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BMC Health Services Research
Setting priorities in health care organizations: criteria, processes,
and parameters of success
Jennifer L Gibson*1, Douglas K Martin1,2 and Peter A Singer1,3
Address: 1University of Toronto Joint Centre for Bioethics, 88 College Street, Toronto, Ontario, M5G 1L4, Canada, 2Department of Health Policy,
Management and Evaluation, University of Toronto, 88 College Street, Toronto, Ontario, M5G 1L4, Canada and 3Department of Medicine,
University of Toronto, 88 College Street, Toronto, Ontario, M5G 1L4, Canada
Email: Jennifer L Gibson* - email@example.com; Douglas K Martin - firstname.lastname@example.org;
Peter A Singer - email@example.com
* Corresponding author
Background: Hospitals and regional health authorities must set priorities in the face of resource
constraints. Decision-makers seek practical ways to set priorities fairly in strategic planning, but find
limited guidance from the literature. Very little has been reported from the perspective of Board
members and senior managers about what criteria, processes and parameters of success they
would use to set priorities fairly.
Discussion: We facilitated workshops for board members and senior leadership at three health
care organizations to assist them in developing a strategy for fair priority setting. Workshop
participants identified 8 priority setting criteria, 10 key priority setting process elements, and 6
parameters of success that they would use to set priorities in their organizations. Decision-makers
in other organizations can draw lessons from these findings to enhance the fairness of their priority
Summary: Lessons learned in three workshops fill an important gap in the literature about what
criteria, processes, and parameters of success Board members and senior managers would use to
set priorities fairly.
Hospitals and regional health authorities in Canada and
elsewhere are facing significant resource allocation chal-
lenges. Priorities must be set among competing opportu-
nities because demand for health care exceeds available
resources. Board members and senior administrators are
looking for practical ways to improve how they set priori-
ties under resource constraints. The priority setting litera-
ture describes priority setting in various health care
contexts [1-9]. It identifies a number of decision-making
principles and approaches that could be used to set prior-
ities [10-16]. However, very little has been reported from
the perspective of Board members and senior administra-
tors themselves about what decision-making elements
(criteria and processes) they would find most useful in set-
ting priorities or how they would evaluate the success of a
priority setting exercise.
Fairness is a key ethical goal of priority setting when
health care resources are scarce. Experience shows that
there is often disagreement on what principles should be
used to make fair allocation decisions (i.e., distributive
Published: 08 September 2004
BMC Health Services Research 2004, 4:25doi:10.1186/1472-6963-4-25
Received: 11 February 2004
Accepted: 08 September 2004
This article is available from: http://www.biomedcentral.com/1472-6963/4/25
© 2004 Gibson et al; licensee BioMed Central Ltd.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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The pre-publication history for this paper can be accessed