title: Introducing New Priority Setting and Resource Allocation Processes in a Canadian Healthcare Organization: A Case Study Analysis Informed by Multiple Streams Theory.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Neale
authors.initials: N
authors.lastname: Smith
authors.affiliation: Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada.|School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Craig
authors.initials: C
authors.lastname: Mitton
authors.affiliation: Dalhousie University, Halifax, NS, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Dowling
authors.affiliation: Strategy and Organizational Performance, IWK Health Centre, Halifax, NS, Canada.
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Hiltz
authors.affiliation: Strategy and Organizational Performance, IWK Health Centre, Halifax, NS, Canada.
authors.forename: Matthew
authors.initials: M
authors.lastname: Campbell
authors.affiliation: Strategy and Organizational Performance, IWK Health Centre, Halifax, NS, Canada.|Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: Shashi Ashok
authors.initials: SA
authors.lastname: Gujar
mesh_terms: D002170:Canada; D003657:Decision Making; D003659:Decision Making, Organizational; D015276:Health Care Rationing / Q000379:methods*; D006292:Health Priorities; D006801:Humans; D008962:Models, Theoretical; D036301:Qualitative Research
keywords: Canada; Multiple Streams Theory; Priority Setting; Resource Allocation; Tertiary Care Health Centre