Introducing New Priority Setting and Resource Allocation Processes in a Canadian Healthcare Organization: A Case Study Analysis Informed by Multiple Streams Theory

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Background In this article we analyze one case instance of how proposals for change to the priority setting and resource allocation PSRA processes at a Canadian healthcare institution reached the decision agenda of the organization’s senior leadership We adopt key concepts from an established policy studies framework – Kingdon’s multiple streams theory – to inform our analysis Methods Twentysix individual interviews were conducted at the IWK Health Centre in Halifax NS Canada Participants were asked to reflect upon the reasons leading up to the implementation of a formal priority setting process – Program Budgeting and Marginal Analysis PBMA – in the 20122013 fiscal year Responses were analyzed qualitatively using Kingdon’s model as a template Results The introduction of PBMA can be understood as the opening of a policy window A problem stream – defined as lack of broad engagement and information sharing across service lines in past practice – converged with a known policy solution PBMA which addressed the identified problems and was perceived as easy to use and with an evidencebase from past applications across Canada and elsewhere Conditions in the political realm allowed for this intervention to proceed but also constrained its potential outcomes Conclusion Understanding in a theoreticallyinformed way how change occurs in healthcare management practices can provide useful lessons to researchers and decisionmakers whose aim is to help health systems achieve the most effective use of available financial resources

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