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Appears in Collections:Management, Work and Organisation Journal Articles
Peer Review Status: Refereed
Title: A multicriteria resource allocation model for the redesign of services following birth
Author(s): Bowers, John
Cheyne, Helen
Mould, Gillian
Miller, Martin
Page, Miranda
Harris, Fiona
Bick, Debra
Keywords: Postnatal care
Maternity services
Cost savings
Care quality
Resource allocation
Priority setting
Program budgeting and marginal analysis
Multicriteria decision analysis
Issue Date: 31-Dec-2018
Citation: Bowers J, Cheyne H, Mould G, Miller M, Page M, Harris F & Bick D (2018) A multicriteria resource allocation model for the redesign of services following birth. BMC Health Services Research, 18 (1), Art. No.: 656.
Abstract: Background Many healthcare services are under considerable pressure to reduce costs while improving quality. This is particularly true in the United Kingdom’s National Health Service where postnatal care is sometimes viewed as having a low priority. There is much debate about the service’s redesign and the reallocation of resources, both along care pathways and between groups of mothers and babies with different needs. The aim of this study was to develop a decision support tool that would encourage a systemic approach to service redesign and that could assess the various quality and financial implications of service change options making the consequent trade-offs explicit. The paper describes the development process and an initial implementation as a preliminary exploration of the possible merits of this approach. Methods Other studies have suggested that combining multicriteria decision analysis with programme budgeting and marginal analysis might offer a suitable basis for resource allocation decisions in healthcare systems. The Postnatal care Resource Allocation Model incorporated this approach in a decision support tool to analyse the consequences of varying design parameters, notably staff contacts and time, on the various quality domains and costs. The initial phase of the study focussed on mapping postnatal care, involving interviews and workshops with a variety of stakeholders. This was supplemented with a literature review and the resultant knowledge base was encoded in the decision support tool. The model was then tested with various stakeholders before being used in an NHS Trust in England. Results The model provides practical support, helping staff explore options and articulate their proposals for the redesign of postnatal care. The integration of cost and quality domains facilitates trade-offs, allowing staff to explore the benefits of reallocating resources between hospital and community-based care, and different patient-categories. Conclusions The main benefits of the model include its structure for assembling the key data, sharing evidence amongst multi-professional teams and encouraging constructive, systemic debate. Although the model was developed in the context of the routine maternity services for mothers and babies in the days following birth it could be adapted for use in other health care services.
DOI Link: 10.1186/s12913-018-3430-1
Rights: © The Author(s). 2018 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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