Best Practice and Resource Allocation
James Hart1, Ethox Centre, University Of Oxford Oxford 1Ethox Centre, University Of Oxford, Oxford, Berkshire, United Kingdom
Abstract
Best practice is at the centre of our current healthcare system: trainee healthcare professionals are taught best practice, hospital policies require best practice, and teams are evaluated against best practice. Best practice often requires more time and resources than sub-optimal practice, and thus best practice can come with an opportunity cost.
There are three ways this tension can be solved: (A) best practice is not provided, (B) less patients are seen or they are seen late, or (C) more time and resources are committed. Each option requires deciding what ought to be prioritised and how resources ought to be allocated. Yet very little attention has been given to the ethics of best practice, especially with regard to resource allocation.
This lack of consideration often leaves healthcare professionals to make allocation decisions in practice without the right legal and ethical backing. I show that these decisions are often ad hoc, inefficient and arbitrarily affected by system structures and pressures. The additional burden on healthcare professionals also adds significant pressures to already stressed staff; leaves them liable for difficult decisions; undermines confidence, expertise and morale; and breeds unhealthy work cultures.
I consider the pros and cons of two potential solutions. (1) We move away from best practice conceptualised as optimal individual care, towards best practice considered at a population level. (2) We de-emphasise best practice by teaching different standards of practice; by providing support to healthcare decision-makers to determine optimal practice in their context; and by evaluating teams against these new standards.
Biography
James works primarily on the ethics of allocating healthcare resources. In particular, he is interested in how various health inequalities ought to be included and weighed in commissioning decisions; identifying hidden injustices in tacit forms of resource allocation; and the role of public involvement in decision-making.