The influence of power and actor relations on priority setting and resource allocation practices at the hospital level in Kenya: a case study
The influence of power and actor relations on priority setting and resource allocation practices at the hospital level in Kenya: a case study
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DOI：
10.1186/s12913-016-1796-5
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发表时间：
2016-09-30
影响因子：
2.8
通讯作者：
Molyneux, Sassy
中科院分区：
文献类型：
--
作者：
Barasa, Edwine W.;Cleary, Susan;Molyneux, Sassy
背景资料：医疗机构的优先级设置和资源分配通常涉及在具有多个相互作用的参与者关系的层次和政治复杂环境中平衡相互竞争的利益和价值观。尽管如此，很少有研究探讨行为者和权力动态对医疗保健组织优先事项设定实践的影响。本文探讨了不同的行为者之间的权力关系的影响，在公立hospitalinKeny.Methods：我们采用了定性的案例研究方法，研究在肯尼亚沿海的两个公立医院的优先事项设置和资源分配的做法。我们收集的数据相结合的国家层面的政策制定者，医院管理者，并在案例研究医院（n = 72）的一线从业人员的深入访谈，审查文件，如医院的计划和预算，会议记录和会计记录，并在案例研究医院的非参与者观察超过7个月。我们应用了两个框架的组合，诺曼龙的演员接口分析和VeneKlasen和米勒的权力框架的表达来检查和解释我们的findingsResults：在案例研究医院的演员的互动导致社会构建的接口之间：1）高级管理人员和中层管理人员2）非临床管理人员和临床医生，和3）医院管理人员和社区。权力不平衡导致中层管理人员（其中一家医院）和临床医生和社区（两家医院）被排除在决策过程之外。除其他外，这导致了不公平的感觉，并降低了医院工作人员的积极性。它也提出了问题的合法性，优先设置过程中，这些hospital.Conclusions：设计医院的决策结构，以加强参与和纳入相关利益相关者可以提高优先设置的做法。然而，这还应辅之以增强利益攸关方为决策作出贡献的能力的措施。加强医院管理者的软领导技能也有助于管理医院优先事项制定过程中的行为者之间的权力动态。
Background: Priority setting and resource allocation in healthcare organizations often involves the balancing of competing interests and values in the context of hierarchical and politically complex settings with multiple interacting actor relationships. Despite this, few studies have examined the influence of actor and power dynamics on priority setting practices in healthcare organizations. This paper examines the influence of power relations among different actors on the implementation of priority setting and resource allocation processes in public hospitals in Kenya.Methods: We used a qualitative case study approach to examine priority setting and resource allocation practices in two public hospitals in coastal Kenya. We collected data by a combination of in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), review of documents such as hospital plans and budgets, minutes of meetings and accounting records, and non-participant observations in case study hospitals over a period of 7 months. We applied a combination of two frameworks, Norman Long's actor interface analysis and VeneKlasen and Miller's expressions of power framework to examine and interpret our findingsResults: The interactions of actors in the case study hospitals resulted in socially constructed interfaces between: 1) senior managers and middle level managers 2) non-clinical managers and clinicians, and 3) hospital managers and the community. Power imbalances resulted in the exclusion of middle level managers (in one of the hospitals) and clinicians and the community (in both hospitals) from decision making processes. This resulted in, amongst others, perceptions of unfairness, and reduced motivation in hospital staff. It also puts to question the legitimacy of priority setting processes in these hospitals.Conclusions: Designing hospital decision making structures to strengthen participation and inclusion of relevant stakeholders could improve priority setting practices. This should however, be accompanied by measures to empower stakeholders to contribute to decision making. Strengthening soft leadership skills of hospital managers could also contribute to managing the power dynamics among actors in hospital priority setting processes.