Hospital priority setting with an appeals process: a qualitative case study and evaluation.
OBJECTIVE: To describe and evaluate priority setting in the context of hospital priority setting and more specifically to evaluate the use of an appeals process. DESIGN: Qualitative case study and evaluation using the ethical framework 'accountability for reasonableness'. SETTING: The University Health Network (UHN), a network of three large urban teaching hospitals affiliated with the University of Toronto in Toronto, Canada. This study focused on Clinical Activity Target Setting (CATS), the final component of the strategic planning process. PARTICIPANTS: Sixty-six board members, senior administrators, managers, clinical leaders and other hospital staff who participated in the hospital strategic planning exercise. DATA COLLECTION: Three primary sources of data were used: key documents, interviews with participants and stakeholders and observations of group deliberations. DATA ANALYSIS: Open and axial coding using an explicit conceptual framework 'accountability for reasonableness'. RESULTS: This was the first time an appeal process has been described and evaluated. The appeals process was found to be a fundamental component to overall perceived fairness of the priority setting process. The appeals process also enhanced the involvement of stakeholders and increased overall participant satisfaction. In addition, four areas of 'good practice' and ten recommendations for improvement of the larger priority setting process were identified. CONCLUSIONS: This case study has provided an in-depth analysis of a priority setting process at a hospital, with a particular focus on the appeals process. Also, we compared the lessons learned from this study with those from a previous study at a different hospital.