Evaluation of Priority Setting and Resource Allocation in Health Care

Transcription

1 Evaluation of Priority Setting and Resource Allocation in Health Care William Hall and Craig Mitton University of British Columbia

2 CIHR Study on High Performance 1. Literature review 1. A national survey of senior healthcare decision makers 1. In depth case studies in six health care organizations 1. Develop a framework using the information gained in the first three phases 1. Apply the framework and evaluate the priority setting and resource allocation process of a health care organization 2

3 Elements of High Performance Structures Processes Attitudes/ Behaviours Ability and authority Process Respectful working relationships Engagement Communication Culture of improvement Outcomes Actual reallocation Stakeholder understanding and endorsement Coordination Skill development Long-term strategic alignment Greater understanding Stability Follow through and change management Fit with social and community Time and resources Project coordinator Strong leadership Improved health is achieved 3

4 Framework to Evaluation Tool Structures Processes Attitudes/ Behaviours Outcomes Evaluation Theory Advisory/Expert Panel Ability and authority Process Respectful working relationships Actual reallocation Engagement Coordination Stability Communication Skill development Follow through and change management Culture of improvement Long-term strategic alignment Fit with social and community Stakeholder understanding and endorsement Greater understanding Evaluation Tool Time and resources Project coordinator Strong leadership Improved health is achieved Balanced Scorecard Development Framework 4

5 Methodology - Methodological Tradition: Case Study - Sampling Technique: Purposive Sampling - Site 1: 27 members were interviewed - 3 clinical leaders, 20 managers, 4 executive team members - Site 2: 25 members interviewed - 11 executive team members, 13 managers - Interview Medium: Tele, video-conferencing, and face-to-face 5

6 Scorecards Site 1 Structures Processes Attitudes/ Outcomes Behaviours P1 P1 A1 O1 S2 P2 A2 O2 S3 P3 A3 O3 S4 P4 A4 O4 S5 P5 A5 Site 2 Structures Processes Attitudes/ Outcomes Behaviours S1 P1 A1 O1 S2 P2 A2 O2 S3 P3 A3 O3 S4 P4 A4 O4 S5 P5 A5 6

7 Site 1 - Evaluation Tool Dashboard Structures Processes Attitudes/ Behaviours Outcomes Ability and authority Process Respectful working relationships Engagement Communication Culture of improvement Actual reallocation Stakeholder understanding and endorsement Coordination Skill development Long-term strategic alignment Greater understanding Stability Follow through and change management Fit with society and community Improved health is achieved Time and Resources Project coordinator Strong leadership 7

8 Site 1 - Strengths Elements of High Performance Description in Test Organization 1. Public Engagement Used town hall meetings to elicit public values and priorities that informed the creation of strategic plan 2. Criteria and Assessment Tool Criteria for evaluating proposals are linked to strategic plan and applied consistently in a weighted Assessment Tool 3. Frontline Staff Involvement Frontline staff are engaged at the proposal development stages 4. Evidence Based Data collection is supported, and multiple forms of evidence are used to inform proposals 5. Leadership Team A strong and stable senior management team supports the process 6. Culture of Improvement A desire to improve and enhance existing mechanisms is pervasive in the organization 7. Ability and Authority to Move Resources Despite some political interference, managers have the ability and authority to re-allocate resources 8

9 Site 1 - Weaknesses Elements of High Performance Description in Test Organization 1. Training and Education No formal education for PSRA process and a lack of understanding among mid to frontline managers 2. Communication PSRA process communication is lacking, and in special need of attention at the proposal feedback stage 3. Timeline and Deadlines Unclear, condensed, and non-harmonized timelines 4. Monitoring and Oversight Variable levels of monitoring and oversight for accepted proposals 5. Coordination of Resource Lack of coordination between Operational, Capital and IT PSRA processes Allocation Processes 6. Program Budgeting Very limited program budgeting taking place within the organization 9

10 Site 1 Recommendations Elements of High Performance Description in Test Organization 1. Training Expand and enhance training provided to lower level managers. Leverage experience of VWG 2. Communication Increase and enhance communication with a special focus on rationale for proposal decisions 3. Circumvention of Proposals Document proposals that circumvent the normal PSRA process 4. Monitoring and Oversight Increase the monitoring and evaluation of proposals 5. Program Budgeting Build upon existing success to expand the practice of program budgeting to other departments in the organization 10

11 Site 2 - Evaluation Tool Dashboard Structures Processes Attitudes/ Behaviours Outcomes Ability and authority Process Respectful working relationships Engagement Communication Culture of improvement Actual reallocation Stakeholder understanding and endorsement Coordination Skill development Long-term strategic alignment Greater understanding Stability Follow through and change management Fit with society and community Improved health is achieved Time and Resources Project coordinator Strong leadership 11

12 Site 2 - Strengths Elements of High Performance Description 1. Culture of Improvement Supportive of learning and staff development: but no specific internal training around PSRA 2. Follow through and Implementation Major initiatives are required to present evaluation and sustainability plans 3. Staff & Public Involvement LEAN projects are a major vehicle for staff and public involvement; program improvements have resulted 4. Evidence Based Offers considerable support to managers in terms of data collection, program evaluation, and research into effective service delivery models 5. Long term strategic alignment Strategic plan developed with input from staff, patients/families and other stakeholders; plan is widely known and a potential guide for PSRA decisions 6. Leadership team Committed to improving its processes (e.g., development of explicit criteria); stability has led to good working relationships 12

13 Site 2 - Weaknesses Elements of High Performance Description 1. Explicit criteria No explicit criteria for deciding among spending options presently exist 2. Communication Few opportunities for face-to-face communication. Scheduled events often cancelled or postponed. 3. Staff Engagement Inconsistent opportunities for middle managers to provide input into organization-wide PSRA decisions 4. Coordination of Resource Allocation Processes 5. Stability There may be impending large scale retirements succession planning? Preferred investments get bumped by external demands 6. Fit with Social & Community Values 7. Ability & Authority to Move Resources Unclear alignment with partner agencies. The organization is struggling to understand its role and audience. Organization appears to function as two silos. 13

14 Site 2 - Recommendations Elements of High Performance Description 1. Process Clarify and/or formalize key aspects of the process (e.g., criteria, communication, staff and public engagement) 2. Communication Establish additional regular and consistent channels for two-way communication about resource allocation decisions 3. Organization Identity Create ways for participants to gain knowledge about the full range of services offered in the organization and to give them tools necessary to make informed trade-offs among these services 4. Coordinator Create a Working or Advisory Group to address Areas for Improvement 14

15 Advances and Contributions to the Literature and Practice Produced the first cross-canada survey of priority setting and resource allocation practice across large, medium and small health service organizations; this can be useful baseline data for future studies Identified a comprehensive list of structure, process and attitude/behaviour elements which contribute to outcomes in organizations which aspire to be high performers in priority setting and resource allocation (based on detailed case studies and review of the literature) Developed the first multi-site assessment tool for high performance priority setting and resource allocation, which has the potential to be further disseminated among health organizations across the country 15

16 Future Research Developing more specific descriptions for levels of performance Longer term evaluation to enable measurement of elements in more detail Develop self-assessment tool for organizations Less resource intensive Greater sample size More specific measurement tools for individual elements 16

17 Discussion 17