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Priority Setting in Surgery: Improve the Process and Share the Learning

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Abstract

Surgeons and surgical programs encounter priority-setting challenges every day, such as in regard to purchasing new technologies or managing waiting lists for elective surgery. The purpose of this paper was to explore priority setting in surgery. Traditionally in surgery, priority-setting decisions for new technologies have been based on evidence of effectiveness and cost-effectiveness; and decisions about managing waiting lists for elective surgery have been based on urgency rating scores. The fairness of priority-setting processes in surgical programs should be enhanced to permit all relevant information and values to be considered. The quality of these decisions can be improved by using an approach that captures and shares lessons from each priority-setting experience. The approach we propose in this paper—describe, evaluate, and improve using a leading conceptual framework for priority setting, called “accountability for reasonableness”—can be used by any surgical program to improve its priority setting, share lessons with others, and develop an evidence base for how these important health policy decisions should be made.

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Acknowledgments.

This research was supported by a grant (6606-06-1999/2590074) from the Canadian Institute of Health Research. D.K.M. is supported by an Ontario Ministry of Health and Long-Term Care Career Scientist award. N.W. is supported by a Lupina Foundation Doctoral Fellowship from the Munk Centre for International Studies and a Faculty of Medicine Fellowship, both from the University of Toronto. P.A.S. is supported by a Canadian Institutes of Health Research Investigator award. We appreciate the help provided to us by Dorothy Pringle, Elizabeth Peter, Martin McKneally, and Norman Daniels.

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Authors and Affiliations

  1. Department of Health Policy, Management, and Evaluation and the Joint Centre for Bioethics, University of Toronto, 88 College Street, Toronto, Ontario M5G 1L4, Canada

    Douglas K. Martin Ph.D.

  2. Faculty of Nursing and the Joint Centre for Bioethics, University of Toronto, 88 College Street, Toronto, Ontario M5G 1L4, Canada

    Nancy Walton B.Sc.N.

  3. Department of Medicine and the Joint Centre for Bioethics, University of Toronto, 88 College Street, Toronto, Ontario M5G 1L4, Canada

    Peter A. Singer M.D., M.P.H.

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  1. Douglas K. Martin Ph.D.
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  3. Peter A. Singer M.D., M.P.H.
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Correspondence to Douglas K. Martin Ph.D..

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Martin, D., Walton, N. & Singer, P. Priority Setting in Surgery: Improve the Process and Share the Learning. World J. Surg. 27, 962–966 (2003). https://doi.org/10.1007/s00268-003-7100-y

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