title: High performance in healthcare priority setting and resource allocation: A literature- and case study-based framework in the Canadian context.
abstract: Priority setting and resource allocation, or PSRA, are key functions of executive teams in healthcare organizations. Yet decision-makers often base their choices on historical patterns of resource distribution or political pressures. Our aim was to provide leaders with guidance on how to improve PSRA practice, by creating organizational contexts which enable high performance. We carried out in-depth case studies of six Canadian healthcare organizations to obtain from healthcare leaders their understanding of the concept of high performance in PSRA and the factors which contribute to its achievement. Individual and group interviews were carried out (n = 62) with senior managers, middle managers and Board members. Site observations and document review were used to assist researchers in interpreting the interview data. Qualitative data were analyzed iteratively with the literature on empirical examples of PSRA practice, in order to develop a framework of high performance in PSRA. The framework consists of four domains - structures, processes, attitudes and behaviours, and outcomes - within which are 19 specific elements. The emergent themes derive from case studies in different kinds of health organizations (urban/rural, small/large) across Canada. The elements can serve as a checklist for 'high performance' in PSRA. This framework provides a means by which decision-makers in healthcare might assess their practice and identify key areas for improvement. The findings are likely generalizable, certainly within Canada but also across countries. This work constitutes, to our knowledge, the first attempt to present a full package of elements comprising high performance in health care PSRA.
authors.affiliation: Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, 7th floor, 828 W 10th Avenue Vancouver, BC V5Z1M9, Canada. Electronic address: neale.smith@ubc.ca.
authors.forename: Neale
authors.initials: N
authors.lastname: Smith
authors.affiliation: Centre for Clinical Epidemiology & Evaluation, UBC, Canada; School of Population and Public Health, UBC, Canada.
authors.forename: Craig
authors.initials: C
authors.lastname: Mitton
authors.affiliation: School of Population and Public Health, UBC, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Hall
authors.affiliation: Centre for Clinical Epidemiology & Evaluation, UBC, Canada; School of Population and Public Health, UBC, Canada.
authors.forename: Stirling
authors.initials: S
authors.lastname: Bryan
authors.affiliation: Yunus Centre for Social & Business Health, Glasgow Caledonian University, United Kingdom.
authors.forename: Cam
authors.initials: C
authors.lastname: Donaldson
authors.affiliation: Canadian Centre for Applied Research in Cancer Control (ARCC), Canada; BC Cancer Agency, Canada.
authors.forename: Stuart
authors.initials: S
authors.lastname: Peacock
authors.affiliation: Joint Centre for Bioethics, Institute of Health Policy, Management and Evaluation, University of Toronto, Canada.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Gibson
authors.affiliation: Northern Health Authority, Canada.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Urquhart
mesh_terms: D001294:Attitude to Health; D002170:Canada; D006075:Governing Board; D006292:Health Priorities / Q000592:standards*; D006739:Hospital Administration; D006740:Hospital Administrators / Q000191:economics / Q000523:psychology*; D006801:Humans; D009937:Organizational Objectives; D017063:Outcome Assessment, Health Care; D036301:Qualitative Research; D040841:Resource Allocation / Q000379:methods*; D000078329:Workforce
keywords: Canada; Healthcare management; High performance; Priority setting; Resource allocation