Resource allocation decision-making in an Ontario teaching hospital

grantor: University of TorontoHospitals occupy an important position within the Canadian health care system and their services are highly valued by the public. As hospitals receive a substantial portion of the public funding allocated by governments to health care, and as governments increasingly seeks ways to reduce public spending, attention has focused on how hospitals ought to make decisions about the allocation and use of the health care resources they receive. The purpose of this study was to describe resource allocation decision-making in a Canadian hospital and to identify themes relevant to the process. The study was conducted using ethnographic methods to examine resource allocation decision-making in one Canadian teaching hospital over a period of approximately eleven months. There were three sources of data: hospital documents collected throughout the field study period, interviews of senior administrators, senior physicians and members of the board of trustees and non-participant observation at the hospital, most of which occurred at meetings of senior level decision-making groups. Two major resource allocation processes were observed during the field work: decision-making about the operating budget and decision-making about the capital budget. Major themes in allocating the operating budget were those of the central role of senior administrators, evolving relationships, incremental budgeting, soft information and professional judgement, power and marginal changes in allocations and responses to fiscal stress. Major themes in allocating the capital budget were roles, goals and preferences, deteriorating relationships, capital budget components and decision processes, power and capital allocations and responses to fiscal stress. These two processes are described in detail and analysis of the processes focuses on the research questions of who makes decisions, how decisions are made and the reasons given for resource allocation decisions.Ph.D