A decision analysis software program helped the Spokane Regional Health District in Spokane County, Washington create a budget that was more transparent, revealing how and why decisions were made.

Public health organizations usually create budgets through an informal process; agencies generally grant funding to programs that appear needy. The administrators in charge of creating budgets rely on information from competing program directors; budgets do not necessarily reflect the best interest of the entire agency. Decision analysis transforms budgeting into a scientific process; it breaks a problem into discrete parts that an organization can analyze.

This article explains the key features of decision analysis and describes how the Spokane Regional Health District implemented a decision analysis software program. The Spokane Regional Health District governs almost 50 public health programs. The district created a decision-making framework, or a hierarchy chart, from numerous goals and sub-goals. The health district’s management team initially created a broad set of budget goals. They met weekly for six months to decide what goals they would enter into the software program.

Key Findings:

• Spokane Regional Health District eliminated funding to four programs.
• Based on data generated by the decision analysis software, the Spokane Regional Health District conducted a review of 15 of its programs.
• The health district discontinued its clinical services program, transferring the activities to community-based Federally Qualified Health Centers.

A public health agency must distribute its limited resources among competing programs. A budget usually has a limited role within a public health organization. This article describes how decision analysis helped the Spokane Regional Health District take a more scientific approach to budgeting.