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Priority setting in an acute care hospital in argentina: a qualitative case study [DistribuciĆ³n prioritaria en un hospital de cuidados intensivos en argentina. estudio cualitativo de un caso]

Gordon, Heather
; 
Kapiriri, Lydia
; 
Douglas K., Martin
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Gordon, Heather
Kapiriri, Lydia
Douglas K., Martin
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Keywords
priority setting
Argentina
hospital
accountability for reasonableness
GE Subjects
Economic ethics
Labour/professional ethics
Methods of ethics
Bioethics
General theology/other
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Business Ethics
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http://hdl.handle.net/20.500.12424/193926
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Abstract
"Purpose: To describe and evaluate priority setting in an Acute Care hospital in Argentina, using Accountability for Reasonableness, an ethical framework for fair priority setting. Methods: Case Study involving key informant interviews and document review. Thirty respondents were identified using a snowball sampling strategy. A modified thematic approach was used in analyzing the data. Results: Priorities are primarily determined at the Department of Health. The committee which is supposed to set priorities within the hospital was thought not to have much influence. Decisions were based on government policies and objectives, personal relationships, economic, political, historical and arbitrary reasons. Decisions at the DOH were publicized through internet; however, apart from the tenders and a general budget, details of hospital decisions were not publicized. CATA provided an accessible but ineffective forum for appeals. There were no clear mechanisms for appeals and leadership to ensure adherence to a fair process. Conclusions: In spite of their efforts to ensure fairness, Priority setting in the study hospital did not meet all the four conditions of a fair process. Policy discussions on improving legitimacy and fairness provided an opportunity for improving fairness in the hospital and Accountability for Reasonableness might be a useful framework for analysis and for identifying and improving strategies." ["PropĆ³sito: Describir y evaluar el establecimiento de prioridades en un hospital de cuidados intensivos en Argentina, empleando la AdministraciĆ³n Razonable como marco Ć©tico para una justa asignaciĆ³n. MĆ©todos: Estudio de un Caso que incluĆ­a entrevistas a un informante y revisiĆ³n de documentos. Se identificĆ³ a treinta participantes empleando la estrategia de muestras tipo ā€œbola de nieveā€. Al analizar los datos, se empleĆ³ un enfoque temĆ”tico modificado. Resultados: Las prioridades se determinan principalmente en el Departamento de Salud. El comitĆ© que, se supone, debe establecer las prioridades dentro del hospital no tiene mayor influencia. Las decisiones se basan en polĆ­ticas y objetivos gubernamentales, relaciones personales, razones econĆ³micas, polĆ­ticas, histĆ³ricas e, incluso, arbitrarias. Las decisiones del Departamento de Salud se publicitan a travĆ©s de Internet; sin embargo, fuera de las propuestas y del presupuesto general, no se publicitan las decisiones del hospital. CATA proporciona un foro accesible pero ineficaz para apelar. No existen mecanismos claros para apelar ni para un liderazgo que asegure un proceso justo. Conclusiones: A pesar de los esfuerzos por asegurar la equidad, el establecimiento de prioridades del hospital no cumple las cuatro condiciones de un proceso justo. Las discusiones acerca de polĆ­ticas de mejoramiento, legitimidad y equidad dan oportunidad para mejorar la equidad en el hospital, y el marco Ć©tico ā€œAdministraciĆ³n Razonableā€ podrĆ­a constituir un marco Ćŗtil para el anĆ”lisis asĆ­ como para identificar y mejorar las estrategias."]
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Article
Date
2009
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With permission of the license/copyright holder
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