| The purpose of this research was to understand what factors influence decision-making by case managers in resource allocation and how the home care context influences their decisions. The four chapters making up the main body of this dissertation consist of two published papers and two manuscripts to be submitted for publication. My two research questions were: What factors influence resource allocation decisions for high needs home care clients? How does the home care context influence the relative importance of factors used in the case manager resource allocation decision-making process?;I used an ethnographic approach, specifically ethnoscience in the tradition of Spradley (1979) to study the language and the way participants use their language to categorize their world. In addition to ethnoscience, I used constant comparative methods to analyze process data. I also drew upon case study methods as a tool to illuminate the decision-making processes in a case exemplar. I conducted this study with 11 case managers within a children's home care program in a regional health authority in Western Canada.;The combined findings of these papers are a validated, observed taxonomy of factors that influence the decision-making of case managers in resource allocation for high needs home care clients, a comparison between the expected and observed taxonomies, and the identification of three themes in case manager resource allocation decision-making. The three themes that emerged in the complex and multidimensional process that case managers go through in making resource allocation decisions were the role of the family in the resource allocation decision, the messiness of the decision-making process in this context, and the collective wisdom of the team.;The first paper is a theoretical review of the literature on home care case management and decision-making (Fraser & Strang, 2004). The second paper is a systematic review of the literature (Fraser & Estabrooks, in press) identifying factors case managers use in resource allocation in home care. These first two papers helped me to identify knowledge gaps related to case manager resource allocation decision-making in home care and guided me in the selection of appropriate study design and methods. |
