Receptive rationing: reflections and suggestions for priority setters in health care

2015 ◽  
Vol 29 (6) ◽  
pp. 701-710 ◽  
Author(s):  
Iestyn Williams
Keyword(s):  
Health Care ◽  
Priority Setting ◽  
Design Methodology ◽  
Decision Makers ◽  
Evidence Based ◽  
Priority Setting Process ◽  
Content Type ◽  
Setting Process ◽  
External Stakeholders ◽  
Health Care Priority Setting

Purpose – The purpose of this paper is to take forward consideration of context in health care priority setting and to offer some practical strategies for priority setters to increase receptiveness to their work. Design/methodology/approach – A number of tools and methods have been devised with the aim of making health care priority setting more robust and evidence based. However, in order to routinely take and implement priority setting decisions, decision makers require the support, or at least the acquiescence, of key external parties. In other words, the priority setting process requires a receptive context if it is to proceed unhindered. Findings – The priority setting process requires a receptive context if it is to proceed unhindered. Originality/value – This paper develops the concept of legitimacy in the “authorising environment” in priority setting and describes strategies which might help decision makers to create a receptive context, and to manage relationships with external stakeholders.

scholarly journals Hospital Managers’ Perceptions Regarding Setting Healthcare Priorities in Kuwait

2020 ◽  
Vol 12 (10) ◽  
pp. 79
Author(s):  
Abdullah M. Alsabah ◽  
Hassan Haghparast-Bidgoli ◽  
Jolene Skordis-Worrall
Keyword(s):  
Resource Allocation ◽  
Priority Setting ◽  
Decision Makers ◽  
Evidence Based ◽  
Priority Setting Process ◽  
Public And Private ◽  
The Public ◽  
Hospital Managers ◽  
Setting Process ◽  
Health Decision

BACKGROUND & OBJECTIVE: In view of the budget limitations resulting from the downturn in the Kuwaiti economy, it is crucial to evaluate the process of priority setting within the health system to identify strengths and weaknesses of this process within both the public and private sectors. Once the weak points are identified, policy makers can work with hospital administration staff to upgrade the process with the aim of utilising health resources more efficiently. The purpose of this study is to give decision makers some insight on the perspective of hospital managers regarding the current process of priority setting, and suggest ways to improve this process. Additionally, this study will provide the opinions of hospital managers in questioning the effect of certain healthcare policies, currently given top priority, on healthcare system efficiency. The views of the hospital managers interviewed indicate their preferences in priority setting and the changes in health spending they believe are required. METHODS: A qualitative study was conducted using semi-structured, face-to-face interviews with 14 managers from public and private hospitals in Kuwait. Content analysis was used to produce major themes and sub-themes from the interview transcripts. RESULTS: While several similarities and differences in the priority-setting process between the public and private sectors were apparent, the main strength in the process that most managers from both sectors mentioned, was that it was simple, systematic, comprehensive and democratic. The several weaknesses of the process include it not being evidence-based due to the lack of accurate and up-to-date data. Also, the discrepancy between the official statements made and the actual practices of health decision makers in the country demonstrate the confusion around the priority-setting process. Most respondents, from both sectors, thought that the availability of a clear and well-communicated national health strategic plan would facilitate the necessary modifications in legislative, structural and administrative strategies to streamline the processes of allocating resources and setting priorities. For example, most respondents believed that the disadvantages of the costly practice of sending patients abroad for treatment and its effect on resource allocation outweighed its advantages. Further, the managers from both sectors had different perceptions regarding the policy of private health insurance for retirees. These two policies, according to some hospital managers, added strain to the health budget and undermined trust in the public-health sector. CONCLUSION: This study examined the perspective of hospital managers regarding the process of healthcare priority setting in Kuwait, and ways to improve it. Priority setting could be improved by having a better understanding of its strengths and weaknesses. The study concludes that health decision makers should remain responsible for accepting and implementing evidence-based, systematic processes of resource allocation. Additionally, continuous monitoring and evaluation of the impact of health policies will be required to improve overall health outcomes.        

Implementing accountability for reasonableness – the case of pharmaceutical reimbursement in Sweden

2007 ◽  
Vol 2 (2) ◽  
pp. 153-171 ◽  
Author(s):  
SANDRA JANSSON
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Social Learning ◽  
Priority Setting ◽  
Relative Importance ◽  
Priority Setting Process ◽  
Structured Interviews ◽  
Accountability For Reasonableness ◽  
Setting Process ◽  
A Priority

AbstractThis paper aims to describe the priority-setting procedure for new original pharmaceuticals practiced by the Swedish Pharmaceutical Benefits Board (LFN), to analyse the outcome of the procedure in terms of decisions and the relative importance of ethical principles, and to examine the reactions of stakeholders. All the ‘principally important’ decisions made by the LFN during its first 33 months of operation were analysed. The study is theoretically anchored in the theory of fair and legitimate priority-setting procedures by Daniels and Sabin, and is based on public documents, media articles, and semi-structured interviews. Only nine cases resulted in a rejection of a subsidy by the LFN and 15 in a limited or conditional subsidy. Total rejections rather than limitations gave rise to actions by stakeholders. Primarily, the principle of cost-effectiveness was used when limiting/conditioning or totally rejecting a subsidy. This study suggests that implementing a priority-setting process that fulfils the conditions of accountability for reasonableness can result in a priority-setting process which is generally perceived as fair and legitimate by the major stakeholders and may increase social learning in terms of accepting the necessity of priority setting in health care. The principle of cost-effectiveness increased in importance when the demand for openness and transparency increased.

Participation in health care priority-setting through the eyes of the participants

2002 ◽  
Vol 7 (4) ◽  
pp. 222-229 ◽  
Author(s):  
Douglas Martin ◽  
Julia Abelson ◽  
Peter Singer
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Qualitative Study ◽  
Priority Setting ◽  
Decision Makers ◽  
Medical Specialist ◽  
Committee Chair ◽  
The Public ◽  
Health Care Priority Setting ◽  
Patient Representative

Objectives: The literature on participation in priority-setting has three key gaps: it focuses on techniques for obtaining public input into priority-setting that are consultative mechanisms and do not involve the public directly in decision-making; it focuses primarily on the public's role in priority-setting, not on all potential participants; and the range of roles that various participants play in a group making priority decisions has not been described. To begin addressing these gaps, we interviewed individuals who participated on two priority-setting committees to identify key insights from participants about participation. Methods: A qualitative study consisting of interviews with decision-makers, including patients and members of the public. Results: Members of the public can contribute directly to important aspects of priority-setting. The participants described six specific priority-setting roles: committee chair, administrator, medical specialist, medical generalist, public representative and patient representative. They also described the contributions of each role to priority-setting. Conclusions: Using the insights from decision-makers, we have described lessons related to direct involvement of members of the public and patients in priority-setting, and have identified six roles and the contributions of each role.

scholarly journals Evidence-based priority setting

2001 ◽  
Vol 24 (2) ◽  
pp. 32 ◽  
Author(s):  
Julie Astley ◽  
Wendy Wake-Dyster
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Priority Setting ◽  
Evidence Based ◽  
Priority Setting Process ◽  
Marginal Analysis ◽  
Community Values ◽  
Setting Process ◽  
Combine Program ◽  
Program Budgeting

This paper describes evidence-based priority setting and resource allocation undertaken by a Division of the Women's & Children's Hospital, Adelaide during 1998-1999. We describe the methods used to combine program budgeting marginal analysis (PBMA), evidence based and "community values" approaches into one decision-making framework.Previous organisational changes involving the formation of multidisciplinary team and program management were pivotal in setting a framework to successfully complete the priority setting process.

Evaluation of a deliberative approach to citizen involvement in health care priority setting

2014 ◽  
Vol 27 (1) ◽  
pp. 5-19 ◽  
Author(s):  
Iestyn Williams ◽  
Daisy Phillips ◽  
Charles Nicholson ◽  
Heather Shearer
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Decision Making ◽  
Public Engagement ◽  
Priority Setting ◽  
Primary Care Trust ◽  
Content Type ◽  
The Public ◽  
Novel Approach ◽  
Health Care Priority Setting

Purpose – The purpose of this paper is to describe and evaluate a novel approach to citizen engagement in health priority setting carried out in the context of Primary Care Trust (PCT) commissioning in the English National Health Service. Design/methodology/approach – Four deliberative events were held with 139 citizens taking part in total. Events design incorporated elements of the Twenty-first Century Town Meeting and the World Café, and involved specially-designed dice games. Evaluation surveys reporting quantitative and qualitative participant responses were combined with follow-up interviews with both PCT staff and members of the public. An evaluation framework based on previous literature was employed. Findings – The evaluation demonstrates high levels of enjoyment, learning and deliberative engagement. However, concerns were expressed over the leading nature of the voting questions and, in a small minority of responses, the simplified scenarios used in dice games. The engagement exercises also appeared to have minimal impact on subsequent Primary Care Trust resource allocation, confirming a wider concern about the influence of public participation on policy decision making. The public engagement activities had considerable educative and political benefits and overall the evaluation indicates that the specific deliberative tools developed for the exercise facilitated a high level of discussion. Originality/value – This paper helps to fill the gap in empirical evaluations of deliberative approaches to citizen involvement in health care priority setting. It reports on a novel approach and considers a range of implications for future research and practice. The study raises important questions over the role of public engagement in driving priority setting decision making.

Intervention as workplace learning

2016 ◽  
Vol 28 (5) ◽  
pp. 266-279 ◽  
Author(s):  
Bente Elkjaer ◽  
Niels Christian Mossfeldt Nickelsen
Keyword(s):  
Health Care ◽  
Workplace Learning ◽  
Design Methodology ◽  
Professional Knowledge ◽  
Hierarchical Structures ◽  
Evidence Based ◽  
Workplace Issues ◽  
Content Type ◽  
Workplace Interventions

Purpose The purpose of this paper is to illustrate how workplace interventions may benefit from a simultaneous focus on individuals’ learning and knowledge and on the situatedness of workplaces in the wider world of changing professional knowledge regimes. This is illustrated by the demand for evidence-based practice in health care. Design/methodology/approach The paper is based on a case study in a public post-natal ward in a hospital in Denmark in which one of the authors acted as both a consultant initiating and leading interventions and a researcher using ethnographic methods. The guiding question was: How to incorporate the dynamics of the workplace when doing intervention in professionals’ work and learning? Findings The findings of the paper show how workplace interventions consist of heterogeneous alliances between politics, discourse and technologies rather than something that can be traced back to a single plan or agency. Furthermore, the paper proposes, a road down the middle, made up by both an intentional and a performative model for intervention. Originality/value Intervention in workplaces is often directed towards changing humans, their behaviour, their ways of communicating and their attitudes. This is often furthered through reflection, making the success of intervention depend on individuals’ abilities to learn and change. In this paper, it is shown how intervention may benefit from bringing in workplace issues like different professional knowledge regimes, hierarchical structures, materiality, politics and power.

scholarly journals Tools for priority setting: lessons from South Australia

2006 ◽  
Vol 30 (1) ◽  
pp. 65 ◽  
Author(s):  
Sandra G Leggat ◽  
Wendy Scheil ◽  
Helena Williams ◽  
Kate Kerin
Keyword(s):  
Priority Setting ◽  
South Australia ◽  
Decision Makers ◽  
Advisory Group ◽  
Priority Setting Process ◽  
Clinical Issues ◽  
Department Of Health ◽  
Setting Process ◽  
A Priority

Background: This paper provides an overview of the process and tools used to develop and implement a priority setting framework for the Clinical Senate of South Australia. Established as a clinical advisory group to the Minister and Department of Health, the Clinical Senate recognised the need for an open priority setting process to fairly assign planning resources to the large number of clinical issues that needed to be addressed. Discussion: Using a workbook, developed from the literature and evidence related to priority setting, agreement was reached on the use, components and structure of the priority setting process. The final products included a Gap Finder Tool and a Priority Setting Framework. Summary: This paper describes the process used to develop the priority setting tools. Decision makers in other organisations can use similar processes and tools to develop or enhance their priority Setting processes.

scholarly journals Patterns of public participation

2016 ◽  
Vol 30 (5) ◽  
pp. 751-768 ◽  
Author(s):  
Jean Slutsky ◽  
Emma Tumilty ◽  
Catherine Max ◽  
Lanting Lu ◽  
Sripen Tantivess ◽  
...  
Keyword(s):  
Public Participation ◽  
Case Studies ◽  
Priority Setting ◽  
Design Methodology ◽  
Political Mobilization ◽  
Qualitative Assessment ◽  
Content Type ◽  
Institutional Processes ◽  
Setting Process ◽  
Cross National

Purpose – The paper summarizes data from 12 countries, chosen to exhibit wide variation, on the role and place of public participation in the setting of priorities. The purpose of this paper is to exhibit cross-national patterns in respect of public participation, linking those differences to institutional features of the countries concerned. Design/methodology/approach – The approach is an example of case-orientated qualitative assessment of participation practices. It derives its data from the presentation of country case studies by experts on each system. The country cases are located within the historical development of democracy in each country. Findings – Patterns of participation are widely variable. Participation that is effective through routinized institutional processes appears to be inversely related to contestatory participation that uses political mobilization to challenge the legitimacy of the priority setting process. No system has resolved the conceptual ambiguities that are implicit in the idea of public participation. Originality/value – The paper draws on a unique collection of country case studies in participatory practice in prioritization, supplementing existing published sources. In showing that contestatory participation plays an important role in a sub-set of these countries it makes an important contribution to the field because it broadens the debate about public participation in priority setting beyond the use of minipublics and the observation of public representatives on decision-making bodies.

Public participation in health care priority setting: A scoping review

Health Policy ◽  
2009 ◽  
Vol 91 (3) ◽  
pp. 219-228 ◽  
Author(s):  
Craig Mitton ◽  
Neale Smith ◽  
Stuart Peacock ◽  
Brian Evoy ◽  
Julia Abelson
Keyword(s):  
Health Care ◽  
Public Participation ◽  
Scoping Review ◽  
Priority Setting ◽  
Health Care Priority Setting

Dual leadership in a hospital practice

2017 ◽  
Vol 30 (1) ◽  
pp. 101-112 ◽  
Author(s):  
Bettina Ravnborg Thude ◽  
Svend Erik Thomsen ◽  
Egon Stenager ◽  
Erik Hollnagel
Keyword(s):  
Health Care ◽  
Qualitative Study ◽  
Design Methodology ◽  
Leadership Teams ◽  
Decision Processes ◽  
Power Balance ◽  
Structured Interviews ◽  
Hospital Practice ◽  
Content Type ◽  
Danish Hospital

Purpose Despite the practice of dual leadership in many organizations, there is relatively little research on the topic. Dual leadership means two leaders share the leadership task and are held jointly accountable for the results of the unit. To better understand how dual leadership works, this study aims to analyse three different dual leadership pairs at a Danish hospital. Furthermore, this study develops a tool to characterize dual leadership teams from each other. Design/methodology/approach This is a qualitative study using semi-structured interviews. Six leaders were interviewed to clarify how dual leadership works in a hospital context. All interviews were transcribed and coded. During coding, focus was on the nine principles found in the literature and another principle was found by looking at the themes that were generic for all six interviews. Findings Results indicate that power balance, personal relations and decision processes are important factors for creating efficient dual leaderships. The study develops a categorizing tool to use for further research or for organizations, to describe and analyse dual leaderships. Originality/value The study describes dual leadership in the hospital context and develops a categorizing tool for being able to distinguish dual leadership teams from each other. It is important to reveal if there are any indicators that can be used for optimising dual leadership teams in the health-care sector and in other organisations.

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