title: Does accountability for reasonableness work? A protocol for a mixed methods study using an audit tool to evaluate the decision-making of clinical commissioning groups in England.
abstract: BACKGROUND
  Clinical commissioning groups (CCGs) in England are tasked with making difficult decisions on which healthcare services to provide against the background of limited budgets. The question is how to ensure that these decisions are fair and legitimate. Accounts of what constitutes fair and legitimate priority setting in healthcare include Daniels' and Sabin's accountability for reasonableness (A4R) and Clark's and Weale's framework for the identification of social values. This study combines these accounts and asks whether the decisions of those CCGs that adhere to elements of such accounts are perceived as fairer and more legitimate by key stakeholders. The study addresses the empirical gap arising from a lack of research on whether frameworks such as A4R hold what they promise. It aims to understand the criteria that feature in CCG decision-making. Finally, it examines the usefulness of a decision-making audit tool (DMAT) in identifying the process and content criteria that CCGs apply when making decisions.
  
  
  METHODS
  The adherence of a sample of CCGs to criteria emerging from theories of fair priority setting will be examined using the DMAT developed by PL. The results will be triangulated with data from semistructured interviews with key stakeholders in the CCG sample to ascertain whether there is a correlation between those CCGs that performed well in the DMAT exercise and those whose decisions are perceived positively by interviewees. Descriptive statistical methods will be used to analyse the DMAT data. A combination of quantitative and qualitative content analysis methods will be used to analyse the interview transcripts.
  
  
  BACKGROUND
  Full ethics approval was received by the King's College London Biomedical Sciences, Dentistry, Medicine and Natural and Mathematical Sciences Research Ethics Subcommittee. The results of the study will be disseminated through publications in peer review journals.
authors.affiliation: Faculty of Life Sciences and Medicine, Division of Health and Social Care Research, King's College London, London, UK.
authors.forename: Katharina
authors.initials: K
authors.lastname: Kieslich
authors.affiliation: Faculty of Life Sciences and Medicine, Division of Health and Social Care Research, King's College London, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Littlejohns
mesh_terms: D003625:Data Collection / Q000379:methods; D003657:Decision Making; D003661:Decision Support Techniques; D003695:Delivery of Health Care / Q000458:organization & administration*; D004739:England; D006291:Health Policy; D008485:Medical Audit; D010865:Pilot Projects; D011785:Quality Assurance, Health Care; D013222:State Medicine / Q000458:organization & administration*
keywords: QUALITATIVE RESEARCH