Assessing and Improving Performance: A Longitudinal Evaluation of Priority Setting and Resource Allocation in a Canadian Health Region

Document Type: Original Article

Authors

1 Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada

2 Planning and Performance Improvement, Northern Health Authority, Prince George, BC, Canada

3 School of Population and Public Health, The University of British Columbia (UBC), Vancouver, BC, Canada

Abstract

Background
In order to meet the challenges presented by increasing demand and scarcity of resources, healthcare organizations are faced with difficult decisions related to resource allocation. Tools to facilitate evaluation and improvement of these processes could enable greater transparency and more optimal distribution of resources.
 
Methods
The Resource Allocation Performance Assessment Tool (RAPAT) was implemented in a healthcare organization in British Columbia, Canada. Recommendations for improvement were delivered, and a follow up evaluation exercise was conducted to assess the trajectory of the organization’s priority setting and resource allocation (PSRA) process 2 years post the original evaluation.
 
Results
Implementation of RAPAT in the pilot organization identified strengths and weaknesses of the organization’s PSRA process at the time of the original evaluation. Strengths included the use of criteria and evidence, an ability to re-allocate resources, and the involvement of frontline staff in the process. Weaknesses included training, communication, and lack of program budgeting. Although the follow up revealed a regression from a more formal PSRA process, a legacy of explicit resource allocation was reported to be providing ongoing benefit for the organization. 
 
Conclusion
While past studies have taken a cross-sectional approach, this paper introduces the first longitudinal evaluation of PSRA in a healthcare organization. By including the strengths, weaknesses, and evolution of one organization’s journey, the authors’ intend that this paper will assist other healthcare leaders in meeting the challenges of allocating scarce resources.

Keywords

Main Subjects


  1. Smith N, Mitton C, Cornelissen E, Gibson J, Peacock S. Using evaluation theory in priority setting and resource allocation. J Health Organ Manag. 2012;26(5):655-671. Doi:10.1108/14777261211256963
  2. Mitton C, Donaldson C. Health care priority setting: principles, practice and challenges. Cost Eff Resour Alloc. 2004;2:3. doi:10.1186/1478-7547-2-3
  3. Donaldson C, Mitton C. Priority Setting Toolkit: Guide to the Use of Economics in Healthcare Decision Making. London: BMJ Publishing Group; 2004.
  4. Smith N, Mitton C, Bryan S, et al. Decision maker perceptions of resource allocation processes in Canadian health care organizations: a national survey. BMC Health Serv Res. 2013;13:247. doi:10.1186/1472-6963-13-247
  5. Sibbald SL, Gibson JL, Singer PA, Upshur R, Martin DK. Evaluating priority setting success in healthcare: a pilot study. BMC Health Serv Res. 2010;10:131.
  6. Peacock S. An evaluation of program budgeting and marginal analysis applied in South Australian hospitals. Melbourne: Centre for Health Program Evaluation, Monash University; 1998.
  7. Kapiriri L, Martin DK. Successful priority setting in low and middle income countries: a framework for evaluation. Health Care Anal. 2010;18(2):129-147. Doi:10.1007/s10728-009-0115-2
  8. Smith N, Mitton C, Hall W, et al. High performance in healthcare priority setting and resource allocation: A literature- and case study-based framework in the Canadian context. Soc Sci Med 1982. 2016;162:185-192. Doi:10.1016/j.socscimed.2016.06.027
  9. Kershaw R, Kershaw S. Developing a BALANCED SCORECARD to Implement Strategy at St. Elsewhere Hospital. Manag Account Q. 2001;2(2):28–35.
  10. Baker GR, Pink GH. A Balanced Scorecard for Canadian Hospitals. Healthc Manage Forum. 1995;8(4):7-13.
  11. Hall W, Smith N, Mitton C, Gibson J, Bryan S. An evaluation tool for assessing performance in priority setting and resource allocation: multi-site application to identify strengths and weaknesses. J Health Serv Res Policy. 2016;21(1):15-23. doi10.1177/1355819615596542
  12. Patton MQ. Utilization-Focused Evaluation. Thousand Oaks: Sage Publications; 2008.
  13. Creswell JW. Qualitative Inquiry and Research Design: Choosing Among Five Traditions. London: SAGE; 2007.
  14. Stake RE. The Art of Case Study Research. SAGE; 1995:196.
  15. Smith N, Mitton C, Hall W, et al. High performance in healthcare priority setting and resource allocation: a literature- and case study-based framework in the Canadian context. Soc Sci Med. 2016;162:185-192. doi:10.1016/j.socscimed.2016.06.027
  16. Mitton CR, Donaldson C, Waldner H, Eagle C. The evolution of PBMA: towards a macro-level priority setting framework for health regions. Health Care Manag Sci. 2003;6(4):263-269.
  17. Fabian C, Johnson J, Kavanagh S. The Challenges and Promise of Program Budgeting. Government Finance Review; 2015. http://www.gfoa.org/sites/default/files/GFR101508.pdf. Accessed January 7, 2015.
  18. Hall W. Development and implementation of a priority setting and resource allocation evaluation tool for achieving high performance [Thesis]. University of British Columbia; 2013. doi:10.14288/1.0107199
  19. Guindo LA, Wagner M, Baltussen R, et al. From efficacy to equity: Literature review of decision criteria for resource allocation and healthcare decisionmaking. Cost Eff Resour Alloc. 2012;10(1):9.
  20. Teng F, Mitton C, MacKenzie J. Priority setting in the provincial health services authority: survey of key decision makers. BMC Health Serv Res. 2007;7:84.
  21. Mitton C, Mackenzie J, Cranston L, Teng F. Priority setting in the Provincial Health Services Authority: case study for the 2005/06 planning cycle. Healthc Policy. 2006;2(1):91-106.
  22. Khan A, Hildreth WB. Budget Theory in the Public Sector. Greenwood Publishing Group; 2002:322.
  23. Accreditation Canada website. https://accreditation.ca/. Accessed December 7, 2016.