Priority Setting in Surgery: Improve theProcess and Share the Learning

Abstract

Surgeons and surgical programs encounter priority-setting challenges every day, such as in regard to purchasing new technologies or managing waiting lists for elective surgery. The purpose of this paper was to explore priority setting in surgery. Traditionally in surgery, priority-setting decisions for new technologies have been based on evidence of effectiveness and cost-effectiveness; and decisions about managing waiting lists for elective surgery have been based on urgency rating scores. The fairness of priority-setting processes in surgical programs should be enhanced to permit all relevant information and values to be considered. The quality of these decisions can be improved by using an approach that captures and shares lessons from each priority-setting experience. The approach we propose in this paper- describe, evaluate, and improve using a leading conceptual framework for priority setting, called "accountability for reasonableness"-can be used by any surgical program to improve its priority setting, share lessons with others, and develop an evidence base for how these important health policy decisions should be made.

Priority setting and cardiac surgery: A qualitative case study

“…Moreover, it is the first study to evaluate these practices using an ethical framework. Accountability for reasonableness has previously been used to evaluate priority setting at a macro, or health system level [60] in hospitals [51][52][53][54][55], and in critical care programs [56,61,62].…”

Setting priorities in health care organizations: criteria, processes, and parameters of success

“…An evaluation of the normative 'rightness' depends to some extent on the specific institutional circumstances under which priority setting is taking place, the stakeholders who are affected, and the strategic goals that are being pursued. Experience shows, moreover, that the conditions of A4R are sufficiently general to guide fair priority setting in various institutional settings [9,16,20,27]. Thus, decision-makers in other health care organisations may draw lessons from these workshops to operationalise fair priority setting processes that reflect the particularities of their institutional circumstances and ensure accountability for the reasonableness of their clinical service priorities.…”

Drug formulary decision-making in two regional health authorities in British Columbia, Canada

“…Committee members drew upon a wide range of information such as scientific literature, clinical anecdotes, regional trends in hospital admission and drug utilization, budget data, formularies in other jurisdictions, previous decisions, contracts with pharmaceutical companies, and stakeholder input. This finding highlights that decision-makers performing drug formulary priority-setting, akin to those operating in other policy-making contexts, utilize a "mixed economy" of evidence [19][20][21][22][23][24].…”