initials: S
authors.lastname: Patten
authors.forename: Cam
authors.initials: C
authors.lastname: Donaldson
mesh_terms: D000288:Administrative Personnel; D000416:Alberta; D002017:Budgets / Q000379:methods* / Q000458:organization & administration; D003659:Decision Making, Organizational; D003695:Delivery of Health Care / Q000191:economics* / Q000458:organization & administration; D017048:Health Care Costs; D006292:Health Priorities / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic; D012040:Regional Health Planning / Q000191:economics / Q000458:organization & administration; D040841:Resource Allocation / Q000191:economics / Q000458:organization & administration