International Journal of Health Policy and Management

International Journal of Health Policy and Management

Introducing New Priority Setting and Resource Allocation Processes in a Canadian Healthcare Organization: A Case Study Analysis Informed by Multiple Streams Theory

Document Type : Original Article

Authors
Neale Smith 1
Craig Mitton 1, 2
Laura Dowling 3
Mary-Ann Hiltz 4
Matthew Campbell 4
Shashi Gujar 4, 5
1 Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
2 School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
3 Dalhousie University, Halifax, NS, Canada
4 Strategy and Organizational Performance, IWK Health Centre, Halifax, NS, Canada
5 Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
10.15171/ijhpm.2015.169
Abstract
Background
In this article, we analyze one case instance of how proposals for change to the priority setting and resource allocation (PSRA) processes at a Canadian healthcare institution reached the decision agenda of the organization’s senior leadership. We adopt key concepts from an established policy studies framework – Kingdon’s multiple streams theory – to inform our analysis.
 
Methods
Twenty-six individual interviews were conducted at the IWK Health Centre in Halifax, NS, Canada. Participants were asked to reflect upon the reasons leading up to the implementation of a formal priority setting process – Program Budgeting and Marginal Analysis (PBMA) – in the 2012/2013 fiscal year. Responses were analyzed qualitatively using Kingdon’s model as a template.
 
Results
The introduction of PBMA can be understood as the opening of a policy window. A problem stream – defined as lack of broad engagement and information sharing across service lines in past practice – converged with a known policy solution, PBMA, which addressed the identified problems and was perceived as easy to use and with an evidence-base from past applications across Canada and elsewhere. Conditions in the political realm allowed for this intervention to proceed, but also constrained its potential outcomes.
 
Conclusion
Understanding in a theoretically-informed way how change occurs in healthcare management practices can provide useful lessons to researchers and decision-makers whose aim is to help health systems achieve the most effective use of available financial resources.

Highlights

Commentary Published on this Paper

  • Priority Setting Meets Multiple Streams: A Match to Be Further Examined?; Comment on “Introducing New Priority Setting and Resource Allocation Processes in a Canadian Healthcare Organization: A Case Study Analysis Informed by Multiple Streams Theory”

          Abstract | PDF

Keywords
Priority Setting
Resource Allocation
Multiple Streams Theory
Tertiary Care Health Centre
Canada
Subjects
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  • Received Date 11 June 2015
  • Revised Date 18 August 2015
  • Accepted Date 14 September 2015
  • First Published Date 01 January 2016
  • Published Date 01 January 2016