Hospital priority setting with an appeals process: a qualitative case study and evaluation.
OBJECTIVE
To describe and evaluate priority setting in the context of hospital priority setting and more specifically to evaluate the use of an appeals process.


METHODS
Qualitative case study and evaluation using the ethical framework 'accountability for reasonableness'.


METHODS
The University Health Network (UHN), a network of three large urban teaching hospitals affiliated with the University of Toronto in Toronto, Canada. This study focused on Clinical Activity Target Setting (CATS), the final component of the strategic planning process.


METHODS
Sixty-six board members, senior administrators, managers, clinical leaders and other hospital staff who participated in the hospital strategic planning exercise.


METHODS
Three primary sources of data were used: key documents, interviews with participants and stakeholders and observations of group deliberations.


METHODS
Open and axial coding using an explicit conceptual framework 'accountability for reasonableness'.


RESULTS
This was the first time an appeal process has been described and evaluated. The appeals process was found to be a fundamental component to overall perceived fairness of the priority setting process. The appeals process also enhanced the involvement of stakeholders and increased overall participant satisfaction. In addition, four areas of 'good practice' and ten recommendations for improvement of the larger priority setting process were identified.


CONCLUSIONS
This case study has provided an in-depth analysis of a priority setting process at a hospital, with a particular focus on the appeals process. Also, we compared the lessons learned from this study with those from a previous study at a different hospital.
Madden
Shannon
S
Department of Health Policy, Management and Evaluation and the Joint Centre for Bioethics, University of Toronto, 88 College Street, Toronto, Ont., Canada M5G 1L4.
Martin
Douglas K
DK
Downey
Sarah
S
Singer
Peter A
PA
D001291:Attitude of Health Personnel; D032921:Consensus; D003659:Decision Making, Organizational; D017144:Focus Groups; D006292:Health Priorities / Q000145:classification*; D006785:Hospitals, University / Q000458:organization & administration*; D006801:Humans; D017008:Negotiating; D009864:Ontario; D019982:Organizational Case Studies; D015397:Program Evaluation; D036301:Qualitative Research; D012941:Social Responsibility; D011795:Surveys and Questionnaires