A Qualitative Evaluation of Program Budgeting and Marginal Analysis in a Canadian Pediatric Tertiary Care Institution.
BACKGROUND
Hospitals in Canada are being asked by governments to improve efficiency and do more with fewer resources. Healthcare decision makers are thus driven to find better ways to manage budgets and deliver on their mission. Formal processes of priority setting and resource allocation (PSRA) are one means to this end.


OBJECTIVE
This paper reports an evaluation of one such approach, Program Budgeting and Marginal Analysis (PBMA), as applied at a children and women's tertiary care facility in Nova Scotia, Canada. A brief evaluation conducted immediately after the conclusion of the PBMA process was supplemented with a larger retrospective evaluation.


METHODS
The retrospective evaluation included 26 face-to-face individual interviews with senior and middle managers who took part in PBMA. Interview transcripts were analyzed against a template consisting of 19 elements of structure, process, attitudes, and outcomes associated with high performance in PSRA.


RESULTS
Respondents had a good experience with the implementation of PBMA, and considered it an improvement over past practice. Success was attributed to effective leadership, and substantial efforts to engage staff members. Understanding of economic and ethical principles of decision making was reportedly increased. Areas for improvement included ensuring that everyone participated in good faith, better communication of final results, and stronger follow-through to determine if anticipated changes and benefits in fact occurred.


CONCLUSIONS
The evaluation framework employed here proved useful in assessing the quality of this resource allocation exercise. The results are directly useful to local decision makers, and the identified strengths and weaknesses are broadly consistent with those reported in studies of other organizations.
Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, 7th floor, 828 W 10th Avenue, Vancouver, BC, V5Z1M9, Canada. neale.smith@ubc.ca.
Neale
N
Smith
Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, 7th floor, 828 W 10th Avenue, Vancouver, BC, V5Z1M9, Canada.|School of Population and Public Health, University of British Columbia, Vancouver, BC, V5Z1M9, Canada.
Craig
C
Mitton
Quality and System Performance, IWK Health Centre, Halifax, NS, B3K6R8, Canada.
Mary-Ann
MA
Hiltz
Quality and System Performance, IWK Health Centre, Halifax, NS, B3K6R8, Canada.
Matthew
M
Campbell
Nova Scotia Health Authority, Halifax, NS, B3H1V7, Canada.
Laura
L
Dowling
Pathology and Laboratory Medicine, University of Saskatchewan and Saskatoon Health Region, 103 Hospital Dr, Saskatoon, Sk, SK S7N0W8, Canada.
J Fergall
JF
Magee
Quality and System Performance, IWK Health Centre, Halifax, NS, B3K6R8, Canada.|Faculty of Medicine, Dalhousie University, Halifax, NS, B3H1X5, Canada.
Shashi Ashok
SA
Gujar
D002017:Budgets / Q000458:organization & administration*; D002648:Child; D005069:Evaluation Studies as Topic; D017721:Hospital Costs / Q000458:organization & administration; D006776:Hospitals, Pediatric / Q000191:economics* / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic; D009674:Nova Scotia; D015397:Program Evaluation; D062606:Tertiary Care Centers / Q000191:economics* / Q000458:organization & administration