Fit for purpose? Introducing a rational priority setting approach into a community care setting
Journal of Health Organization and Management
ISSN: 1477-7266
Article publication date: 20 June 2016
Abstract
Purpose
Program budgeting and marginal analysis (PBMA) is a priority setting approach that assists decision makers with allocating resources. Previous PBMA work establishes its efficacy and indicates that contextual factors complicate priority setting, which can hamper PBMA effectiveness. The purpose of this paper is to gain qualitative insight into PBMA effectiveness.
Design/methodology/approach
A Canadian case study of PBMA implementation. Data consist of decision-maker interviews pre (n=20), post year-1 (n=12) and post year-2 (n=9) of PBMA to examine perceptions of baseline priority setting practice vis-à-vis desired practice, and perceptions of PBMA usability and acceptability.
Findings
Fit emerged as a key theme in determining PBMA effectiveness. Fit herein refers to being of suitable quality and form to meet the intended purposes and needs of the end-users, and includes desirability, acceptability, and usability dimensions. Results confirm decision-maker desire for rational approaches like PBMA. However, most participants indicated that the timing of the exercise and the form in which PBMA was applied were not well-suited for this case study. Participant acceptance of and buy-in to PBMA changed during the study: a leadership change, limited organizational commitment, and concerns with organizational capacity were key barriers to PBMA adoption and thereby effectiveness.
Practical implications
These findings suggest that a potential way-forward includes adding a contextual readiness/capacity assessment stage to PBMA, recognizing organizational complexity, and considering incremental adoption of PBMA’s approach.
Originality/value
These insights help us to better understand and work with priority setting conditions to advance evidence-informed decision making.
Keywords
Acknowledgements
The authors would like to thank Mr Tom Fulton and Dr Paul Hasselback, who were both members of the Executive Team at IH Authority at the time of this study, for their support and contribution to the implementation of this study. The authors also thank Drs Stuart Peacock and Cam Donaldson for their contributions to the design of this study. The authors thank Ms Jen Bitz for her help with qualitative data analysis, and Dr Lynda Workman for her contributions as a public member on the PBMA advisory panel. And finally, The authors are grateful to Community Care management team for their active participation in and contributions to this study. This study was funded by the Canadian Institutes of Health Research (CIHR), with a Partnership for Rational priority setting approach Health System Improvement grant entitled “Priority setting, health care utilization and outcomes evaluation in community care in Interior Health” and led by principal investigator Dr CraigMitton. This work was undertaken as part of Dr Evelyn Cornelissen ' s PhD at the University of British Columbia.
Conflicts of interest: the authors have no conflicts of interest to declare.
Citation
Cornelissen, E., Mitton, C., Davidson, A., Reid, C., Hole, R., Visockas, A.-M. and Smith, N. (2016), "Fit for purpose? Introducing a rational priority setting approach into a community care setting", Journal of Health Organization and Management, Vol. 30 No. 4, pp. 690-710. https://doi.org/10.1108/JHOM-05-2013-0103
Publisher
:Emerald Group Publishing Limited
Copyright © 2016, Emerald Group Publishing Limited