Priority-setting and hospital strategic planning: a qualitative case study.

OBJECTIVES To describe and evaluate the priority-setting element of a hospital's strategic planning process. METHODS Qualitative case study and evaluation against the conditions of 'accountability for reasonableness' of a strategic planning process at a large urban university-affiliated hospital. RESULTS The hospital's strategic planning process met the conditions of 'accountability for reasonableness' in large part. Specifically: the hospital based its decisions on reasons (both information and criteria) that the participants felt were relevant to the hospital; the number and type of participants were very extensive; the process, decisions and reasons were well communicated throughout the organization, using multiple communication vehicles; and the process included an ethical framework linked to an effort to evaluate and improve the process. However, there were opportunities to improve the process, particularly by giving participants more time to absorb the information relevant to priority-setting decisions, more time to take difficult decisions and some means to appeal or revise decisions. CONCLUSION A case study linked to an evaluation using 'accountability for reasonableness' can serve to improve priority-setting in the context of hospital strategic planning.