title: Changing priority setting practice: the role of implementation in practice change.
abstract: BACKGROUND
  Programme budgeting and marginal analysis (PBMA) is a priority setting approach that assists decision makers in choosing among resource demands. This paper describes and evaluates the process of implementing PBMA in a Canadian regional health authority, and draws out key lessons learned from this experience.
  
  
  METHODS
  Qualitative data were collected through semi-structured participant interviews (twelve post year-1; nine post year-2), meeting attendance, and document review. Interview transcripts were analyzed using a constant comparison technique. Other data were analyzed to evaluate PBMA implementation.
  
  
  RESULTS
  Desire for more clarity and for PBMA adaptations emerged as overarching themes. Participants desired greater clarity of their roles and how PBMA should be used to achieve PBMA's potential benefits. They argued that each PBMA stage should be useful independent of the others so that implementation could be adapted. To help improve clarity and ensure that resources were available to support PBMA, participants requested an organizational readiness and capacity assessment.
  
  
  CONCLUSIONS
  We suggest tactics by which PBMA may be more closely aligned with real-world priority setting practice. Our results also contribute to the literature on PBMA use in various healthcare settings. Highlighting implementation issues and potential responses to these should be of interest to decision makers implementing PBMA and other evidence-informed practices.
authors.affiliation: Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: evelyn.cornelissen@ubc.ca.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Cornelissen
authors.affiliation: Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: craig.mitton@ubc.ca.
authors.forename: Craig
authors.initials: C
authors.lastname: Mitton
authors.affiliation: Faculty of Health and Social Development, University of British Columbia - Okanagan, Kelowna, British Columbia, Canada. Electronic address: alan.davidson@ubc.ca.
authors.forename: Alan
authors.initials: A
authors.lastname: Davidson
authors.affiliation: Faculty of Health and Social Development, University of British Columbia - Okanagan, Kelowna, British Columbia, Canada. Electronic address: colin.reid@ubc.ca.
authors.forename: R Colin
authors.initials: RC
authors.lastname: Reid
authors.affiliation: Faculty of Health and Social Development, University of British Columbia - Okanagan, Kelowna, British Columbia, Canada. Electronic address: rachelle.hole@ubc.ca.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Hole
authors.affiliation: Alberta Health Services, Calgary, Alberta, Canada. Electronic address: anne-marie.visockas@albertahealthservices.ca.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Visockas
authors.affiliation: Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: neale.smith@ubc.ca.
authors.forename: Neale
authors.initials: N
authors.lastname: Smith
mesh_terms: D001955:British Columbia; D002017:Budgets; D003659:Decision Making, Organizational; D015276:Health Care Rationing / Q000379:methods*; D006284:Health Plan Implementation; D006292:Health Priorities / Q000191:economics*; D006801:Humans; D007407:Interviews as Topic; D017146:Models, Organizational; D009936:Organizational Innovation / Q000191:economics*; D036301:Qualitative Research; D040841:Resource Allocation / Q000379:methods
keywords: Decision making; Health care rationing; Health plan implementation; Health planning; Health services research; Resource allocation