What do hospital decision-makers in Ontario, Canada, have to say about the fairness of priority setting in their institutions?

BACKGROUND: Priority setting, also known as rationing or resource allocation, occurs at all levels of every health care system. Daniels and Sabin have proposed a framework for priority setting in health care institutions called 'accountability for reasonableness', which links priority setting to theories of democratic deliberation. Fairness is a key goal of priority setting. According to 'accountability for reasonableness', health care institutions engaged in priority setting have a claim to fairness if they satisfy four conditions of relevance, publicity, appeals/revision, and enforcement. This is the first study which has surveyed the views of hospital decision makers throughout an entire health system about the fairness of priority setting in their institutions. The purpose of this study is to elicit hospital decision-makers' self-report of the fairness of priority setting in their hospitals using an explicit conceptual framework, 'accountability for reasonableness'. METHODS: 160 Ontario hospital Chief Executive Officers, or their designates, were asked to complete a survey questionnaire concerning priority setting in their publicly funded institutions. Eight-six Ontario hospitals completed this survey, for a response rate of 54%. Six close-ended rating scale questions (e.g. Overall, how fair is priority setting at your hospital?), and 3 open-ended questions (e.g. What do you see as the goal(s) of priority setting in your hospital?) were used. RESULTS: Overall, 60.7% of respondents indicated their hospitals' priority setting was fair. With respect to the 'accountability for reasonableness' conditions, respondents indicated their hospitals performed best for the relevance (75.0%) condition, followed by appeals/revision (56.6%), publicity (56.0%), and enforcement (39.5%). CONCLUSIONS: For the first time hospital Chief Executive Officers within an entire health system were surveyed about the fairness of priority setting practices in their institutions using the conceptual framework 'accountability for reasonableness'. Although many hospital CEOs felt that their priority setting was fair, ample room for improvement was noted, especially for the enforcement condition

Priority setting in Ontario hospitals

First, I conducted a hospital survey of 160 Ontario hospital Chief Executive Officers (CEOs) asking CEOs to self report on the fairness of their priority setting. Eight-six CEOs completed the survey (54%). 60.7% of respondents indicated their hospitals' priority setting was fair. With respect to A4R conditions, respondents indicated their hospitals performed best for 'relevance' (75.0%), followed by 'revision/appeals' (56.6%), 'publicity' (56.0%), and 'enforcement' (39.5%) conditions. Greatest room for improvement existed in meeting the 'enforcement' condition. This study expands on the likely relationship between leadership and priority setting. The overall aim of this research was to describe, evaluate and identify opportunities to improve priority setting in Ontario hospitals using Daniels and Sabin's ethical framework of 'accountability for reasonableness' (A4R). Second, I conducted interviews with 46 CEOs of Ontario hospitals, and developed a framework of leadership characteristics in hospital priority setting, involving: vision, alignment, relationships, values and process. The fledgling framework developed in this research provides, I believe, a leadership guide for decision makers to improve the quality of their leadership, and in so doing, fairness of their priority setting. Overall, the most valuable innovation of this research was the finding of an alignment between leadership concepts and concepts of ethical priority setting. Third, I conducted a policy analysis concerning the implementation of Ontario hospital accountability agreements, evaluated against A4R. Analysis suggested that government only partially met the 'relevance' condition however there was evidence of social learning and movement towards the establishment of inclusive stakeholder arrangements. Evidence suggested government eventually progressed towards meeting the 'publicity' condition. Government only partially met the 'revision/appeals' condition. Government did not meet the 'enforcement' condition, as the other conditions were only partially met. It is my view that regional governance structures in Ontario (i.e. Local Health Integration Networks or LHINs) provide an opportunity for the province to improve the fairness of their accountability agreement processes.Ph.D

Aspects of the photoperiodic response of the pea aphid Acyrthosiphon pisum (Harris).

Dept. of Biological Sciences. Paper copy at Leddy Library: Theses & Major Papers - Basement, West Bldg. / Call Number: Thesis1979 .R445. Source: Masters Abstracts International, Volume: 40-07, page: . Thesis (M.Sc.)--University of Windsor (Canada), 1979

Aspects of the photoperiodic response of the pea aphid Acyrthosiphon pisum (Harris).

Dept. of Biological Sciences. Paper copy at Leddy Library: Theses & Major Papers - Basement, West Bldg. / Call Number: Thesis1979 .R445. Source: Masters Abstracts International, Volume: 40-07, page: . Thesis (M.Sc.)--University of Windsor (Canada), 1979

What do hospital decision-makers in Ontario, Canada, have to say about the fairness of priority setting in their institutions?

Abstract Background Priority setting, also known as rationing or resource allocation, occurs at all levels of every health care system. Daniels and Sabin have proposed a framework for priority setting in health care institutions called 'accountability for reasonableness', which links priority setting to theories of democratic deliberation. Fairness is a key goal of priority setting. According to 'accountability for reasonableness', health care institutions engaged in priority setting have a claim to fairness if they satisfy four conditions of relevance, publicity, appeals/revision, and enforcement. This is the first study which has surveyed the views of hospital decision makers throughout an entire health system about the fairness of priority setting in their institutions. The purpose of this study is to elicit hospital decision-makers' self-report of the fairness of priority setting in their hospitals using an explicit conceptual framework, 'accountability for reasonableness'. Methods 160 Ontario hospital Chief Executive Officers, or their designates, were asked to complete a survey questionnaire concerning priority setting in their publicly funded institutions. Eight-six Ontario hospitals completed this survey, for a response rate of 54%. Six close-ended rating scale questions (e.g. Overall, how fair is priority setting at your hospital?), and 3 open-ended questions (e.g. What do you see as the goal(s) of priority setting in your hospital?) were used. Results Overall, 60.7% of respondents indicated their hospitals' priority setting was fair. With respect to the 'accountability for reasonableness' conditions, respondents indicated their hospitals performed best for the relevance (75.0%) condition, followed by appeals/revision (56.6%), publicity (56.0%), and enforcement (39.5%). Conclusions For the first time hospital Chief Executive Officers within an entire health system were surveyed about the fairness of priority setting practices in their institutions using the conceptual framework 'accountability for reasonableness'. Although many hospital CEOs felt that their priority setting was fair, ample room for improvement was noted, especially for the enforcement condition.</p