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Table 2 Criteria and rating scale*

From: Difficult decisions in times of constraint: Criteria based Resource Allocation in the Vancouver Coastal Health Authority

DOMAIN

Domain Weights

CRITERIA

DEFINITION

Criteria Weight

RATING SCALE

     

-3

-2

-1

0

1

2

3

  

Alignment to Mandate

1) The service is directly related to health care or preventative health

        
   

2) The service is not provided by another organization outside VCH

15

Strong alignment with mandate (for releases)

Moderate alignment with mandate (for releases)

Weak alignment with mandate (for releases)

No alignment with mandate (for releases or investments)

Weak alignment with mandate (for invests)

Moderate alignment with mandate (for invests)

Strong alignment with mandate (for invests)

   

3) The service is not the responsibility of an organization outside VCH

        

Strategic alignment

30

Efficiency, Effectiveness and Appropriate-ness

1) Optimal use of resources to yield maximum benefits and results,

        
   

2) Care that is known to achieve intended outcomes

5

Goes against four or five of the five objectives

Goes against two or three of the five objectives

Goes against one of the five objectives

No net impact

Supports one of the five objectives

Supports two or three of the five objectives

Supports four or five of the five objectives

   

3) Care provided is evidence based and specific to individual clinical needs

        
   

4) Promote wellness & prevention initiatives

        
   

5) Support clients at home/returning home or self management

        
  

Access

Impact on timely access to appropriate health care services for defined population(s). Note: the 'defined populations' are those using the services affected by the proposed changes.

5

Significant (more than 10%) worsening of the waiting times for more than 20% of the population or complete closure of a service

Significant (more than 10%) worsening of the waiting times 10% to 20% of the population or closure of a service for more than 25% of the time

Significant (more than 10%) worsening of the waiting times for less than 10% of the population or closure of a service for less than 25% of the time

No impact

Significant (more than 10%) improvement of the waiting times for less than 10% of the population or expansion of hours by less than 25%

Significant (more than 10%) improvement of the waiting times for 10% to 20% of the population or expansion of the hours by more than 25%

Significant (more than 10%) improvement of the waiting times for more than 20% of the population or opening of a new service facility (not a replacement)

  

Flow/Integration

Impact on the coordination of health care services among programs to ensure flow and continuity of care from the patient's perspective (improve flow transitions)

5

Negative impact on continuity for more than 20% of clients or significant worsening for some patients

Negative impact on continuity for 10% to 20% of clients

Negative impact on continuity for 5% to 10% of clients

Impact on less than 5% of clients

Improvement in continuity for 5% to 10% of clients

Improvement in continuity for 10% to 20% of clients

Improvement in continuity for more than 20% of patients or significant improvement for some clients

Health Impact

45

Numbers affected

Number of individuals affected by the proposed change

8

More than 1500 have less services

251 to 1500 have less services

1 to 250 have less services

0

1 to 250 have more services

251 to 1500 have more services

More than 1500 have more services

  

Equity

Impact on the health status of recognized groups where there is a known health status gap.

10

More than 50% of those affected are in the most disadvantaged groups (releases)

More than 50% of those affected are in moderately disadvantaged groups (releases)

10% to 50% of those affected are in the most disadvantaged groups (releases)

Less than 50% of those affected are in moderately disadvantaged groups (releases or investments)

10% to 50% of those affected are in the most disadvantaged groups (invests)

More than 50% of those affected are in moderately disadvantaged groups (invests)

More than 50% of those affected are in the most disadvantaged groups (investments)

  

Significance of impact

Impact on clinical outcomes for the patient/client, including risk of adverse events, as compared to current practice/service.

11

Significant negative impact (either more than 25% of affected clients suffer negative effects or some clients are significantly affected)

Moderate negative impact (10% to 25% of affected clients suffer negative effects)

Small negative impact (5% to 10% of affected clients suffer some negative effects)

Less than 5% of affected clients experience any changes in satisfaction of safety

Small positive impact (5% to 10% of affected clients enjoy some positive effects)

Moderate positive impact (10% to 25% of affected clients enjoy positive effects)

Significant positive impact (either more than 25% of affected clients enjoy positive effects or some clients are significantly affected)

  

Health promotion and disease prevention

Impact on illness and/or injury prevention, well-being and harm reduction as measured by projected longer term improvements in health

8

Significant negative impact on burden of disease

Moderate negative impact on burden of disease

Small negative impact on burden of disease

No impact on burden of disease

Small positive impact on burden of disease

Moderate positive impact on burden of disease

Significant positive impact on burden of disease

  

Client experience

Impact on safety, effectiveness, and client experience of health service(s) provided.

8

Negative impact (safety or satisfaction) for more than 20% of affected clients

Negative impact (safety or satisfaction) for 10% to 20% of affected clients

Negative impact (safety or satisfaction) for 5% to 10% of affected clients

Less than 5% of affected clients experience any changes in satisfaction of safety

Positive impact (safety or satisfaction) for 5% to 10% of affected clients

Positive impact (safety or satisfaction) for 10% to 20% of affected clients

Positive impact (safety or satisfaction) for more than 20% of affected clients

  

Workplace environment

Impact on workplace environment including morale, tools and equipment, personal and professional growth and teamwork

5

Significant negative impact on recruitment and retention or on stress leave

Moderate negative impact on recruitment and retention or on stress leave

Small negative impact on recruitment and retention or on stress leave

No impact

Small positive impact on recruitment and retention or on stress leave

Moderate positive impact on recruitment and retention or on stress leave

Significant positive impact on recruitment and retention or on stress leave

Organizational Impact

25

Innovation and knowledge transfer

Impact on the generation and/or application of new knowledge/practice.

5

Significant negative impact on the generation or application of new knowledge/practice

Moderate negative impact on the generation or application of new knowledge/practice

Small negative impact on the generation or application of new knowledge/practice

No impact

Small positive impact on the generation or application of new knowledge/practice

Moderate positive impact on the generation or application of new knowledge/practice

Significant positive impact on the generation or application of new knowledge/practice

  

Implementation

Challenges to the implementation of proposed initiative (or reversal)

5

Significant political resistance and change would be very difficult to undo

Significant political resistance but change could be undone

Moderate political resistance expected

No political impact

Moderate political support expected

Strong political support expected

Strong political support and change can be reversed

  

Downstream impact on service utilization

Impact of the proposed change on future use of health care services

10

Significant increase in future use of health care services

Moderate increase in future use of health care services

Small increase in future use of health care services

No impact on future use of services

Small decrease in future use of health care services

Moderate decrease in future use of health care services

Significant decrease in future use of health care services

  1. *This table describes the overall domain, criteria, brief definition of criteria, weighting of criteria and rating scale for assessing each proposal.