Priority setting: what constitutes success? A conceptual framework for successful priority setting

Abstract

BackgroundThe sustainability of healthcare systems worldwide is threatened by a growing demand for services and expensive innovative technologies. Decision makers struggle in this environment to set priorities appropriately, particularly because they lack consensus about which values should guide their decisions. One way to approach this problem is to determine what all relevant stakeholders understand successful priority setting to mean. The goal of this research was to develop a conceptual framework for successful priority setting.MethodsThree separate empirical studies were completed using qualitative data collection methods (one-on-one interviews with healthcare decision makers from across Canada; focus groups with representation of patients, caregivers and policy makers; and Delphi study including scholars and decision makers from five countries).ResultsThis paper synthesizes the findings from three studies into a framework of ten separate but interconnected elements germane to successful priority setting: stakeholder understanding, shifted priorities/reallocation of resources, decision making quality, stakeholder acceptance and satisfaction, positive externalities, stakeholder engagement, use of explicit process, information management, consideration of values and context, and revision or appeals mechanism.ConclusionThe ten elements specify both quantitative and qualitative dimensions of priority setting and relate to both process and outcome components. To our knowledge, this is the first framework that describes successful priority setting. The ten elements identified in this research provide guidance for decision makers and a common language to discuss priority setting success and work toward improving priority setting efforts.

Priority-setting and rationing in healthcare: Evidence from the English experience

“…In other words, respondents were simultaneously concerned with both instrumental effects and the wider legitimacy of their priority-setting activities. While the presence of this dual focus is not surprising when considered in the light of previous research (Sibbald et al, 2009), our study identifies a number of limitations in PCT attempts to meet these aims, and casts some doubt over the compatibility of seeking decisions that are both 'right' and perceived to be 'right'.…”

“…Making priority-setting a driver of substantive (and inherently contentious) decisions would undoubtedly require a more formally constituted set of implementation mechanisms than was in place in any of the sites. To make inroads into service organisation and delivery, priority-setting would also need to be connected to broader change (and change management) processes -something that had yet to feature in the work of sites or the priority-setting literature more generally (Gibson et al, 2005;Sibbald et al, 2009). .…”

Swaziland National Health Research Agenda: The Formulation Process

“…First, search and review of the existing health research priority setting guidelines by WHO [9], Council on Health Research for Development (CO-HRED) [10], Ghaffar [11], Global Forum for Health Research [12], Montorzi et al [13], Sibbald [14], and Hindin et al [15].…”

Developing a spinal cord injury research strategy using a structured process of evidence review and stakeholder dialogue. Part III: outcomes

“…14 Arguably, SCI research can be more multidisciplinary and complex with greater potential for competing interests than may be the case for research in an Intensive Care Unit setting. However, the example of ANZICS demonstrates that a defined framework and rationale reflecting an explicit vision and mission, such that decisions are based on clear value choices of the network, 21 is critical to mitigating potential conflict and disenfranchisement arising from prioritisation processes. Health research prioritisation criteria include clinical importance, magnitude of the problem, likelihood of reducing burden, cost effectiveness, present knowledge, resources, ethical aspects, research capacity, novelty and controversy.…”