Table 7 Features of a model for systematic approach to resource allocation in a local health service
Domain | SHARE features |
|---|---|
Purpose â–ª descriptive, explanatory or predictive | The model is primarily descriptive to enable replication and testing in other settings. There are also some explanatory elements addressed in the relationships between components, for example the systems, processes and projects are thought to require input from the four support services to ensure successful implementation |
Development â–ª deductive or inductive â–ª supporting evidence | Methods used in development were both deductive and inductive. Evidence from the research literature and other publications, health service staff, consumers and external experts was used. |
Theoretical underpinning â–ª explicit or implicit | No specific theory was used to underpin the model. A theoretical framework for evaluation of implementation of an evidence-based innovation was used to design questionnaires for data collection to inform program development. |
Conceptual clarity â–ª well-described, coherent language for identification of elements â–ª strengths and weaknesses of theories â–ª potential to stimulate new theoretical developments | Four components are outlined in the model. The relationships between them are delineated in a simple diagram. The details of each component, the aims and objectives, are provided in the surrounding boxes. The principles that underpin the program and the preconditions for success and sustainability are also detailed in surrounding boxes. No specific theories were used so no comparisons are made. There is potential for new theoretical developments if: â–ª specific theories are tested in development and implementation of the components â–ª components are removed or the relationships changed â–ª principles or preconditions are varied â–ª the model is applied in contexts other than resource allocation for technologies and clinical practices â–ª the model is applied in settings other than local health service networks |
Level â–ª individual, team, unit, organisation, policy | The program was developed for organisation-wide implementation in a local health service. This approach could also be used at a higher (regional, state/provincial, national) or lower (single facility, department or unit) level, however is unlikely to be applicable to individual decision-makers. |
Situation â–ª hypothetical, real | The model represents actual settings and contexts in health service decision-making and implementation of change. However it could also be used for teaching or capacity building through hypothetical classroom discussions or simulation exercises. |
Users â–ª nursing, medical, allied health, policy makers, multidisciplinary | SHARE focuses on decision-makers at the organisation-wide level in a local health service. This includes senior clinicians, managers and policy makers across all professional disciplines, all clinical settings and some areas of corporate practice (eg finance, procurement, legal, ethics, IT, biomedical engineering); and health service consumers. |
Function â–ª barrier analysis â–ª intervention development â–ª selection of outcome measures â–ª process evaluation | The main function is to enable replication and testing of the SHARE program by capturing the components and their relationships, principles and preconditions. The principle of an evidence-based approach to change requires assessment of barriers and enablers but the model itself does not specifically facilitate this process. The model would assist in development of an intervention for systematic evidence-based decision-making and implementation of change. Evaluation of process and outcomes is a key element, however selection of variables and outcome measures is not facilitated by the model per se, but an evaluation framework and plan has been developed [38]. |
Testable â–ª hypothesis generation â–ª supported by empirical data â–ª suitable for different methodologies | The model describes settings and opportunities, systems and processes, and structures to support decision-making, implementation of change and evaluation of process and outcomes. A range of hypotheses could be developed for each of these elements and the relationships between them which could be tested in a number of ways using various methodologies. |