Local prioritisation work in health care—Assessment of an implementation process

Political, horizontal prioritisation requires knowledge on local health care resource use on unit or patient group level. This in turn requires unit level structures (meeting forums) and processes for creation of knowledge and continuous, open decision-making on prioritisation. Ideally, for decisions to be legitimate, such procedures should meet the “Accountability for reasonableness”—criteria of Daniels and Sabin [Daniels N. Accountability for reasonableness. Establishing a fair process for priority setting is easier than agreeing on principles. British Medical Journal 2000;321:1300–1].A strategy, aiming at shaping such an organisational culture, was developed and set to work within a regional health care organisation, responsible for around 250 000 inhabitants.This pilot study regarding topic and methodology assesses the changes of knowledge in open prioritisation as well as structures, processes for and results of such work on unit level in that organisation 1998 through early 2005. Initial interviews and two consecutive surveys were analysed.Results indicate that only early adopters respond to the surveys and among them a growing knowledge in priority setting, acceptance of personal leadership for local priority setting work and recognition of a need for adequate structures and processes. Among respondents, one could note a development:a.towards taking on prioritisation work as a personal leadership task rather than placing responsibility on politicians;b.from general comments towards specificity;c.from general knowledge about prioritisation in health care towards local experiences of practical prioritisation work.A tentative model expressing different positions towards prioritisation was developed.