14 results
Search Results
2. Sustainability in Health care by allocating resources effectively (SHARE) 1: introducing a series of papers reporting an investigation of disinvestment in a local healthcare setting
- Author
-
Richard King, Wayne Ramsey, Sally Green, Kelly Allen, and Claire Harris
- Subjects
Decision Making ,Disinvestment ,Health informatics ,Resource Allocation ,Health administration ,Health care rationing ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Health care ,Humans ,Medicine ,030212 general & internal medicine ,Investments ,Health Services Administration ,Health policy ,De-implement ,De-list ,Health Care Rationing ,business.industry ,lcsh:Public aspects of medicine ,030503 health policy & services ,Health Policy ,Nursing research ,Australia ,Health technology ,lcsh:RA1-1270 ,De-adopt ,Public relations ,Editorial ,Implementation ,Decommission ,TCP ,0305 other medical science ,business ,Decision-making - Abstract
This is the first in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE). The SHARE Program is an investigation of concepts, opportunities, methods and implications for evidence-based investment and disinvestment in health technologies and clinical practices in a local healthcare setting. The papers in this series are targeted at clinicians, managers, policy makers, health service researchers and implementation scientists working in this context. This paper presents an overview of the organisation-wide, systematic, integrated, evidence-based approach taken by one Australian healthcare network and provides an introduction and guide to the suite of papers reporting the experiences and outcomes.
- Published
- 2017
3. Sustainability in Health care by allocating resources effectively (SHARE) 1: introducing a series of papers reporting an investigation of disinvestment in a local healthcare setting.
- Author
-
Harris, Claire, Green, Sally, Ramsey, Wayne, Allen, Kelly, and King, Richard
- Subjects
SUSTAINABILITY ,MEDICAL care ,DISINVESTMENT ,INVESTMENTS ,MEDICAL technology ,DECISION making ,HEALTH care rationing ,HEALTH services administration ,RESOURCE allocation - Abstract
This is the first in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE). The SHARE Program is an investigation of concepts, opportunities, methods and implications for evidence-based investment and disinvestment in health technologies and clinical practices in a local healthcare setting. The papers in this series are targeted at clinicians, managers, policy makers, health service researchers and implementation scientists working in this context. This paper presents an overview of the organisation-wide, systematic, integrated, evidence-based approach taken by one Australian healthcare network and provides an introduction and guide to the suite of papers reporting the experiences and outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
4. Sustainability in Health care by Allocating Resources Effectively (SHARE) 2: identifying opportunities for disinvestment in a local healthcare setting.
- Author
-
Harris, Claire, Allen, Kelly, King, Richard, Ramsey, Wayne, Kelly, Cate, and Thiagarajan, Malar
- Subjects
SOCIAL sustainability ,MEDICAL care ,DISINVESTMENT ,PHYSICIAN practice patterns ,RESOURCE allocation ,DECISION making in clinical medicine ,MEDICAL economics ,MEDICAL care standards ,GROUP decision making ,INVESTMENTS ,MEDICAL care use ,TECHNOLOGY ,EVIDENCE-based dentistry ,COST analysis ,ECONOMICS - Abstract
Background: This is the second in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. Rising healthcare costs, continuing advances in health technologies and recognition of ineffective practices and systematic waste are driving disinvestment of health technologies and clinical practices that offer little or no benefit in order to maximise outcomes from existing resources. However there is little information to guide regional health services or individual facilities in how they might approach disinvestment locally. This paper outlines the investigation of potential settings and methods for decision-making about disinvestment in the context of an Australian health service.Methods: Methods include a literature review on the concepts and terminology relating to disinvestment, a survey of national and international researchers, and interviews and workshops with local informants. A conceptual framework was drafted and refined with stakeholder feedback.Results: There is a lack of common terminology regarding definitions and concepts related to disinvestment and no guidance for an organisation-wide systematic approach to disinvestment in a local healthcare service. A summary of issues from the literature and respondents highlight the lack of theoretical knowledge and practical experience and provide a guide to the information required to develop future models or methods for disinvestment in the local context. A conceptual framework was developed. Three mechanisms that provide opportunities to introduce disinvestment decisions into health service systems and processes were identified. Presented in order of complexity, time to achieve outcomes and resources required they include 1) Explicit consideration of potential disinvestment in routine decision-making, 2) Proactive decision-making about disinvestment driven by available evidence from published research and local data, and 3) Specific exercises in priority setting and system redesign.Conclusion: This framework identifies potential opportunities to initiate disinvestment activities in a systematic integrated approach that can be applied across a whole organisation using transparent, evidence-based methods. Incorporating considerations for disinvestment into existing decision-making systems and processes might be achieved quickly with minimal cost; however establishment of new systems requires research into appropriate methods and provision of appropriate skills and resources to deliver them. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
5. Sustainability in Health care by Allocating Resources Effectively (SHARE) 6: investigating methods to identify, prioritise, implement and evaluate disinvestment projects in a local healthcare setting.
- Author
-
Harris, Claire, Allen, Kelly, Brooke, Vanessa, Dyer, Tim, Waller, Cara, King, Richard, Ramsey, Wayne, and Mortimer, Duncan
- Subjects
SUSTAINABILITY ,MEDICAL care ,RESOURCE allocation ,DISINVESTMENT ,INVESTMENT management ,GROUP decision making ,HEALTH care rationing ,HEALTH services administration ,MEDICAL quality control ,MEDICAL care use ,EVIDENCE-based medicine ,COST analysis ,PILOT projects ,PROFESSIONAL practice - Abstract
Background: This is the sixth in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE program was established to investigate a systematic, integrated, evidence-based approach to disinvestment within a large Australian health service. This paper describes the methods employed in undertaking pilot disinvestment projects. It draws a number of lessons regarding the strengths and weaknesses of these methods; particularly regarding the crucial first step of identifying targets for disinvestment.Methods: Literature reviews, survey, interviews, consultation and workshops were used to capture and process the relevant information. A theoretical framework was adapted for evaluation and explication of disinvestment projects, including a taxonomy for the determinants of effectiveness, process of change and outcome measures. Implementation, evaluation and costing plans were developed.Results: Four literature reviews were completed, surveys were received from 15 external experts, 65 interviews were conducted, 18 senior decision-makers attended a data gathering workshop, 22 experts and local informants were consulted, and four decision-making workshops were undertaken. Mechanisms to identify disinvestment targets and criteria for prioritisation and decision-making were investigated. A catalogue containing 184 evidence-based opportunities for disinvestment and an algorithm to identify disinvestment projects were developed. An Expression of Interest process identified two potential disinvestment projects. Seventeen additional projects were proposed through a non-systematic nomination process. Four of the 19 proposals were selected as pilot projects but only one reached the implementation stage. Factors with potential influence on the outcomes of disinvestment projects are discussed and barriers and enablers in the pilot projects are summarised.Conclusion: This study provides an in-depth insight into the experience of disinvestment in one local healthcare service. To our knowledge, this is the first paper to report the process of disinvestment from identification, through prioritisation and decision-making, to implementation and evaluation, and finally explication of the processes and outcomes. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
6. Sustainability in health care by allocating resources effectively (SHARE) 3: examining how resource allocation decisions are made, implemented and evaluated in a local healthcare setting.
- Author
-
Harris, Claire, Allen, Kelly, Waller, Cara, and Brooke, Vanessa
- Subjects
RESOURCE allocation ,MEDICAL care ,HEALTH services administration ,MEDICAL technology ,DISINVESTMENT ,DECISION making ,HEALTH care rationing ,INTERVIEWING ,LEADERSHIP ,MEDICAL care research ,TECHNOLOGY ,EVIDENCE-based medicine ,PROFESSIONAL practice - Abstract
Background: This is the third in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. Leaders in a large Australian health service planned to establish an organisation-wide, systematic, integrated, evidence-based approach to disinvestment. In order to introduce new systems and processes for disinvestment into existing decision-making infrastructure, we aimed to understand where, how and by whom resource allocation decisions were made, implemented and evaluated. We also sought the knowledge and experience of staff regarding previous disinvestment activities.Methods: Structured interviews, workshops and document analysis were used to collect information from multiple sources in an environmental scan of decision-making systems and processes. Findings were synthesised using a theoretical framework.Results: Sixty-eight respondents participated in interviews and workshops. Eight components in the process of resource allocation were identified: Governance, Administration, Stakeholder engagement, Resources, Decision-making, Implementation, Evaluation and, where appropriate, Reinvestment of savings. Elements of structure and practice for each component are described and a new framework was developed to capture the relationships between them. A range of decision-makers, decision-making settings, type and scope of decisions, criteria used, and strengths, weaknesses, barriers and enablers are outlined. The term 'disinvestment' was not used in health service decision-making. Previous projects that involved removal, reduction or restriction of current practices were driven by quality and safety issues, evidence-based practice or a need to find resource savings and not by initiatives where the primary aim was to disinvest. Measuring resource savings is difficult, in some situations impossible. Savings are often only theoretical as resources released may be utilised immediately by patients waiting for beds, clinic appointments or surgery. Decision-making systems and processes for resource allocation are more complex than assumed in previous studies.Conclusion: There is a wide range of decision-makers, settings, scope and type of decisions, and criteria used for allocating resources within a single institution. To our knowledge, this is the first paper to report this level of detail and to introduce eight components of the resource allocation process identified within a local health service. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
7. Sustainability in Health care by Allocating Resources Effectively (SHARE) 11: reporting outcomes of an evidence-driven approach to disinvestment in a local healthcare setting
- Author
-
Harris, Claire, Allen, Kelly, Ramsey, Wayne, King, Richard, and Green, Sally
- Published
- 2018
- Full Text
- View/download PDF
8. Sustainability in Health care by Allocating Resources Effectively (SHARE) 11: reporting outcomes of an evidence-driven approach to disinvestment in a local healthcare setting
- Author
-
Claire Harris, Kelly Allen, Wayne Ramsey, Richard King, and Sally Green
- Subjects
Disinvestment ,Decommission ,de-adopt ,de-list ,de-implement ,Health technology ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background This is the final paper in a thematic series reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE Program was established to explore a systematic, integrated, evidence-based organisation-wide approach to disinvestment in a large Australian health service network. This paper summarises the findings, discusses the contribution of the SHARE Program to the body of knowledge and understanding of disinvestment in the local healthcare setting, and considers implications for policy, practice and research. Discussion The SHARE program was conducted in three phases. Phase One was undertaken to understand concepts and practices related to disinvestment and the implications for a local health service and, based on this information, to identify potential settings and methods for decision-making about disinvestment. The aim of Phase Two was to implement and evaluate the proposed methods to determine which were sustainable, effective and appropriate in a local health service. A review of the current literature incorporating the SHARE findings was conducted in Phase Three to contribute to the understanding of systematic approaches to disinvestment in the local healthcare context. SHARE differed from many other published examples of disinvestment in several ways: by seeking to identify and implement disinvestment opportunities within organisational infrastructure rather than as standalone projects; considering disinvestment in the context of all resource allocation decisions rather than in isolation; including allocation of non-monetary resources as well as financial decisions; and focusing on effective use of limited resources to optimise healthcare outcomes. Conclusion The SHARE findings provide a rich source of new information about local health service decision-making, in a level of detail not previously reported, to inform others in similar situations. Multiple innovations related to disinvestment were found to be acceptable and feasible in the local setting. Factors influencing decision-making, implementation processes and final outcomes were identified; and methods for further exploration, or avoidance, in attempting disinvestment in this context are proposed based on these findings. The settings, frameworks, models, methods and tools arising from the SHARE findings have potential to enhance health care and patient outcomes.
- Published
- 2018
- Full Text
- View/download PDF
9. Sustainability in Health care by Allocating Resources Effectively (SHARE) 2: identifying opportunities for disinvestment in a local healthcare setting
- Author
-
Claire Harris, Kelly Allen, Richard King, Wayne Ramsey, Cate Kelly, and Malar Thiagarajan
- Subjects
Disinvestment ,Decommission ,De-adopt ,De-list ,De-implement ,Health Clinical Practice ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background This is the second in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. Rising healthcare costs, continuing advances in health technologies and recognition of ineffective practices and systematic waste are driving disinvestment of health technologies and clinical practices that offer little or no benefit in order to maximise outcomes from existing resources. However there is little information to guide regional health services or individual facilities in how they might approach disinvestment locally. This paper outlines the investigation of potential settings and methods for decision-making about disinvestment in the context of an Australian health service. Methods Methods include a literature review on the concepts and terminology relating to disinvestment, a survey of national and international researchers, and interviews and workshops with local informants. A conceptual framework was drafted and refined with stakeholder feedback. Results There is a lack of common terminology regarding definitions and concepts related to disinvestment and no guidance for an organisation-wide systematic approach to disinvestment in a local healthcare service. A summary of issues from the literature and respondents highlight the lack of theoretical knowledge and practical experience and provide a guide to the information required to develop future models or methods for disinvestment in the local context. A conceptual framework was developed. Three mechanisms that provide opportunities to introduce disinvestment decisions into health service systems and processes were identified. Presented in order of complexity, time to achieve outcomes and resources required they include 1) Explicit consideration of potential disinvestment in routine decision-making, 2) Proactive decision-making about disinvestment driven by available evidence from published research and local data, and 3) Specific exercises in priority setting and system redesign. Conclusion This framework identifies potential opportunities to initiate disinvestment activities in a systematic integrated approach that can be applied across a whole organisation using transparent, evidence-based methods. Incorporating considerations for disinvestment into existing decision-making systems and processes might be achieved quickly with minimal cost; however establishment of new systems requires research into appropriate methods and provision of appropriate skills and resources to deliver them.
- Published
- 2017
- Full Text
- View/download PDF
10. Sustainability in health care by allocating resources effectively (SHARE) 3: examining how resource allocation decisions are made, implemented and evaluated in a local healthcare setting
- Author
-
Claire Harris, Kelly Allen, Cara Waller, and Vanessa Brooke
- Subjects
Disinvestment ,Decommission ,De-adopt ,De-list ,Environmental scan ,Health technology ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background This is the third in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. Leaders in a large Australian health service planned to establish an organisation-wide, systematic, integrated, evidence-based approach to disinvestment. In order to introduce new systems and processes for disinvestment into existing decision-making infrastructure, we aimed to understand where, how and by whom resource allocation decisions were made, implemented and evaluated. We also sought the knowledge and experience of staff regarding previous disinvestment activities. Methods Structured interviews, workshops and document analysis were used to collect information from multiple sources in an environmental scan of decision-making systems and processes. Findings were synthesised using a theoretical framework. Results Sixty-eight respondents participated in interviews and workshops. Eight components in the process of resource allocation were identified: Governance, Administration, Stakeholder engagement, Resources, Decision-making, Implementation, Evaluation and, where appropriate, Reinvestment of savings. Elements of structure and practice for each component are described and a new framework was developed to capture the relationships between them. A range of decision-makers, decision-making settings, type and scope of decisions, criteria used, and strengths, weaknesses, barriers and enablers are outlined. The term ‘disinvestment’ was not used in health service decision-making. Previous projects that involved removal, reduction or restriction of current practices were driven by quality and safety issues, evidence-based practice or a need to find resource savings and not by initiatives where the primary aim was to disinvest. Measuring resource savings is difficult, in some situations impossible. Savings are often only theoretical as resources released may be utilised immediately by patients waiting for beds, clinic appointments or surgery. Decision-making systems and processes for resource allocation are more complex than assumed in previous studies. Conclusion There is a wide range of decision-makers, settings, scope and type of decisions, and criteria used for allocating resources within a single institution. To our knowledge, this is the first paper to report this level of detail and to introduce eight components of the resource allocation process identified within a local health service.
- Published
- 2017
- Full Text
- View/download PDF
11. Sustainability in Health care by Allocating Resources Effectively (SHARE) 6: investigating methods to identify, prioritise, implement and evaluate disinvestment projects in a local healthcare setting
- Author
-
Claire Harris, Kelly Allen, Vanessa Brooke, Tim Dyer, Cara Waller, Richard King, Wayne Ramsey, and Duncan Mortimer
- Subjects
Disinvestment ,Decommission ,De-adopt ,De-list ,De-implement ,Health technology ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background This is the sixth in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE program was established to investigate a systematic, integrated, evidence-based approach to disinvestment within a large Australian health service. This paper describes the methods employed in undertaking pilot disinvestment projects. It draws a number of lessons regarding the strengths and weaknesses of these methods; particularly regarding the crucial first step of identifying targets for disinvestment. Methods Literature reviews, survey, interviews, consultation and workshops were used to capture and process the relevant information. A theoretical framework was adapted for evaluation and explication of disinvestment projects, including a taxonomy for the determinants of effectiveness, process of change and outcome measures. Implementation, evaluation and costing plans were developed. Results Four literature reviews were completed, surveys were received from 15 external experts, 65 interviews were conducted, 18 senior decision-makers attended a data gathering workshop, 22 experts and local informants were consulted, and four decision-making workshops were undertaken. Mechanisms to identify disinvestment targets and criteria for prioritisation and decision-making were investigated. A catalogue containing 184 evidence-based opportunities for disinvestment and an algorithm to identify disinvestment projects were developed. An Expression of Interest process identified two potential disinvestment projects. Seventeen additional projects were proposed through a non-systematic nomination process. Four of the 19 proposals were selected as pilot projects but only one reached the implementation stage. Factors with potential influence on the outcomes of disinvestment projects are discussed and barriers and enablers in the pilot projects are summarised. Conclusion This study provides an in-depth insight into the experience of disinvestment in one local healthcare service. To our knowledge, this is the first paper to report the process of disinvestment from identification, through prioritisation and decision-making, to implementation and evaluation, and finally explication of the processes and outcomes.
- Published
- 2017
- Full Text
- View/download PDF
12. Sustainability in Health care by Allocating Resources Effectively (SHARE) 11: reporting outcomes of an evidence-driven approach to disinvestment in a local healthcare setting
- Author
-
Kelly Allen, Sally Green, Claire Harris, Wayne Ramsey, and Richard King
- Subjects
Process management ,Debate ,Decision Making ,de-list ,Disinvestment ,Context (language use) ,Health informatics ,Health administration ,Resource Allocation ,Body of knowledge ,03 medical and health sciences ,0302 clinical medicine ,Health care ,Medicine ,Humans ,030212 general & internal medicine ,Investments ,Decision Making, Organizational ,Health Services Administration ,de-adopt ,Evidence-Based Medicine ,business.industry ,030503 health policy & services ,Health Policy ,Nursing research ,lcsh:Public aspects of medicine ,Australia ,Community Participation ,Health technology ,lcsh:RA1-1270 ,Health Services ,de-implement ,Implementation ,Decommission ,0305 other medical science ,business ,TCP ,Delivery of Health Care ,Decision-making - Abstract
Background This is the final paper in a thematic series reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE Program was established to explore a systematic, integrated, evidence-based organisation-wide approach to disinvestment in a large Australian health service network. This paper summarises the findings, discusses the contribution of the SHARE Program to the body of knowledge and understanding of disinvestment in the local healthcare setting, and considers implications for policy, practice and research. Discussion The SHARE program was conducted in three phases. Phase One was undertaken to understand concepts and practices related to disinvestment and the implications for a local health service and, based on this information, to identify potential settings and methods for decision-making about disinvestment. The aim of Phase Two was to implement and evaluate the proposed methods to determine which were sustainable, effective and appropriate in a local health service. A review of the current literature incorporating the SHARE findings was conducted in Phase Three to contribute to the understanding of systematic approaches to disinvestment in the local healthcare context. SHARE differed from many other published examples of disinvestment in several ways: by seeking to identify and implement disinvestment opportunities within organisational infrastructure rather than as standalone projects; considering disinvestment in the context of all resource allocation decisions rather than in isolation; including allocation of non-monetary resources as well as financial decisions; and focusing on effective use of limited resources to optimise healthcare outcomes. Conclusion The SHARE findings provide a rich source of new information about local health service decision-making, in a level of detail not previously reported, to inform others in similar situations. Multiple innovations related to disinvestment were found to be acceptable and feasible in the local setting. Factors influencing decision-making, implementation processes and final outcomes were identified; and methods for further exploration, or avoidance, in attempting disinvestment in this context are proposed based on these findings. The settings, frameworks, models, methods and tools arising from the SHARE findings have potential to enhance health care and patient outcomes. Electronic supplementary material The online version of this article (10.1186/s12913-018-3172-0) contains supplementary material, which is available to authorized users.
- Published
- 2018
13. Sustainability in Health care by Allocating Resources Effectively (SHARE) 6: investigating methods to identify, prioritise, implement and evaluate disinvestment projects in a local healthcare setting
- Author
-
Tim Dyer, Wayne Ramsey, Kelly Allen, Cara Waller, Claire Harris, Vanessa Brooke, Duncan Mortimer, and Richard King
- Subjects
Process management ,Disinvestment ,Pilot Projects ,Health informatics ,Health administration ,Resource Allocation ,03 medical and health sciences ,0302 clinical medicine ,Health care ,Medicine ,Humans ,030212 general & internal medicine ,Decision Making, Organizational ,Health Services Administration ,De-implement ,De-list ,Data collection ,Health Care Rationing ,business.industry ,030503 health policy & services ,Health Policy ,Nursing research ,lcsh:Public aspects of medicine ,Health technology ,lcsh:RA1-1270 ,De-adopt ,Implementation ,Evidence-Based Practice ,Organizational Case Studies ,Costs and Cost Analysis ,Health Resources ,Decommission ,0305 other medical science ,business ,TCP ,Strengths and weaknesses ,Research Article ,Decision-making - Abstract
Background This is the sixth in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE program was established to investigate a systematic, integrated, evidence-based approach to disinvestment within a large Australian health service. This paper describes the methods employed in undertaking pilot disinvestment projects. It draws a number of lessons regarding the strengths and weaknesses of these methods; particularly regarding the crucial first step of identifying targets for disinvestment. Methods Literature reviews, survey, interviews, consultation and workshops were used to capture and process the relevant information. A theoretical framework was adapted for evaluation and explication of disinvestment projects, including a taxonomy for the determinants of effectiveness, process of change and outcome measures. Implementation, evaluation and costing plans were developed. Results Four literature reviews were completed, surveys were received from 15 external experts, 65 interviews were conducted, 18 senior decision-makers attended a data gathering workshop, 22 experts and local informants were consulted, and four decision-making workshops were undertaken. Mechanisms to identify disinvestment targets and criteria for prioritisation and decision-making were investigated. A catalogue containing 184 evidence-based opportunities for disinvestment and an algorithm to identify disinvestment projects were developed. An Expression of Interest process identified two potential disinvestment projects. Seventeen additional projects were proposed through a non-systematic nomination process. Four of the 19 proposals were selected as pilot projects but only one reached the implementation stage. Factors with potential influence on the outcomes of disinvestment projects are discussed and barriers and enablers in the pilot projects are summarised. Conclusion This study provides an in-depth insight into the experience of disinvestment in one local healthcare service. To our knowledge, this is the first paper to report the process of disinvestment from identification, through prioritisation and decision-making, to implementation and evaluation, and finally explication of the processes and outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2269-1) contains supplementary material, which is available to authorized users.
- Published
- 2017
14. Sustainability in health care by allocating resources effectively (SHARE) 3: examining how resource allocation decisions are made, implemented and evaluated in a local healthcare setting
- Author
-
Cara Waller, Vanessa Brooke, Claire Harris, and Kelly Allen
- Subjects
Process management ,Decision Making ,Biomedical Technology ,Disinvestment ,Stakeholder engagement ,Resource Allocation ,Health administration ,Interviews as Topic ,03 medical and health sciences ,0302 clinical medicine ,Resource (project management) ,Nursing ,Health care ,Humans ,Medicine ,030212 general & internal medicine ,Health Services Administration ,De-list ,Health Care Rationing ,business.industry ,lcsh:Public aspects of medicine ,030503 health policy & services ,Health Policy ,Australia ,Health services research ,Health technology ,lcsh:RA1-1270 ,De-adopt ,Environmental scan ,Leadership ,Evidence-Based Practice ,Implementation ,Resource allocation ,Health Services Research ,Decommission ,TCP ,0305 other medical science ,business ,Research Article ,Decision-making - Abstract
Background This is the third in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. Leaders in a large Australian health service planned to establish an organisation-wide, systematic, integrated, evidence-based approach to disinvestment. In order to introduce new systems and processes for disinvestment into existing decision-making infrastructure, we aimed to understand where, how and by whom resource allocation decisions were made, implemented and evaluated. We also sought the knowledge and experience of staff regarding previous disinvestment activities. Methods Structured interviews, workshops and document analysis were used to collect information from multiple sources in an environmental scan of decision-making systems and processes. Findings were synthesised using a theoretical framework. Results Sixty-eight respondents participated in interviews and workshops. Eight components in the process of resource allocation were identified: Governance, Administration, Stakeholder engagement, Resources, Decision-making, Implementation, Evaluation and, where appropriate, Reinvestment of savings. Elements of structure and practice for each component are described and a new framework was developed to capture the relationships between them. A range of decision-makers, decision-making settings, type and scope of decisions, criteria used, and strengths, weaknesses, barriers and enablers are outlined. The term ‘disinvestment’ was not used in health service decision-making. Previous projects that involved removal, reduction or restriction of current practices were driven by quality and safety issues, evidence-based practice or a need to find resource savings and not by initiatives where the primary aim was to disinvest. Measuring resource savings is difficult, in some situations impossible. Savings are often only theoretical as resources released may be utilised immediately by patients waiting for beds, clinic appointments or surgery. Decision-making systems and processes for resource allocation are more complex than assumed in previous studies. Conclusion There is a wide range of decision-makers, settings, scope and type of decisions, and criteria used for allocating resources within a single institution. To our knowledge, this is the first paper to report this level of detail and to introduce eight components of the resource allocation process identified within a local health service. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2207-2) contains supplementary material, which is available to authorized users.
- Published
- 2017
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.