Search results

Current conditions have intensified the need for health systems to engage in the difficult task of priority setting. As the search for a “magic bullet” is replaced by an appreciation for the interplay between evidence, interests, culture, and outcomes, progress in relation to these dimensions requires assessment of achievements to date and identification of areas where knowledge and practice require attention most urgently. The paper aims to discuss these issues.

An international survey was administered to experts in the area of priority setting. The survey consisted of open-ended questions focusing on notable achievements, policy and practice challenges, and areas for future research in the discipline of priority setting. It was administered online between February and March of 2015.

“Decision-making frameworks” and “Engagement” were the two most frequently mentioned notable achievements. “Priority setting in practice” and “Awareness and education” were the two most frequently mentioned policy and practical challenges. “Priority setting in practice” and “Engagement” were the two most frequently mentioned areas in need of future research.

Sampling bias toward more developed countries. Future study could use findings to create a more concise version to distribute more broadly.

Globally, these findings could be used as a platform for discussion and decision making related to policy, practice, and research in this area.

Whilst this study reaffirmed the continued importance of many longstanding themes in the priority setting literature, it is possible to also discern clear shifts in emphasis as the discipline progresses in response to new challenges.

Joint commissioning is an important part of the current health and social care context and will continue to be crucial in the future. An essential component of any commissioning process is priority setting, and this paper begins to explore the idea of integrated priority setting as a key element of health and social care commissioning. After setting out the key terminology in this area and the main priority‐setting processes for health and social care, the paper describes a number of barriers that might be encountered in integrated priority setting. We argue that there are significant barriers in financing, accessibility, evidence and politics, and it is important that such barriers are acknowledged if priority setting is to become a component of joint commissioning. While these barriers are not insurmountable, the solution lies in engagement with a range of stakeholders, rather than simply a technical process.

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.

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.

The priority setting process requires a receptive context if it is to proceed unhindered.

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.

The purpose of this paper is to evaluate the claims made for the clinical microsystems approach of healthcare improvement within an English NHS context.

The research adopted a Realistic Evaluation approach to examine a series of pilot clinical microsystems sites to determine what worked for whom, when and within what circumstances. Interviews and group discussions were used to collect qualitative data, whist quantitative outcome data was also collected within each of the sites. Data was triangulated to produce case studies for each of the sites.

The research concurred with many of the claims for clinical microsystems, particularly that democratic, consensual approaches to change and improvement can be better received than externally derived initiatives with imposed targets. The clinical microsystem approach emphasises identifying and nurturing strengths – of both teams and individuals – and this reinforced these positive aspects. The case study sites demonstrated higher staff morale, empowerment, commitment and clarity of purpose. To a lesser extent the research also indicated an enhanced predisposition towards improvement and innovation and a seemingly embedded sense of improvement as an ongoing (if essentially episodic) process.

The evaluation was limited in terms of the numbers of case study sites that it was able to incorporate. This sample represented sites of different sizes, coverage of primary, secondary and tertiary care and those reporting more and less positive experiences of the clinical microsystems approach – but any findings may be limited in their generaliseability and further studies may be needed to test out the relevance of these findings in wider settings.

Future microsystem programmes will need to address components of patient involvement and process/outcome monitoring if the broader legitimacy of the approach is to be cemented and enhanced. In particular, the importance of strong data collection in achieving “high performing” status is emphasised.

There is currently no other empirical studies within the academic literature which investigate the value of the clinical microsystems approach to an English NHS context.

Involving communities, citizens and service users in the design and delivery of public services has long been a key aim of government policy and arguably has it never been more important than within times of austerity. Yet, whilst acknowledging the importance of engagement, many health and social care organisations struggle with this in practice. This paper sets out some guiding principles for engagement.

This paper draws on conversations at a series of events in 2013 which brought together researchers, those charged with delivering on government policy at the local level and active citizens, to debate and explore evidence and practice on how to involve and mobilise citizens in local decision making in a time of austerity. Learning is distilled from these events to provide a useful guide for working effectively with communities.

As with any issue as complex as this, there is no magic bullet, quick fix, simple check-list or solve-all tool. Like doing anything worthwhile, working with communities is difficult, takes time and is at its core about building relationships. However, this does not mean that every attempt to design involvement processes needs to start entirely from scratch. There is a wealth and diversity of experience in designing and developing involvement mechanisms to draw upon.

This paper will provide a helpful guide to those who are about to embark on a programme of engagement or who are presently involved in engagement activities with communities, citizens and service users.

The purpose of this paper is to reflect on the findings of this special issue and discusses the future challenges for policy, research and society. The findings suggest that challenges emerge as a result of legitimacy deficits of both consensus and contestatory modes of public involvement in health priority setting.

The paper draws on the discussions and findings presented in this special issue. It seeks to bring the country experiences and case studies together to draw conclusions for policy, research and society.

At least two recurring themes emerge. An underlying theme is the importance, but also the challenge, of establishing legitimacy in health priority setting. The country experiences suggest that we understand very little about the conditions under which representative, or authentic, participation generates legitimacy and under which it will be regarded as insufficient. A second observation is that public participation takes a variety of forms that depend on the opportunity structures in a given national context. Given this variety the conceptualization of public participation needs to be expanded to account for the many forms of public participation.

The paper concludes that the challenges of public involvement are closely linked to the question of how legitimate processes and decisions can be generated in priority setting. This suggests that future research must focus more narrowly on conditions under which legitimacy are generated in order to expand the understanding of public involvement in health prioritization.

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.

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.

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.

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.

The aims of this paper are to explore the experiences of budget holders within the English National Health Service (NHS), in their attempts to implement programmes of disinvestment, and to consider factors which influence the success (or otherwise) of this activity.

Between 24 January and 15 March 2011 semi-structured, telephone interviews were conducted with representatives of 12 Primary Care Trusts in England. Interviews focussed on: understanding of the term “disinvestment”; current activities, and perceived determinants of successful disinvestment decision making and implementation. Data were organised into themes according to standard qualitative data coding practices.

Findings indicate that experiences of disinvestment are varied and that organisations are currently adopting a range of approaches. There are a number of apparently influential determinants of disinvestment which relate to both health system features and organisational characteristics. According to the experiences of the interviewees, many of the easier disinvestment options have now been taken and more ambitious plans, which require wider engagement and more thorough project management, will be required in the future.

Findings from the research suggest that issues around understanding and usage of disinvestment terminology should be addressed and that a more in-depth and ethnographic research agenda will be of most value in moving forward both the theory and practice of disinvestment.

This research suggests that, in the English NHS at least, there is a disjuncture between common usage of the term “disinvestment” and the way that it has previously been understood by the wider research community. In addition to this, the research also highlights a broader range of potential determinants of disinvestment than are considered in the extant literature.