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Allocating Limited Resources in a Time of Fiscal Constraints: A Priority Setting Case Study From Dalhousie University Faculty of Medicine

Mitton, Craig PhD; Levy, Adrian PhD; Gorsky, Diane MBA; MacNeil, Christina CMA; Dionne, Francois PhD; Marrie, Tom MD

doi: 10.1097/ACM.0b013e318294fb7e
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Facing a projected $1.4M deficit on a $35M operating budget for fiscal year 2011/2012, members of the Dalhousie University Faculty of Medicine developed and implemented an explicit, transparent, criteria-based priority setting process for resource reallocation. A task group that included representatives from across the Faculty of Medicine used a program budgeting and marginal analysis (PBMA) framework, which provided an alternative to the typical public-sector approaches to addressing a budget deficit of across-the-board spending cuts and political negotiation. Key steps to the PBMA process included training staff members and department heads on priority setting and resource reallocation, establishing process guidelines to meet immediate and longer-term fiscal needs, developing a reporting structure and forming key working groups, creating assessment criteria to guide resource reallocation decisions, assessing disinvestment proposals from all departments, and providing proposal implementation recommendations to the dean. All departments were required to submit proposals for consideration. The task group approved 27 service reduction proposals and 28 efficiency gains proposals, totaling approximately $2.7M in savings across two years. During this process, the task group faced a number of challenges, including a tight timeline for development and implementation (January to April 2011), a culture that historically supported decentralized planning, at times competing interests (e.g., research versus teaching objectives), and reductions in overall health care and postsecondary education government funding. Overall, faculty and staff preferred the PBMA approach to previous practices. Other institutions should use this example to set priorities in times of fiscal constraints.

Dr. Mitton is associate professor, School of Population and Public Health, University of British Columbia Faculty of Medicine, and senior scientist, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada.

Dr. Levy is professor and head, Community Health and Epidemiology, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada.

Ms. Gorsky is associate dean, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada.

Ms. MacNeil is director of finance, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada.

Dr. Dionne is associate member, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada.

Dr. Marrie is dean, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada.

Correspondence should be addressed to Dr. Mitton, Centre for Clinical Epidemiology and Evaluation, 7th Floor, 828 W. 10th Ave., Research Pavilion, Vancouver BC V5Z 1M9, Canada; telephone: (604) 875-4111 ext. 62995; fax: (604) 875-5179; e-mail: craig.mitton@ubc.ca.

© 2013 by the Association of American Medical Colleges