Fit for purpose? Introducing a rational priority setting approach into a community care setting

Area of Science:

• Health Services Research
• Health Economics
• Decision Science

Background:

• Program budgeting and marginal analysis (PBMA) is a recognized approach for resource allocation and priority setting in healthcare.
• Existing research confirms PBMA's efficacy but notes that contextual factors can impede its successful implementation and effectiveness.
• Understanding these contextual factors is crucial for optimizing PBMA's application in real-world settings.

Purpose of the Study:

• To qualitatively explore the effectiveness of Program budgeting and marginal analysis (PBMA) implementation.
• To gain insights into decision-makers' perceptions of PBMA's usability, acceptability, and fit within their specific organizational context.
• To identify barriers and facilitators influencing PBMA adoption and effectiveness.

Main Methods:

• A Canadian case study involving qualitative data collection through interviews with decision-makers.
• Interviews were conducted at three time points: pre-implementation, post-year-1, and post-year-2 of PBMA.
• Data analysis focused on perceptions of baseline priority setting, desired practices, and PBMA's usability and acceptability.

Main Results:

• 'Fit'—encompassing desirability, acceptability, and usability—emerged as a critical factor for PBMA effectiveness.
• While decision-makers desired rational approaches like PBMA, the timing and application format were perceived as unsuitable for the case study context.
• Barriers to PBMA adoption included leadership changes, limited organizational commitment, and concerns about organizational capacity, which negatively impacted effectiveness.

Conclusions:

• Effective implementation of PBMA requires careful consideration of contextual factors, particularly the 'fit' between the approach and the organization's needs and readiness.
• Recommendations include incorporating a contextual readiness/capacity assessment stage into PBMA processes.
• Recognizing organizational complexity and considering incremental adoption strategies can enhance PBMA's success and advance evidence-informed decision-making.