Smith Neale, Mitton Craig, Hall William, Bryan Stirling, Donaldson Cam, Peacock Stuart, Gibson Jennifer L, Urquhart Bonnie
Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, 7th floor, 828 W 10th Avenue Vancouver, BC V5Z1M9, Canada.
Centre for Clinical Epidemiology & Evaluation, UBC, Canada; School of Population and Public Health, UBC, Canada.
Soc Sci Med. 2016 Aug;162:185-92. doi: 10.1016/j.socscimed.2016.06.027. Epub 2016 Jun 21.
Priority setting and resource allocation, or PSRA, are key functions of executive teams in healthcare organizations. Yet decision-makers often base their choices on historical patterns of resource distribution or political pressures. Our aim was to provide leaders with guidance on how to improve PSRA practice, by creating organizational contexts which enable high performance. We carried out in-depth case studies of six Canadian healthcare organizations to obtain from healthcare leaders their understanding of the concept of high performance in PSRA and the factors which contribute to its achievement. Individual and group interviews were carried out (n = 62) with senior managers, middle managers and Board members. Site observations and document review were used to assist researchers in interpreting the interview data. Qualitative data were analyzed iteratively with the literature on empirical examples of PSRA practice, in order to develop a framework of high performance in PSRA. The framework consists of four domains - structures, processes, attitudes and behaviours, and outcomes - within which are 19 specific elements. The emergent themes derive from case studies in different kinds of health organizations (urban/rural, small/large) across Canada. The elements can serve as a checklist for 'high performance' in PSRA. This framework provides a means by which decision-makers in healthcare might assess their practice and identify key areas for improvement. The findings are likely generalizable, certainly within Canada but also across countries. This work constitutes, to our knowledge, the first attempt to present a full package of elements comprising high performance in health care PSRA.
确定优先事项和资源分配（PSRA）是医疗保健组织执行团队的关键职能。然而，决策者往往基于资源分配的历史模式或政治压力来做出选择。我们的目标是通过创建能够实现高绩效的组织环境，为领导者提供有关如何改进PSRA实践的指导。我们对加拿大的六个医疗保健组织进行了深入的案例研究，以了解医疗保健领导者对PSRA中高绩效概念的理解以及促成其实现的因素。我们对高级管理人员、中层管理人员和董事会成员进行了个人和小组访谈（n = 62）。实地观察和文件审查被用于协助研究人员解释访谈数据。定性数据与PSRA实践的实证例子的文献进行了反复分析，以建立一个PSRA高绩效框架。该框架由四个领域组成——结构、流程、态度和行为以及结果——其中包含19个具体要素。这些新出现的主题来自加拿大不同类型卫生组织（城市/农村、小型/大型）的案例研究。这些要素可作为PSRA“高绩效”的检查表。该框架为医疗保健领域的决策者提供了一种评估其实践并确定关键改进领域的方法。这些发现很可能具有普遍性，肯定在加拿大境内，也可能在各国之间。据我们所知，这项工作是首次尝试提出一套完整的要素，构成医疗保健PSRA中的高绩效。
