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Open Access Highly Accessed Research article

Priority setting: what constitutes success? A conceptual framework for successful priority setting

Shannon L Sibbald12*, Peter A Singer3, Ross Upshur24 and Douglas K Martin12

Author Affiliations

1 Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

2 University of Toronto Joint Centre for Bioethics, Toronto, Canada

3 The McLaughlin-Rotman Centre for Global Health, Toronto, Canada

4 Sunnybrook Health Science Centre, Toronto, Canada

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BMC Health Services Research 2009, 9:43  doi:10.1186/1472-6963-9-43

Published: 5 March 2009

Abstract

Background

The sustainability of healthcare systems worldwide is threatened by a growing demand for services and expensive innovative technologies. Decision makers struggle in this environment to set priorities appropriately, particularly because they lack consensus about which values should guide their decisions. One way to approach this problem is to determine what all relevant stakeholders understand successful priority setting to mean. The goal of this research was to develop a conceptual framework for successful priority setting.

Methods

Three separate empirical studies were completed using qualitative data collection methods (one-on-one interviews with healthcare decision makers from across Canada; focus groups with representation of patients, caregivers and policy makers; and Delphi study including scholars and decision makers from five countries).

Results

This paper synthesizes the findings from three studies into a framework of ten separate but interconnected elements germane to successful priority setting: stakeholder understanding, shifted priorities/reallocation of resources, decision making quality, stakeholder acceptance and satisfaction, positive externalities, stakeholder engagement, use of explicit process, information management, consideration of values and context, and revision or appeals mechanism.

Conclusion

The ten elements specify both quantitative and qualitative dimensions of priority setting and relate to both process and outcome components. To our knowledge, this is the first framework that describes successful priority setting. The ten elements identified in this research provide guidance for decision makers and a common language to discuss priority setting success and work toward improving priority setting efforts.