Table 6 Characteristics of a framework for organisation-wide approach to disinvestment in the local setting
Domain | SHARE features |
|---|---|
Purpose  ▪ descriptive, explanatory or predictive | The framework is primarily descriptive to enable application and allow replication and testing. There are also some explanatory elements addressed in the relationships between components, for example ethical principles underpin all activities, decision-making settings sit within the scaffold of all eight principles, projects follow on from decisions, research is conducted in all aspects. |
Development  ▪ deductive or inductive  ▪ supporting evidence | Methods used in development were both deductive and inductive. Evidence from research literature and other publications was the primary source. Many of these findings were based on extensive work with stakeholder groups. This was supplemented with experience from the SHARE program. |
Theoretical underpinning  ▪ explicit or implicit | No specific theory was used to underpin the framework. |
Conceptual clarity  ▪ well-described, coherent language for identification of elements  ▪ strengths and weaknesses of theories  ▪ potential to stimulate new theoretical developments | Three components are outlined in the framework: Program, Projects and Research. The Program is based on eight principles and nine settings for decision-making. The Projects are outlined in eight main steps. The relationships between them are captured in a diagram. Details of each component and the elements within them are provided in the text and in tables. No specific theories were used so no comparisons are made. There is potential for new theoretical developments if:  ▪ specific theories are tested in development and implementation of the components  ▪ components are removed or the relationships changed  ▪ principles or pre-conditions are varied  ▪ the framework is applied for purposes other than resource allocation  ▪ the framework is applied in a range of contexts |
Level  ▪ individual, team, unit, organisation, policy | The framework was developed for implementation at meso level within the health system eg local network, institution, department, ward or committee. |
Situation  ▪ hypothetical, real | The framework 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  ▪ nursing, medical, allied health, policy makers, multidisciplinary | The framework can be used by any decision-makers within the health system. While use of the framework could be initiated by any group, engagement and involvement of all relevant stakeholders is an underlying principle of application. The framework could be used in policy, management or clinical contexts. |
Function  ▪ barrier analysis  ▪ intervention development  ▪ selection of outcome measures  ▪ process evaluation | The main function is to establish and maintain systems and processes to make, implement and evaluate decisions regarding resource allocation and research the components involved. The principle of evidence-based implementation requires assessment of barriers and enablers but the framework itself does not specifically facilitate this process other than to prompt users. Details of barriers identified from the literature are contained in the text and tables. The steps within the Project component will facilitate 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 framework per se, other than to prompt users to take an evidence-based approach. Examples of measures proposed by others are included in the text. |
Testable  ▪ hypothesis generation  ▪ supported by empirical data  ▪ suitable for different methodologies | The framework describes principles to underpin robust decision-making, settings and opportunities, 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. The framework could also be tested beyond the local healthcare level, at national or state/provincial level; or outside the health context in education, community development, social services, etc |