Listening to the decision makers: sustainability of PBMA in Alberta

Abstract

Background: Decision makers within the Calgary Health Region adopted and applied programme budgeting and marginal analysis (PBMA) for priority-setting activity across major service portfolios within the Region.

Methods: Seventeen in-depth qualitative interviews were conducted with senior managers and clinicians to gain a user perspective and identify specific areas for process refinement. Data were thematically coded and categorised into relevant themes.

Results: Key strengths included a culture shift in thinking about the need to reallocate resources within a fixed funding envelope, whereas a key challenge identified was in putting forth genuine disinvestment options. Areas suggested for improvement included evoking an incentive system for stakeholder engagement and having a mechanism for tracking the effect of resource reallocations.

Conclusions: Both an evidence-based approach to priority setting, as well as a way of thinking around managing resource scarcity, can be integrated into organisational processes. Findings reported in this article will influence further application in Calgary and should provide insight for those attempting such activity elsewhere.