Achieving high performance in healthcare resource allocation Neale Smith, Craig Mitton, Jennifer Gibson, Alan Davidson, Stuart Peacock & Stirling Bryan Presentation to the Annual Conference of the Canadian Association for Health Services & Policy Research May 2011 Halifax NS
Overview of the Full Study CIHR-funded PHSI grant, 2010-2013 Phase 1=online survey; Phase 2=case studies Definition of high performance will be emergent and based on our data
Phase I Methods Online surveys (English & French), hosted by EduData (UBC Faculty of Education) Survey data collection: January 25-April 30, 2011 (four waves) Contact names & emails obtained mainly from health organization websites Initial contacts given about three weeks to reply, then replaced by new names Maximum of three responses per organization
Responses Region # of Responses # of Org ns West 46 25 of 31 Ontario 10 7 of 14 Quebec 12 10 of 18 Atlantic 18 12 of 16 North 5 5 of 10 TOTAL 91
About the Respondents Primary Role Educational Background 26 46 19 Finance Operations Planning 41 10 40 Medicine Other health Non- Health
More about the Respondents Years as a senior manager Mean = 11.9; Median = 12; range 1 to 32 Years as a health sector manager Mean = 10.9; Median = 11; range 1 to 32 Years with current organization Mean = 10.5; Median = 8
Type of Resource Allocation Process 12 Historical 22 Ext. Politics & Mandates Int. Politics 33 2 20 Formal/Rational A Formal/Rational B (zerobased)
Strengths Please identify what you consider to be two main strengths of your current organization-wide process for resource allocation [i.e., what works well?] N=86 Collaborative approach, engagement with key stakeholders & the public Quality of the senior management team Alignment of resource allocation with strategic directions Also: Small size of organization Use of an ethics framework
Weaknesses Please identify what you consider to be two main weaknesses of your current organization-wide process for resource allocation [i.e., what works well?] N=85 Role of politics /limited autonomy & flexibility Dominance of historical allocation and limited efforts to re-assess base budgets Lack of data Unwillingness or inability to undertake major transformation or re-allocate across sectors Also: Tension between finance-driven and other perspectives
Enablers & Barriers Are these features present in your org n? Disagree Neither Agree Aligned with other key processes 11% 10% 79% Strong leadership 10% 15% 75% Learning culture 11% 14% 75% Appropriate knowledge and skills 13% 22% 64% Effective process management 12% 34% 54% Manageable in time and resources 31% 20% 48% Honest engagement* 27% 26% 46% Trust* 23% 33% 44% Buy-in from stakeholders* 30% 31% 39% Available data* 47% 21% 32% Guarantee no disproportionate loss 38% 37% 24% * = reverse coded
Are Processes (seen as) Fair? 60 50 40 30 20 10 0 7 0 53 22 29 29 13 14 Strongly agree Agree Neither A or D Disagree Strongly disagree 4 8 Personal Belief Perception of Others' Belief
Overall, how would you rate your organization s resource allocation process very good, 2 very poor, 3 poor, 10 good, 44 fair, 32 Mean score = 3.432 out of 5
Type of Process vs. Perceived Success Poor or Very Poor Fair Good or Very Good Formal/Rational Process 7% 23% 70% Historical or Political Process 18% 50% 32%
Turnover vs. Perceived Success Poor or Very Poor Fair Good or Very Good Major Turnover 17% 46% 38% Moderate Turnover 16% 38% 47% Minimal Turnover 11% 26% 63%
3-year Budget Trend vs. Perceived Success Poor or Very Poor Fair Good or Very Good Increasing 20% 38% 43% Stable 4% 31% 66% Decreasing 13% 35% 52%
Conclusions Respondents overall had generally positive impressions of their organizations resource allocation processes Many responses in regard to organization resource allocation were generally consistent with the existing literature There are also interesting gaps and disjunctions to explore
Contact Me Neale Smith Centre for Clinical Epidemiology & Evaluation Vancouver Coastal Health Research Institute University of British Columbia 7th floor, 828 W 10th Avenue Vancouver, BC V5Z1M9 Ph: (604) 875-4111 ext 66712 neale.smith@ubc.ca