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

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

Splitting and blaming: The psychic life of neoliberal executive women

The aim of the article is to explore the psychic life of executive women under neoliberalism using psychosocial approaches. The article shows how, despite enduring unfair treatment and access to opportunities, many executive women remain emotionally invested in upholding the neoliberal ideal that if one perseveres, one shall be successful, regardless of gender. Drawing on psychosocial approaches, we explore how the accounts given by some executive women of repudiation, as denying gender inequality, and individualization, as subjects completely agentic, are underpinned by the unconscious, intertwined processes of splitting and blaming. Women sometimes split off undesirable aspects of the workplace, which repudiates gender inequality, or blame other women, which individualizes failure and responsibility for change. We explain that splitting and blaming enable some executive women to manage the anxiety evoked from threats to the neoliberal ideal of the workplace. This article thereby makes a contribution to existing postfeminist scholarship by integrating psychosocial approaches to the study of the psychic life of neoliberal executive women, by exploring why they appear unable to engage directly with and redress instances of gender discrimination in the workplace