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Background: Priority-setting models have the potential to enhance transparency and support decision-making under conditions of resource scarcity; however, their practical application remains limited, particularly in large-scale decommissioning programmes. This article examines department managers' perceptions of using a National Model for Transparent Prioritization (NMTP) at their clinics during the implementation of a decommissioning programme. In addition, the study explores whether the model contributes to fair priority setting and to procedural and substantive legitimacy.

Methods: A convergent mixed-methods design was employed, integrating quantitative and qualitative data from a survey (n = 33) and semi-structured interviews (n = 22). The analysis addressed six questions grouped into two overarching themes: (1) the model's use and contribution (adoption, exclusion, and inclusion of care) and (2) the model's legitimacy (acceptance, justification, and fairness of priorities).

Results: Department managers expressed varying perceptions of the NMTP. Approximately half of them considered the time and resources required to be justified and perceived that the model ensured patients with the greatest needs were given the highest priority. About one third agreed that the NMTP was accepted as a tool for prioritization and resource allocation, and a similar proportion reported that the NMTP had been used to exclude care that was previously provided.

Conclusions: Department managers perceived that the NMTP facilitated the application of the Swedish ethical guidelines; however, they also identified several challenges associated with its use in the context of a large-scale decommissioning programme, including time constraints, a substantial initial threshold, demanding evidence requirements, and insufficient alignment with national objectives. Furthermore, resistance encountered within clinical units may have been attributable to limited stakeholder engagement.