Table 2 Decision-makers and scope and types of decisions for resource allocation

DECISION-MAKERS

 Clinicians

  Health practitioners delivering patient care.

 Authorised individuals

  Authorised individuals include Board Members, Executive Directors, Directors and Managers at all levels within the organisation. They are designated by their role in the organisation, for example ‘Director of Pharmacy’, rather than as a named individual ‘John Smith’.

 Authorised groups

  Authorised groups can be classified into those with

  ▪ ongoing roles and responsibilities for decisions such as the Board, Executive Management Team, Standing Committees, Approved Purchasing Units and Profession-specific groups such as the Nursing Executive.

  ▪ a specific, often time-limited, purpose such as a project Steering Committee, a Procurement Evaluation Committee to purchase a large piece of equipment and special initiatives like the High Cost Drugs Working Party of the Therapeutics Equivalence Program.

SCOPE OF DECISIONS

 Clinicians make decisions for individual patients within the limits of parameters outlined in their position description, relevant professional standards and any local credentialing requirements.

 Authorised individuals and groups make decisions on behalf of the organisation which impact on all patients, all staff or identified subgroups.

 Individuals are authorised to make decisions on behalf of the organisation within a range of specified parameters outlined in their position description or the Authority Delegation Schedule.

 Committees and other groups are authorised to make decisions on behalf of the organisation as stipulated in their Terms of Reference.

 Examples of the parameters decision-makers are authorised to work within include, but are not limited to, location (eg South East sites), professional group (eg occupational therapists), specialty area (eg stomal therapy), patient group (eg children), nature of purchase or resource use (eg surgical equipment and consumables) and cost limit (eg up to $10,000).

TYPES OF DECISIONS

 Clinical

 ▪ Clinical decisions arise in the encounter between a health practitioner and an individual patient or client. Their purpose is to assess, treat and/or plan ongoing management of a health issue.

 Strategic, operational or professional

 ▪ Strategic decisions point the organisation in the direction it wants to go; they are captured in strategic goals and policies which reflect a particular position, priority or plan the organisation wishes to communicate to staff, patients and other stakeholders. Strategic planning is usually undertaken at organisation-level driven by the Board, Executive and Senior Managers but can also be undertaken at any level.

 ▪ Operational decisions make the strategic goals happen; they enable day-to-day operations and are undertaken by managers at all levels.

 ▪ Professional decisions address standards and methods of practice and are made by senior staff in the discipline to which they are relevant.

 Routine, reactive or proactive

 ▪ Routine decisions are made on a regular basis; examples include annual budget setting processes, monthly committee meetings and reviews of guidelines or protocols at specified intervals after their introduction.

 ▪ Reactive decisions are made in response to situations as they arise; for example new legislation, product alerts and recalls, critical incidents and applications for new drugs to be included in the formulary.

 ▪ Proactive decisions are driven by information that was actively sought for this purpose such as accessing newly published research evidence to compare against current practice or interrogating local data to ascertain practices with high costs or high rates of adverse events.

 Conditional or unconditional

 ▪ Conditional decisions specify requirements to be met before or after their implementation; for example availability of funding, clinical indications (eg disease/condition, severity, patient group), authorised practitioners (eg specific training, named individuals), monitoring of outcomes (eg patient outcomes, adverse events, costs), location (eg ICU, Hospital in the Home ), time limitation (eg until 2 year review).

 ▪ Unconditional decisions have no requirements.

 Allocating funds or non-monetary resources

 ▪ Allocating funds involves spending money or putting it aside to purchase specified items later.

 ▪ Allocating non-monetary resources can include rostering staff time; specifying health professional groups; providing clinic or operating room time; and developing protocols that direct use of clinical interventions, equipment, drugs, diagnostic tests and referral mechanisms.

 Whether to buy or what, where and how to buy

 ▪ ‘Whether to buy’ is a decision about what is required, for example a new drug to improve patient outcomes, a new scanner to reduce waiting time, consumables for a piece of equipment in current use. These decisions are undertaken by authorised individuals and some of the authorised groups such as Technology/Clinical Practice Committee, Therapeutics Committee, Falls Prevention Committee, etc.

 ▪ ‘What, where and how to buy’ is a decision about how the requirement is met and considers product and manufacturer reliability, availability of parts and tools, service and maintenance contracts, IT requirements for hardware and software, price negotiations, etc. These decisions are undertaken by the Approved Purchasing Units and groups established for specific purchases.

 Purchase of budgeted or unbudgeted items

 ▪ Decisions to purchase budgeted items are made by the relevant authorised individual, usually the budget holder or their line manager depending on the purchase price and the designated cost limits of their respective approval levels (eg < $10,000, <$50,000).

 ▪ Decisions to purchase unbudgeted items can only be approved by specified committees and Executive Directors