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Programme approach to managing informed commissioning.

P Miller1, L Vale

  • 1University of Aberdeen, UK.

Health Services Management Research
|August 18, 2001
PubMed
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UK NHS commissioners face barriers to adopting Programme Budgeting and Marginal Analysis (PBMA). Institutional inertia, fear of explicitness, and aversion to innovation hinder its implementation despite its proven benefits.

Area of Science:

  • Health Services Research
  • Health Economics
  • Public Health Policy

Background:

  • Healthcare commissioning in the UK faces challenges with priority-setting processes.
  • Programme Budgeting and Marginal Analysis (PBMA) offers potential solutions but adoption is low.
  • Discontent with current commissioning practices is increasing.

Purpose of the Study:

  • To investigate organizational barriers hindering the adoption of PBMA by UK NHS commissioners.
  • To understand decision-makers' perspectives on implementing PBMA.
  • To identify factors contributing to the lack of PBMA uptake.

Main Methods:

  • Conducted two separate semi-structured surveys with commissioning decision-makers.
  • Interviewed 29 decision-makers across Grampian Health Board and Newcastle & North Tyneside Health Authority.

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  • Analyzed qualitative data to identify common themes and barriers.

    • Main Results:

    • Common barriers to PBMA implementation were identified as 'institutional inertia'.
    • Key barriers include a reactive environment, fear of "unnecessary" explicitness, aversion to unilateral innovation, and demand for concrete evaluation evidence.
    • Despite evidence supporting PBMA, these organizational factors impede its adoption.

    Conclusions:

    • Qualitative surveys suggest significant organizational barriers prevent independent adoption of PBMA by NHS commissioning.
    • Implementation strategies should address institutional factors alongside the intervention itself.
    • Future research should focus on overcoming organizational inertia for successful commissioning innovations.