International Journal of Health Policy and Management

International Journal of Health Policy and Management

What Factors Do Allied Health Take Into Account When Making Resource Allocation Decisions?

Document Type : Original Article

Authors
Haylee Lane 1
Tamica Sturgess 2
Kathleen Philip 3
Donna Markham 4
Jennifer Martin 5
Jill Walsh 4
Wendy Hubbard 6
Terry Haines 1
1 School of Primary & Allied Health Care, Monash University, Frankston, VIC, Australia
2 Workforce Innovation Strategy Education and Research Unit, Monash Health, Clayton, VIC, Australia
3 Department of Health and Human Services, Melbourne, VIC, Australia
4 Monash Health, Clayton, VIC, Australia
5 Centre of Applied Social Research, RMIT University, Melbourne, VIC, Australia
6 State-Wide Equipment Program, Ballarat Health Services, Ballarat, VIC, Australia
10.15171/ijhpm.2017.105
Abstract
Background
Allied health comprises multiple professional groups including dietetics, medical radiation practitioners, occupational therapists, optometrists and psychologists. Different to medical and nursing, Allied health are often organized in discipline specific departments and allocate budgets within these to provide services to a range of clinical areas. Little is known of how managers of allied health go about allocating these resources, the factors they consider when making these decisions, and the sources of information they rely upon. The purpose of this study was to identify the key factors that allied health consider when making resource allocation decisions and the sources of information they are based upon.

 
Methods
Four forums were conducted each consisting of case studies, a large group discussion and two hypothetical scenarios to elicit data. A thematic content analysis commenced during post-forum discussions of key factors by forum facilitators. These factors were then presented to an expert working party for further discussion and refinement. Transcripts were generated of all data recordings and a detailed thematic analysis was undertaken by one author to ensure coded data matched the initial thematic analysis.

 
Results
Twelve factors affecting the decision-making of allied health managers and clinicians were identified. One of these factors was disendorsed by the expert working party. The 11 remaining factors can be considered to be key decision-making principles that should be consistently applied to resource allocation. These principles were clustered into three overarching themes of readiness, impact and appropriateness.

 
Conclusion
Understanding these principles now means further research can be completed to more effectively integrate research evidence into health policy and service delivery, create partnerships among policy-makers, managers, service providers and researchers, and to provide support to answer difficult questions that policy-makers, managers and service providers face.
Keywords
Resource Allocation
Allied Health
Decision-Making
Priority Setting
Subjects
  1. Klein R. Dimensions of rationing: who should do what? BMJ. 1993;307(6899):309-311.
  2. Baeroe K. Priority setting in health care: on the relation between reasonable choices on the micro-level and the macro-level. Theor Med Bioeth. 2008;29(2):87-102. doi:10.1007/s11017-008-9063-3
  3. Adams R, Jones A, Lefmann S, Sheppard L. Service Level Decision-making in Rural Physiotherapy: Development of Conceptual Models. Physiother Res Int. 2016;21(2):116-126. doi:10.1002/pri.1627
  4. National Health and Hospitals Reform Commission. A Healthier Future for All Australians: Final Report June 2009. http://www.cotasa.org.au/cms_resources/documents/news/nhhrc_report.pdf.  Accessed August 2016. Published 2009.
  5. Hoffmann TC, Legare F, Simmons MB, et al. Shared decision making: what do clinicians need to know and why should they bother? Med J Aust. 2014;201(1):35-39.
  6. Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997;44(5):681-692.
  7. Offredy M. The application of decision making concepts by nurse practitioners in general practice. J Adv Nurs. 1998;28(5):988-1000.
  8. Stacey D, Murray MA, Legare F, Sandy D, Menard P, O'Connor A. Decision coaching to support shared decision making: a framework, evidence, and implications for nursing practice, education, and policy. Worldviews Evid Based Nurs. 2008;5(1):25-35. doi:10.1111/j.1741-6787.2007.00108.x
  9. Towle A, Godolphin W. Framework for teaching and learning informed shared decision making. BMJ. 1999;319(7212):766-771.
  10. Australian Institute of Health and Welfare. Monitoring pulmonary rehabilitation and long-term oxygen therapy for people with COPD in Australia: a discussion paper. Canberra: AIHW; 2013.
  11. Puhan M, Scharplatz M, Troosters T, Walters EH, Steurer J. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2009(1):Cd005305. doi:10.1002/14651858.CD005305.pub2
  12. Runciman WB, Hunt TD, Hannaford NA, et al. CareTrack: assessing the appropriateness of health care delivery in Australia. Med J Aust. 2012;197(2):100-105.
  13. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care. Lancet. 2003;362(9391):1225-1230. doi:10.1016/s0140-6736(03)14546-1
  14. Rubin A, Babbie E. Research Methods for Social Work. 8th Ed. Belmont USA: Brooks/Cole; 2004.  
  15. Sandelowski M. Sample size in qualitative research. Res Nurs Health. 1995;18(2):179-183.
  16. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277-1288. doi:10.1177/1049732305276687
  17. Klenke K. Qualitative research as method. In: Qualitative Research in the Study of Leadership. 1st ed. UK: Emerald Group publishing Limited; 2008.
  18. Potter WJ, Levine‐Donnerstein D. Rethinking validity and reliability in content analysis. J Appl Commun Res. 1999;27(3):258-284. doi:10.1080/00909889909365539
  19. Scottish Executive National Health System. Allied Health Professions: Workload Measurement and Management. Scotland. http://www.sehd.scot.nhs.uk/ahp/_documents/ahpworkloadmeasureandmanage.pdf.  Accessed August 2016. Published 2006.
  20. Sibbald SL, Singer PA, Upshur R, Martin DK. Priority setting: what constitutes success? A conceptual framework for successful priority setting. BMC Health Serv Res. 2009;9:43. doi:10.1186/1472-6963-9-43
  21. Yancey AK, Cole BL, McCarthy WJ. A graphical, computer-based decision-support tool to help decision makers evaluate policy options relating to physical activity. Am J Prev Med. 2010;39(3):273-279. doi:10.1016/j.amepre.2010.05.013
  22. Simmons NC, Kuys SS. Trial of an allied health workload allocation model. Aust Health Rev. 2011;35(2):168-175. doi:10.1071/ah09860
  23. Angelis A, Kanavos P, Montibeller G. Resource allocation and priority setting in health care: a multi-criteria decision analysis problem of value? Global Policy. 2017;8:76-83. doi:10.1111/1758-5899.12387
  24. Sabik LM, Lie RK. Priority setting in health care: Lessons from the experiences of eight countries. Int J Equity Health. 2008;7:4. doi:10.1186/1475-9276-7-4
  25. Mainz J. Health care and Medical Priorities Commission. No Easy Choices. the Difficult Priorities of Health Care. Stockholm, Sweden: Swedish Government Official Reports, 1993; 93. 133 pages. Scand J Public Health. 1995;23(2):144-144. doi:10.1177/140349489502300212
  26. Arvidsson E, Andre M, Borgquist L, Andersson D, Carlsson P. Setting priorities in primary health care--on whose conditions? A questionnaire study. BMC Fam Pract. 2012;13:114. doi:10.1186/1471-2296-13-114
  27. Imison C, Sonola L, Honeyman M, Ross S. The Reconfiguration of Clinical Services: What Is The Evidence? London. The King’s Fund; 2014.
  28. Williams A. Thinking about equity in health care. J Nurs Manag. 2005;13(5):397-402. doi:10.1111/j.1365-2834.2005.00578.x
  29. Mitton CR, Donaldson C. Setting priorities and allocating resources in health regions: lessons from a project evaluating program budgeting and marginal analysis (PBMA). Health Policy. 2003;64(3):335-348.
  30. Menon D, Stafinski T, Martin D. Priority-setting for healthcare: who, how, and is it fair? Health Policy. 2007;84(2-3):220-233. doi:10.1016/j.healthpol.2007.05.009
  31. Mitton C, Donaldson C. Setting priorities in Canadian regional health authorities: a survey of key decision makers. Health Policy. 2002;60(1):39-58.
  32. Parsons W. From Muddling Through to Muddling Up - Evidence Based Policy Making and the Modernisation of British Government. Public Policy Adm. 2002;17(3):43-60. doi:10.1177/095207670201700304
  33. Heiwe S, Kajermo KN, Tyni-Lenne R, et al. Evidence-based practice: attitudes, knowledge and behaviour among allied health care professionals. Int J Qual Health Care. 2011;23(2):198-209. doi:10.1093/intqhc/mzq083
  34. Philibert DB, Snyder P, Judd D, Windsor MM. Practitioners' reading patterns, attitudes, and use of research reported in occupational therapy journals. Am J Occup Ther. 2003;57(4):450-458.
  35. Salbach NM, Jaglal SB, Korner-Bitensky N, Rappolt S, Davis D. Practitioner and organizational barriers to evidence-based practice of physical therapists for people with stroke. Phys Ther. 2007;87(10):1284-1303. doi:10.2522/ptj.20070040
  36. Robert G, Harlock J, Williams I. Disentangling rhetoric and reality: an international Delphi study of factors and processes that facilitate the successful implementation of decisions to decommission healthcare services. Implement Sci. 2014;9:123. doi:10.1186/s13012-014-0123-y
International Journal of Health Policy and Management
Volume 7, Issue 5
2018
Pages 412-420

  • Received Date 20 March 2017
  • Revised Date 28 August 2017
  • Accepted Date 28 August 2017
  • First Published Date 01 May 2018
  • Published Date 01 May 2018