Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
Administration, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
BMJ Open. 2019 Apr 24;9(4):e025752. doi: 10.1136/bmjopen-2018-025752.
Health 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.
We 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.
Twelve 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.
This 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.
卫生行政工作纷繁复杂，涉及多方利益。价值、质量、基础设施和报销等只是影响行政决策的部分相互竞争的利益。这就需要决策过程兼具合理性和全面性。
我们开发了一种多标准决策分析工具，用于评估医疗服务的六个领域：投资回报率、能力、结果、安全性、培训和风险。该工具旨在前瞻性使用，即在每个竞争项目的资金回合开始时使用。管理者被要求按照偏好程度对其标准进行排序。每个领域都根据排名确定了一个代表权重。然后将项目数据输入到该工具的六个领域中。为每个领域的分数按最高得分项目的比例进行缩放，然后根据偏好进行加权。然后，我们将研究结果绘制在成本效益平面上。该项目由医院执行委员会经过多次试用和改进。
该工具对皇家布里斯班妇女医院的 12 个竞争项目进行了评分。它根据执行委员会为每个领域分配的权重为每个倡议创建了一个优先级排序。项目在成本效益平面上进行了绘制，得分作为 x 轴，实施成本作为 y 轴。位于右下角的项目被认为优于位于上方和左侧的项目，这表明它们以较低的成本提供了更大的收益。位于 x 轴下方的项目具有成本节约性，如果它们不损害患者，则被推荐。所有位于 x 轴上方的剩余项目按照得分从低到高的顺序进行推荐。
该工具使用可访问的软件提供了一种透明、客观的决策分析方法。它将为寻求实现医疗保健价值的卫生服务提供组织提供服务。
