Priority setting in the Provincial Health Services Authority: case study for the 2005/06 planning cycle

Building on a survey of key decision-makers within the Provincial Health Services Authority (PHSA) of British Columbia, a process for prioritizing new service options within this organization for the 2005/06 budget cycle was developed and implemented by senior managers and researchers at the University of British Columbia.

A case study approach was taken in which development and implementation of the prioritization process was documented and feedback was obtained from decision-makers to evaluate the activity. Information from the literature was also used to identify areas for improvement.

The 13-member Executive Committee of the PHSA conducted the prioritization. Criteria were defined and weighted, and options for new funding were explicitly rated against them. Multi-attribute decision software was used to rank options based on an overall benefit score. Cost-benefit ratios were also derived and program options were further ranked according to decision-makers' "gut-feel." Ranking between the methods was comparable, and each method contributed to the final decisions by the Executive Committee regarding which programs would receive limited new funding.

Through a collaborative effort between decision-makers and researchers, the PHSA was able to shift from allocating new resources on the basis of politics and bargaining to an evidence-driven, transparent, defensible process. Lessons learned from the current activity will help inform future priority setting in the PHSA and should provide insight for decision-makers elsewhere.