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IntroductionHealth administration is complex and serves many masters. Value, quality, infrastructure and reimbursement are just a sample of the competing interests influencing executive decision-making. This creates a need for decision processes that are rational and holistic.MethodsWe created a multicriteria decision analysis tool to evaluate six fields of healthcare provision: return on investment, capacity, outcomes, safety, training and risk. The tool was designed for prospective use, at the beginning of each funding round for competing projects. Administrators were asked to rank their criteria in order of preference. Each field was assigned a representative weight determined from the rankings. Project data were then entered into the tool for each of the six fields. The score for each field was scaled as a proportion of the highest scoring project, then weighted by preference. We then plotted findings on a cost-effectiveness plane. The project was piloted and developed over successive uses by the hospital’s executive board.ResultsTwelve projects competing for funding at the Royal Brisbane and Women’s Hospital were scored by the tool. It created a priority ranking for each initiative based on the weights assigned to each field by the executive board. Projects were plotted on a cost-effectiveness plane with score as the x-axis and cost of implementation as the y-axis. Projects to the bottom right were considered dominant over projects above and to the left, indicating that they provided greater benefit at a lower cost. Projects below the x-axis were cost-saving and recommended provided they did not harm patients. All remaining projects above the x-axis were then recommended in order of lowest to highest cost-per-point scored.ConclusionThis tool provides a transparent, objective method of decision analysis using accessible software. It would serve health services delivery organisations that seek to achieve value in healthcare.

Aim: To describe the drug use evaluation (DUE) models used in hospitals in Australia and New Zealand. Method: 18 hospitals in Australia and New Zealand were identified as having DUE pharmacist positions and 15 were willing to participate in the survey. DUE pharmacists were surveyed about the DUE process, structure, service implementation and their job descriptions. Results: 47% (7/15) of DUE pharmacists reported to the Director of Pharmacy, 33% (5/15) to the Drug and Therapeutics Committee and 20% (3/15) to the Director of Clinical Pharmacology. 73% (11/15) of DUE pharmacists were located in the hospital's pharmacy department. On average, a 0.8 full-time equivalent (range 0.2 to 2.5) pharmacist was dedicated to DUE activities per hospital with an average of 0.2 full-time equivalent (range 0 to 0.8) assigned to clinical activities. 79% (12/15) of hospitals only funded DUE pharmacist positions; 7% (1/15) funded combined pharmacist and pharmacy technician positions; 7% (1/15) funded combined pharmacist and rotating pharmacy intern positions; and 7% (1/15) funded clinical pharmacologist, nurse and pharmacist positions. 20% (3/15) of hospitals had a DUE subcommittee to coordinate DUE activities. All of the hospitals reported their DUE results to the Drug and Therapeutics Committees. Conclusion: A variety of DUE models exist in hospitals in Australia and New Zealand. Successful DUE services had a multidisciplinary approach with support and collaboration from medical, pharmacy, nursing and administrative staff.