Table 8 Recommendations from Pilot Study Report

1. Increase consultation with stakeholders (internal and external) - the hospital should engage with a broader range of internal and external stakeholders in the budgeting process, including front line staff, other healthcare providers, and the public. This would facilitate buy-in across a range of stakeholder interests, enhances the evidence-base of decisions, and strengthens alignment of decisions with relevant stakeholder values.

2. Develop an explicit and formalized communication plan - the hospital should develop a formal communication plan that involves multiple vehicles and includes relevant information on the budgeting process from start to finish. This will enhance the process' transparency -- access to important information, which facilitates more meaningful participation.

3. Revisit data and information needs - the decision makers should have access to adequate information and decision support. The hospital should engage with program directors/managers to identify gaps in data and develop strategies for collecting appropriate data.

4. Include a Revision or Appeals Process - The hospital should develop a revision process as a constructive way for stakeholders to raise concerns about decisions and to propose reasonable alternatives to improve the quality of decisions.

5. Improve the computer-based budget tool - Most participants felt that the computer-based budgeting program was a positive advance that helped the process, but some experienced some frustrations with the programs shortcoming. The hospital should work with participants to improve the program. An improved tool could offer more evidence-based decisions, more confidence in the quality of decisions, and a greater ease in making decisions.

6. Address Key Timing Concerns - The hospital should revisit the timing of the budgeting process and reconsider both the length of time and time of year to complete the budgeting in order to allow stakeholders time to review and gather information. This would not only allow for a more explicit decision making process, but could also help create conditions for more effective stakeholder engagement.

7. Provide Training for Decision Makers - In order build capacity in decision makers within the organization, the hospital should provide specific training that is tailored to increase the budgeting skill set of decision makers.

8. Build on lessons learned - In order to benefit from the lessons learned in this evaluation and to improve future priority setting activities, the hospital should develop improvement strategies based on these recommendations and re-evaluating budgeting process every year, capturing new lessons and improvements with each iteration.