Session 1.4 – Local Application of Priority Setting
Wednesday October 29 9:00-10:30
An Evidence-Based Approach to Resource Allocation in an Australian Health Service
(Abstract 0093)Claire Harris, Kelly Allen, Greg Rumbold, Catherine Voutier, Marie Garrubba, Tari Turner, Jane Reid
Centre for Clinical Effectiveness, Southern Health, Australia
Background: Reducing or ceasing unsafe, ineffective or inefficient practices has the advantage of both improving patient care and allowing for more efficient use of available resources. Southern Health, a large integrated regional health service in Melbourne Australia, sought to introduce a program of systematic decision-making for resource allocation.
Objectives: To develop, implement and evaluate an organisation-wide system of evidence-based decision making for effective allocation of resources related to technologies and clinical practices
Methods: An evidence-based change model was used. This model is based on four key steps in a change process: 1.Identifying the need for change, 2.Developing a proposal to meet the need, 3.Implementing the proposal and 4.Evaluating the change. Each step is informed by data collected from research, multidisciplinary consultation and consumer input in line with an evidence-based approach. The framework also explicitly addresses sustainability, avoidance of duplication and facilitation of existing systems at each step.
Results: Six potential models of decision-making regarding resource allocation emerged following a literature review. Project scope, timelines, deliverables and governance structure were agreed at Executive level and funding has been committed. The need for two ‘support’ services was identified leading to development of an ‘Evidence Dissemination Service’ to enable evidence-based decision-making and a ‘Project Support Service’ to enable pilot ‘disinvestment’ projects.
Policy Implications: Early results have demonstrated commitment at the highest level within the organisation and support from key clinical stakeholders.
Evidence-Based Priority Setting at an Organization-Wide Level: Lessons Learned from Two Health Authorities in Western Canada
(Abstract 0036)Craig Mitton1, Howard Waldner2, Mike Conroy2, Cam Donaldson3
1University of BC, Canada, 2Vancouver Island Health Authority, Canada, 3Newcastle University, United Kingdom
Health organizations the world over are charged with allocating resources within a limited funding envelope. In recent years, within the field of health economics, there has been a deliberate shift from technical solutions to implementation of approaches that align with management science more broadly. In that, much focus has been placed on addressing key challenges such as benefit measurement, the need to ensure process fairness and issues pertaining to disinvestment or decommissioning of services.
Over the last few years, two large, urban health authorities in Western Canada – Calgary Health Region and Vancouver Island Health Authority – have implemented and evaluated an evidence-based framework to inform priority setting decisions at an organization-wide level, across all programs and service areas. This work has been carried out collaboratively, with senior executives working closely with university-based health services researchers.
Key lessons learned to date include:
Importance of strong leadership and Board endorsement
- Process alignment with organizational goals and strategies
- Well defined criteria and applying a formal service proposal scoring tool
- Transparency and communication of the process and resulting decisions
- Physician engagement in criteria development and decision validation
- Recognition of political overlay and stakeholder expectations
These lessons are likely relevant elsewhere as health service organizations in all countries are faced with making difficult rationing decisions in politically charged, complex environments. Collectively, this organization-wide activity in two separate provinces in Western Canada constitutes a major advance in the policy literature and has generated important insight that can be applied elsewhere.
Local Application of Technical and Ethical Principles in Decision-Making
(Abstract 0065)Don Sinclair1, Claire Cheong-Leen2, Henrietta Ewart2
1Berkshire East PCT, United Kingdom, 2Priority Service Unit, United Kingdom
Background: Nationally, patients are challenging PCTs’ decisions on funding new technologies, and political capital is being made out of “the postcode lottery”. In South Central, nine PCTs must commission services within resource limits, but face activity targets, expensive technologies and rising public expectation that threaten to exceed available resources. With nine PCTs, there is the risk of geographical variation in access to services.
Objective: Each PCT must make rational investment decisions. These must be supported by commissioners and providers to be implemented effectively, and must have proper patient/public involvement. Decisions must be capable of withstanding challenge and robust enough to avoid judicial review.
Methods: Four priorities committees serve the PCTs and providers of South Central. They have common terms of reference and Ethical Framework, and similar membership. Each includes commissioning and provider organisations, and lay members. A central Priorities Service Unit prepares papers to meet the criteria of the ethical framework. Each PCT has mechanisms to implement decisions and to consider exceptional cases.
Results: This presentation will show how the priorities system in South Central operates, including examples of the impact of decisions on the health care system. It will demonstrate how a successful methodology has been incorporated into other decision-making processes and how exceptional cases are considered.
Policy Implications: There will be discussions of how commissioner/provider separation may impact on the ability to make whole-system decisions, and about the optimum size and configuration of priority decision-making and how patient/public involvement can be strengthened.
Priority Setting in the Local Health Integration Networks of Ontario
(Abstract 0143)Jennifer Gibson1, Gwen Dubois-Wing2
1University of Toronto, Canada, 2North West Local Health Integration Network, Canada, 3On behalf of the LHIN Working Group, Canada
Background: Decision-makers across health systems are looking for practical guidance on how to meet health needs in the context of competing system goals, multiple stakeholder interests, conflicting values and finite resources. In Fall 2007, Local Health Integration Networks (LHINs) in Ontario struck a working group of decision-makers and two university-based consultants to address this challenge.
Objective: To develop and pilot a priority setting framework to support LHIN decision-making.
Methods: 1) A draft framework was developed based on the literature, LHIN documents and experience elsewhere; 2) the framework was implemented formally in three LHINs as a pilot; 3) the three pilots were evaluated using qualitative case study methods; and 4) the framework was refined at a workshop involving decision makers from across the LHINs.
Results: The priority-setting framework has four main decision criteria (each with multiple sub-criteria) and eight process elements. A criteria-based evaluation tool allows decision-makers to trade off funding options explicitly and systematically in relation to local and health system strategic directions, values, performance goals and population health needs. Fair processes enhance the public defensibility of LHIN decisions and facilitate constructive stakeholder engagement around local priorities.
Policy Implications: Decision-makers in other health systems can learn from the Ontario experience to improve strategic alignment of resources with their local system goals and community needs, public defensibility of their decisions based on evidence and community values, and stakeholder engagement around local priorities within the constraint of limited resources.