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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.