Introducing New Priority Setting and Resource Allocation
Processes in a Canadian Healthcare Organization: A Case
Study Analysis Informed by Multiple Streams Theory
Background: In this article, we analyze one case instance of how proposals for change to the priority setting
and resource allocation (PSRA) processes at a Canadian healthcare institution reached the decision agenda of
the organization’s senior leadership. We adopt key concepts from an established policy studies framework –
Kingdon’s multiple streams theory – to inform our analysis.
Methods: Twenty-six individual interviews were conducted at the IWK Health Centre in Halifax, NS, Canada.
Participants were asked to reflect upon the reasons leading up to the implementation of a formal priority setting
process – Program Budgeting and Marginal Analysis (PBMA) – in the 2012/2013 fiscal year. Responses were
analyzed qualitatively using Kingdon’s model as a template.
Results: The introduction of PBMA can be understood as the opening of a policy window. A problem stream –
defined as lack of broad engagement and information sharing across service lines in past practice – converged
with a known policy solution, PBMA, which addressed the identified problems and was perceived as easy to
use and with an evidence-base from past applications across Canada and elsewhere. Conditions in the political
realm allowed for this intervention to proceed, but also constrained its potential outcomes.
Conclusion: Understanding in a theoretically-informed way how change occurs in healthcare management
practices can provide useful lessons to researchers and decision-makers whose aim is to help health systems
achieve the most effective use of available financial resource